REVIEW – October 2003

Towards reasonable use of topical corticosteroids


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Topical corticosteroids are the most commonly used drugs in dermatology. Since the discovery of hydrocortisone in the 50s new, more potent (effective) and safer corticosteroids have been developed. In Europe they are divided into four groups by the potency of the active ingredient. It is always important to bear in mind what kind of corticoid should be used in different body areas (the face and the anogenital area need milder corticoids than the soles and hands). Treatment outcome is better when a proper formula of the drug is used: in the acute stage a lotion or a cream is needed; in the chronic stage a more fatty base, an ointment, is suitable. Novel corticosteroids are effective when used once a day: due to the faster effect the duration of treatment is also shorter. Sometimes (e.g. in palmopustular psoriasis) intermittent treatment is needed. One should always remember when topical corticosteroids should not be used: mycosal and viral infections, scabies, versicolor and syhilides. The rule of thumb: never use when diagnosis is not yet established, an unnecessarily used corticoid can change the typical signs of disease (e.g. tinea incognito). In the case of systemic corticoids side effects (Cushingoid, osteoporosis, growth impairment, etc.) are common. When topical corticoids are properly used there are few local side-effects (skin atrophy, etc). Older fluorinated corticoids cause skin atopy more commonly than novel corticoids (e.g. mometasone). Also, it is important to take into account that novel corticoids cause side effects as frequently as hydrocortisone. In what order should corticoids be applied? The answer is simple: first a corticoid cream/ointment and then a base cream which should be used more that once a day.