Topical Steroid

• topical steroids stop skin cells from producing various inflammation-causing chemicals that are normally released when the skin reacts to allergens or irritation.
• These inflammation-causing chemicals, including prostaglandins and leukotrienes, cause blood vessels to widen (vasodilate) and signal other inflammatory substances to arrive.
• This results in the affected area of skin becoming red, swollen and itchy.

Absorption depends on

• Age
• The very young and very old have higher rates of absorption due to thinner skin.
• Thickness of the skin
• Thin skin is able to absorb more steroids than thick skin.
• Areas of thinner skin include: eyelids, face or genitals.
• Skin can also become thinner with high potency or long-term steroid use, or both.
• Condition of the skin
• Absorption is increased on open, cracked, or raw skin, or skin that has lesions.
• Percentage of the body surface area treated
• Treating large areas of the body allows for greater absorption, especially in children where there is a higher ratio of skin surface area to body mass.
•  For instance, topical steroid drug inserts state, “Pediatric patients applying topical corticosteroids to greater than 20% of body surface are at higher risk of HPA axis suppression”
• Time frame used
• Usage for longer periods of time, especially without breaks, increases absorption.
• “Do not use daily TCS [topical corticosteroids] continuously for more than two to four weeks . . . Your provider should strive to help create a safe and effective long-term treatment plan that does not include daily use of TCS, especially on more sensitive areas.”  source: National Eczema Association
• Vehicle
• Ointments are absorbed more than creams, creams more than lotions, etc.
• Occlusion
• Topical steroid-treated areas covered by tight-fitting pajamas or clothes, gauze wraps, bandages, diapers, or any other means of occlusion, increases the level of absorption.
• Site treated
• Certain areas of skin absorb more than others, such as areas that rub together (between the thighs or buttocks or under the breasts), as well as the face, genitals, eyelids and underarms (axilla).

 Potency

 Dosing

Adult

References:

1. http://itsan.org/topical-steroids-101/
2. http://www.medscape.com/viewarticle/551352_6
3. www.uptodate.com