Glucorticosteroids topical

Overview of topical glucocorticoids (monopreparations, modified classification according to Niedner)

Class I (mild)

• dexamethasone (0.02-0.05%)
• clobetasone butyrate (0.05%)
• hydrocortisone (0.25%-1.0%)
• Hydrocortisone acetate (0.25-1.0%)
• Prednisolone (0.4-0.5%)

Class II (moderately strong)

• Alclometasone dipropionate (0.05%)
• Betamethasone valerate(0.05%)
• Desoximetasone (0.25%)
• Flumethasone (0.02%)
• Flumetasone-pivalate (0.02%)
• Fluocortolone (0.25%)
• Flupredniden-21-acetat (0,1-2,5%)
• Hydrocortisone-17-butyrate (0.1%)
• hydrocortisone acetate (0.1%)
• hydrocortisone buteprate (0.1%)
• methylprednisolone aceponate (0.1%)
• prednicarbate (0.25%)
• Triamcinolone acetonide (0.05-0.1%)
• dexamethasone (0.1%)

Class III (strong)

• Amcinonide (0.1%)
• Betamethasone-17,21-dipropionate (0.05%)
• Betamethasone-17-valerate (0.1%)
• Desoximetasone (0.05%)
• diflorasone-diacetate (0.01%)
• diflucortolone-21-pentanoate (0.1%)
• Fluocinolone acetonide (0.025- 0.1%)
• Fluticasone propionate (0.025-0.1%)
• Mometasone furoate (0.1%)

Class IV (very strong)

• Clobetasol-propionate (0.05%)
• Diflucortolon-valerate (0.3%)

Pregnancy, first trimester, nursing, diaper rash.

Depending on the concentration of the topical glucocorticoid and the indication, apply thinly 1-3 times/day to the affected skin areas.

On palms and soles, application under hourly (2-4h) occlusion is recommended.

Intermittent maintenance therapy prolongs remission times.

Allergic reactions, glaucoma with prolonged use in the eye area, purpura, Cushing's syndrome, acne, infections, perioral dermatitis, folliculitis, skin atrophy, striae cutis distensae, skin dryness, hypertrichosis, wound healing disorders.

Contact allergic reactions are observed (Wurpts G 2018). Their incidence is (astonishing!) 0.2-5.0% according to an older European study. 85% of these patients are sensitized to more than one glucocorticoid (Wurpts G 2018).

Topical glucocortioids are divided into 4 groups according to allergological relevance (see also glucocorticoids epicutaneous test series):

• A (hydrocortisone type)
• B (acetonide type)
• C (Betamethasone type)
• D (ester type - esterifications in the C16 position).

Halogenation in C6 position reduces the risk of sensitization. Moderate sensitization accumulations are found with amcinonide, hydrocortisone-17-butyrate and budesonide.

With simultaneous application of idoxuridine delay of wound healing.

Application in the facial area should only be carried out under strict indication.

In the case of large-area application, a not inconsiderable systemic resorption must be expected, especially in inflammatory dermatoses.

Important for histological clarification of inflammatory dermatoses: in order to obtain relevant information, external glucocorticoids must be discontinued for several days (7-10 days) beforehand, as an assessment is otherwise not very meaningful.

Various topical glucocorticoids can be combined with topical antibiotics or topical antiseptics (see below Glucocorticoids topical, combinations).

1. Castela E et al (2012) Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy. J Eur Acad Dermatol Venereol 26: Suppl 3, 47-51
2. Dooms-Goossens A et al (1996) Corticosteroid contact allergy: an EECDRG multicentre study. Contact dermatitis 35:40-44.
3. Goossens A (2000) Reactions to corticosteroids: some new aspects regarding cross-sensitivity. Cutis 65:43-45.
4. Wurtps G (2018) Contact allergy to glucocorticoids. Allergo J 27: 13-15