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Chapter 216

Topical Corticosteroids
Isabel C. Valencia &
Francisco A. Kerdel

CLINICAL FORMULATIONS
Topical steroids come in many different vehicles
and dosage forms. The clinical potency of a topical
corticosteroid depends not only on the inherent
potency of the molecule but also on factors such as
the vehicle and the nature of the skin onto which it
is applied. The vehicle in which the steroid is incorporated may be as important as the steroid molecule itself because the vehicle affects the amount
of steroid that is released in any given period of
time. Very occlusive vehicles, such as ointments,
potentiate glucocorticoid effects because they provide increased hydration of the stratum corneum
and increase its permeability. By covering the skin
with an occlusive dressing such as plastic wrap, this
effect can be heightened as much as 100-fold. The
solubility of the glucocorticoid in the vehicle also
affects penetration into the epidermis. Propylene
glycol is one agent commonly used to dissolve
the glucocorticoid in the vehicle, and it is found
in many topical glucocorticoid preparations.32 In
general, compounds that contain higher amounts
of propylene glycol tend to be more potent.

ointments and oils are too greasy and prefer the


use of creams that are cosmetically more acceptable, but provide less hydration of the skin. New
emollient creams have been devised that contain
an increased amount of petrolatum but with less
greasiness than ointments, and some patients find
them more cosmetically appealing.
Certain body areas require the use of specific
vehicles to obtain good compliance. For example,
lotions and creams are preferred in acute eczema
as well as dermatoses that involve large surface
body areas. Lotions, solutions, and gels have less
penetration than ointments but are useful in treating hair-bearing areas, such as the scalp, where
greasiness is cosmetically displeasing to the patient.
Steroid-impregnated tapes are useful because they
provide occlusion with increased penetration and
provide protection of the skin lesion from manipulation, such as scratching, by the patient. Sprays
containing steroids are available and represent a
convenient mode of applying these agents. Additionally, foam products have been added to
currently available topical formulations. They are
highly efficacious, cosmetically superior, and well
tolerated. (For more discussion on vehicles for topical preparations, see Chapter 214.)

Treatment of the skin before application of the


topical steroid may also affect the absorption of
the compounds into the skin. For example, use of
keratolytics or fat solvents such as acetone enables
increased penetration by disrupting the epidermal
barrier. Tape stripping of the skin also increases the
absorption of hydrocortisone by 78% to 90%.33
The major classes of formulations for corticosteroids are ointments, creams, lotions, and gels.
Ointments are the best preparation when treating
dry skin conditions because they provide the most
moisture and are useful for treating conditions on
areas of the body with thick skin, such as the palms
and soles. Peanut oil has also been combined with
steroids to form a preparation that is thinner and
easier to apply while retaining the hydrating capability of ointments. However, patients may feel that

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