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13.4 Topical corticosteroids

(including compound corticosteroid + anti-infective preparations)

PrescQIPP: Topical Corticosteroids

This bulletin focuses on the cost effective use of topical corticosteroids

Plain preparations

Mild potency
Hydrocortisone cream, ointment 0.5%, 1%
Moderately potent
Alphaderm cream
Betnovate RD (1 in 4) cream/ointment
Eumovate cream, ointment

Fludroxycortide Tape
Synalar 1 in 4 cream, ointment *

 

Potent
Betnovate cream, ointment
Locoid cream, ointment
Locoid Lipocream
Metosyn cream, ointment *
Synalar cream, ointment, gel
Mometasone Cream

 

Very potent
Dermovate cream

 

Scalp applications
Betamethasone scalp application
Diprosalic scalp application
Dermovate scalp application
Synalar gel

 

Steroid/anti-infective combinations

Mild potency
Canesten HC cream
Daktacort cream, ointment
Fucidin H cream, gel *
Nystaform HC cream, ointment
Timodine cream

 

Moderately potent
Trimovate cream

 

Potent
Aureocort ointment *
Betnovate-C cream, ointment (considered 2nd line to Synalar C on cost grounds)
Betnovate-N cream, ointment
Fucibet cream
Synalar C cream and ointment (preferred to Betnovate C on cost grounds)

 

Notes:

1. Mometasone is for Consultant Dermatologist use only, once daily for atopic excema where compliance is a problem.

2. Topical steroids are the mainstays of treatment for eczematous conditions. A preparation of the weakest potency, which is effective, should be used for maintenance; the more potent steroids should be used only for short spells for initial control of the disorder. The availability of bland emollients (section 13.2.1) will help reduce any tendency to overuse topical steroids.

Precautions

Only hydrocortisone should normally be used on the face. The potent steroids are best avoided in children; it is suggested that nothing more potent than 1% hydrocortisone should be used on infants unless under specialist care. Steroids should not be used in the presence of infection unless specific anti-infective therapy is given.

As well as on the face, potent/very potent steroids should not be used on the axillae, groin (where penetration is greatest), under occlusion, or in children.

Systemic or potent topical corticosteroids should be avoided or given only under specialist supervision in psoriasis, because, although they may suppress the psoriasis in the short term, relapse or vigorous rebound occurs on withdrawal (sometimes precipitating severe pustular psoriasis).

Clioquinol (in 'Vioform-HC' and 'Betnovate C') can stain skin, hair and clothing yellow. Rarely clioquinol may cause allergic contact dermatitis.

 

For the link to the BNF section: 13.4 Topical corticosteroids