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Corticosteroids - topical (skin), nose, and eyes - Management
What formulation of topical corticosteroids should I prescribe?
- Topical corticosteroids are available in several formulations, including creams, ointments, lotions, gels, tapes, mousses, and solutions.
- The choice of formulation depends on the condition being treated, its severity and location, and the person's preference.
- Solutions
- Solutions are low viscosity, alcohol- or water-based liquids.
- They are easy to apply and are non-greasy.
- They are very drying if alcohol is the base, and can sting sore skin.
- Lotions
- Lotions are similar to solutions, but thicker.
- They are useful for treating large or hairy areas, and for treating exudative lesions.
- Creams
- Creams are thicker than lotions and are suitable for moist or weepy lesions.
- They are moisturizing without being greasy. Many people prefer them, especially for use on the face and palms of the hands.
- Ointments
- Ointments are preferred for dry, lichenified, or scaly conditions.
- They have a more prolonged emollient effect and tend to increase the potency of the corticosteroid.
- They are less likely to cause irritation as they are usually preservative-free.
- Gels and mousses
- Gels are thicker than solutions, and can be drying.
- Mousses are stable, non-greasy foams.
- Gels and mousses can be useful for scalp conditions.
- Tapes/bandages
- Occlusive polythene or hydrocolloid dressings increase the absorption of the steroid, and increase the risk of adverse effects.
- They should only be used under supervision for a short period of time, and for areas of very thick skin (such as the palms of the hands and soles of the feet).
- Topical corticosteroids are also available as compound preparations, which contain other substances such as:
- Antibacterials and antifungals — for infected skin.
- Salicylic acid, calcipotriol, or coal tar — for psoriasis and other dry skin conditions.
- Some of these substances (for example urea and salicylic acid) may increase the penetration of the corticosteroid.
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