Topical steroid potency chart

An Alternative Treatment

Decreased tear meniscus in dry eye.
As an alternative to steroids—or as an adjunctive therapy—topical cyclosporine can also be used to control inflammation in dry eye disease. While cyclosporine does not demonstrate the rapid anti-inflammatory effect of steroids, it carries fewer risks and is safe for long-term use.
Because of their complementary efficacy and safety profiles, many practitioners often begin dry eye treatment by prescribing both topical steroids and cyclosporine. Following the recommendation of the Asclepius Panel, the use of combination therapy is instituted with the topical corticosteroid, Lotemax (loteprednol etabonate ophthalmic suspension %, Bausch + Lomb) and Restasis (cyclosporine ophthalmic emulsion %, Allergan). 24 The Asclepius Panel recommends practitioners begin early treatment with an anti-inflammatory agent (such as Lotemax) four times a day to improve symptoms and to prevent disease progression. After two weeks, the frequency of the corticosteroid is reduced to twice daily and supplemented with Restasis twice a day. Treatment with loteprednol was stopped after day 60, while cyclosporine treatment is continued.

The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.

The obvious priority is immediate discontinuation of any further topical corticosteroid use. Protection and support of the impaired skin barrier is another priority. Eliminating harsh skin regimens or products will be necessary to minimize potential for further purpura or trauma, skin sensitivity, and potential infection. Steroid Atrophy [10] [11] is often permanent, though if caught soon enough and the topical corticosteroid discontinued in time, the degree of damage may be arrested or slightly improve. However, while the accompanying Telangectasias may improve marginally, the Striae is permanent and irreversible. [1]

All topical corticosteroids are classified category C by the US Food and Drug Administration, but some are classified category A by the Therapeutic Goods Administration ( /hp/medicines- ). Studies in animals have shown that topical steroids are systemically absorbed and may cause fetal abnormalities. Limited and inconclusive data are available for humans, however there seems to be an association between very potent topical corticosteroids and fetal growth restriction. 8 , 9 Caution is needed, but topical corticosteroids have been frequently used in pregnancy.

Topical steroid potency chart

topical steroid potency chart

All topical corticosteroids are classified category C by the US Food and Drug Administration, but some are classified category A by the Therapeutic Goods Administration ( /hp/medicines- ). Studies in animals have shown that topical steroids are systemically absorbed and may cause fetal abnormalities. Limited and inconclusive data are available for humans, however there seems to be an association between very potent topical corticosteroids and fetal growth restriction. 8 , 9 Caution is needed, but topical corticosteroids have been frequently used in pregnancy.

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