Version May 2024
Corticosteroid-responsive dermatoses: Topical: Apply thin film to affected area(s) 1 to 3 times daily or as directed based on severity of disease and patient response.
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
There are no adverse reactions listed in the manufacturer’s labeling.
Hypersensitivity to any component of the formulation; use on infected skin lesions without concomitant use of an anti-infective agent, fungal and viral infections of the skin including herpes simplex, vaccinia and varicella and tuberculous skin lesions; pregnancy
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Immunosuppression: Prolonged use of topical steroids may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.
• Kaposi sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).
• Local effects: Local adverse reactions may occur (eg, skin atrophy, striae, burning, itching, irritation). Local adverse reactions are more likely to occur with use of occlusive dressings and/or prolonged use.
• Skin infections: Use is contraindicated in patients with skin infections who are not receiving concurrent anti-infective treatment.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome (rare), hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, application to large surface areas, or prolonged use.
Other warnings/precautions:
• Appropriate use: Not for oral, ophthalmic, or intravaginal use; avoid contact with eyes. Use the least amount needed to cover the affected area.
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External:
Propaderm: 0.025% (45 g, 120 g)
Topical: For external use only; avoid contact with eyes. Apply a thin film sparingly. May be used with occlusive dressings for management of certain resistant dermatoses.
Note: Not approved in the US
Corticosteroid-responsive dermatoses: Treatment of skin conditions where a topical corticosteroid may be indicated, including psoriasis, eczema, allergic dermatoses, neurodermatitis, seborrhea, intertrigo, lichen simplex, lichen planus, discoid lupus erythematosus, and anogenital pruritus.
None known.
There are no known significant interactions.
Topical corticosteroids may be used for the treatment of corticosteroid-responsive dermatosis, such as atopic dermatitis, in patients planning a pregnancy (Vestergaard 2019).
Systemic bioavailability of topical corticosteroids is variable (integrity of skin, use of occlusion, etc) and may be further influenced by trimester of pregnancy (Chi 2017). In general, the use of topical corticosteroids is not associated with a significant risk of adverse pregnancy outcomes; however, there may be an increased risk of low-birth-weight infants following maternal use of potent or very potent topical products, especially in high doses, although this risk is likely to be low (Andersson 2021; Chi 2015; Chi 2017).
When first-line treatments, such as emollients, are insufficient, topical corticosteroids may be used for the treatment of atopic dermatitis in pregnant patients (Vestergaard 2019). Topical corticosteroids are classified by potency; the medication and formulation (eg, cream, gel, salt form) contribute to the potency classification (Oakley 2021; Stacey 2021; Tadicherla 2009). In general, use of the least potent product in limited amounts is recommended during pregnancy. Mild to moderate potency corticosteroids are preferred; potent to very potent topical corticosteroids should only be used as alternative therapy in limited amounts under obstetrical care. Pregnant patients should avoid application of topical corticosteroids to areas with high percutaneous absorption (eg, armpit, skin folds, vulva) (Chi 2017), and caution should be used when applying to areas prone to striae formation (eg, abdomen, breast, thighs) (Vestergaard 2019). Use of topical beclomethasone is specifically contraindicated in pregnancy.
Avoid application of topical corticosteroids to the nipple and areola area until breastfeeding ceases; hypertension was noted in a breastfed infant when a high-potency topical corticosteroid was applied to the nipple (AAD-NPF [Elmets 2021]; Butler 2014; Leachman 2006). If needed, apply topical corticosteroids immediately after breastfeeding, then clean nipples prior to the next feeding (Vestergaard 2019).
HPA axis suppression with extensive/prolonged use (ACTH stimulation test, morning plasma cortisol test, urinary free cortisol test); signs of bacterial or fungal infection.
Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Beclomethasone is a potent anti-inflammatory steroid with action similar to that of fluocinolone acetonide.
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