Background:
Glucocorticoids belong to a class of steroid hormones from the adrenal cortex. The name refers to their function in glucose metabolism, where they promote the conversion of proteins into glucose and glycogen. Glucocorticoids have a variety of physiological and therapeutic effects. They influence the metabolism, the water and electrolyte balance, the cardiovascular system and the nervous system. Furthermore, they have an anti-inflammatory and immunosuppressive effect (mitigating the body’s immune reactions).
Acute therapy: Topical (externally applied) glucocorticosteroids (cortisone)
- Anti-inflammatory effect
- Anti-itching effect
- Preferred use of “modern” glucocorticosteroids with an improved risk-benefit profile
- Consider different strengths (“potencies”) of the preparations (classes I-IV)
- Infants and young children are more susceptible to adverse effects (classes III and IV are generally not recommended)
- Use according to the individual severity and the affected body region
- Rapid onset of action
Topically applied active substances are classified according to their potency (according to Niedner):
- Class 1 – weakly potent
- Hydrocortisone (acetate), prednisolone, fluocortin butyl ester, triamcinolone acetonide, dexamethasone, clocortolone pivalate (hexanoate).
- Class 2 – moderately potent
- Clobetasone butyrate, hydocortisone acetonate, dexamethasone(-sulfobenzoate), alclomethasone dipropionate, flumetasone pivalate, triamcinolone acetonide, fluoprednidene acetate, fluorandrenolone, hydrocortisone butyrate, hydrocortisone buteprate, betamethasone benzoate, fluorocortolone, prednicarbate.
- Class 3 – highly potent
- Mometasone furoate, methylprednisolone aceponate, betamethasone valerate, fluticasone propionate, halomethasone, betamethasone dipropionate, fluocortolone (hexanoate), fluocinolone acetonide, diflorasone diacetate, deoximethasone, fluocinonide, amcinonide, halcinonide, diflucortolone valerate.
- Class 4 – very highly potent
- Diflucortolone valerate, clobetasol propionate.
Examples of modern topical glucocorticosteroids:
4th generation (double-step esterification C17+C21)
Potency Class 1 according to Niedner
- Prednicarbat 0.25%
- Methylprednisolonaceponat 0.1%
- Hydrocortisonbutyrat 0.1%
- Hydrocortisonaceponat 0.1%
- Hydrocortisonbuteprat 0.1%
Potency Class 3 according to Niedner
- Mometasonfuroat 0.1%
- Fluticasonpropionat 0.005%, 0.05%
Notes on the topical application of glucocorticosteroids
- When used sensibly, the advantages (anti-inflammatory, itch-relieving) far outweigh the possible disadvantages
- Lack of use can be just as damaging to the skin as irresponsible use
- Generally used once a day until the individual lesion has healed
- No permanent daily application
- Increase of potency in case of insufficient effect
- In the case of (almost complete) healing with once-daily application, do not stop abruptly, but reduce gradually, i.e:
- Switch from daily application to application every other day.
- If the skin condition remains stable, the frequency of application can then be further reduced to every third day and so on.
Special notes on problem areas:
- Face, neck, skin folds, genitals (boys), in children and infants in addition to the scalp
- Caution: Occlusion leads to increased effects and side effects (e.g. in the diaper area)
A steroid can of course also be used in these areas in individual cases, but this should only be done on a physician’s orders and for a short period of time. The same applies to steroids in occlusive dressings*. These are also possible in highly acute situations under physician supervision.
*What exactly is an occlusive dressing?
The occlusive dressing is used in the dermatological treatment of skin diseases. It is an airtight film dressing that forms a warm, moist chamber underneath it. This ensures that the upper horny layer of the skin is kept soft.
