Version May 2024
Atopic dermatitis: Topical: Foam, gel: Apply 2 times daily sparingly. Therapy should be discontinued when control is achieved. If no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary; treatment should not exceed 4 consecutive weeks.
Corticosteroid-responsive dermatoses: Topical: Cream, ointment, lotion: Apply to the affected area(s) sparingly 2 or 3 times daily (lotion) or 2 to 4 times daily (cream, ointment). Therapy should be discontinued when control is achieved. If no improvement is seen within 2 weeks, reassessment of diagnosis may be necessary.
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.
(For additional information see "Desonide: Pediatric drug information")
Note: Dosage should be based on severity of disease and patient response; use smallest amount for shortest period of time to avoid hypothalamic-pituitary-adrenal (HPA) axis suppression. Therapy should be discontinued when control is achieved.
Atopic dermatitis: Infants ≥3 months, Children, and Adolescents: Foam 0.05%, gel 0.05%: Apply a thin layer to affected area twice daily. If no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary; treatment should not exceed 4 consecutive weeks.
Corticosteroid-responsive dermatoses: Limited data available: Infants, Children, and Adolescents: Topical: Cream, ointment, lotion (0.05%): Apply sparingly to the affected area(s) twice daily (Ref).
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Cardiovascular: Increased blood pressure (2%)
Central nervous system: Headache (2%), irritability (1%)
Dermatologic: Stinging of the skin (≤3%), atopic dermatitis (<2%; exacerbation), contact dermatitis (<2%), exfoliation of skin (<2%), pruritus (<2%), skin irritation (<2%), xeroderma (<2%), skin rash (≤1%)
Endocrine & metabolic: Hyperglycemia (2%), HPA-axis suppression (more common in pediatric patients)
Hepatic: Abnormal liver function (1%)
Infection: Viral infection (2%)
Local: Application site reaction (1% to 6%), application site burning (≤3%), application site atrophy (1%)
Respiratory: Upper respiratory tract infection (10%), cough (4%), asthma (1%), pharyngitis (1%)
<1%, postmarketing, and/or case reports: Application site erythema, application site induration, application site irritation, application-site pruritus, dermatological reaction, diaphoresis, erythema of skin, facial swelling, folliculitis, oily skin, pain, peripheral edema, pustular rash
Hypersensitivity to desonide or any component of the formulation.
Verdeso: There are no contraindications listed in the manufacturer's labeling.
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.
• Contact dermatitis: Allergic contact dermatitis can occur, it is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.
• 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, telangiectasias, burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection miliaria); may be irreversible. Local adverse reactions are more likely to occur with occlusive and/or prolonged use.
• Ocular effects: Topical corticosteroids, including desonide, may increase the risk of posterior subcapsular cataracts and glaucoma. Monitor for ocular symptoms. Avoid contact with eyes.
• Skin infections: Concomitant skin infections may be present or develop during therapy; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Use of the foam for >4 weeks may suppress the immune system. Absorption of topical corticosteroids is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.
Special populations:
• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing's syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage forms specific issues:
• Foam: Flammable; keep away from fire or flame. Instruct patients to avoid smoking during and immediately after application.
• Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated with hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP ["Inactive" 1997]; Zar 2007).
Other warnings/precautions:
• Appropriate use: Do not use if there is atrophy at the treatment site. Do not use with occlusive dressing.
Topical corticosteroids may be absorbed percutaneously. The extent of absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Hypothalamic-pituitary-adrenal (HPA) axis suppression may occur, particularly in younger children or in patients receiving high doses for prolonged periods; with gel or foam, application to ≥25% to 35% of the body for at least 4 weeks resulted in adrenal suppression in 3% to 4% of patients. Acute adrenal insufficiency (adrenal crisis) may occur with abrupt withdrawal after long-term therapy or with stress. Infants and small children may be more susceptible to HPA axis suppression or other systemic toxicities due to larger skin surface area to body mass ratio; use with caution in pediatric patients.
Some dosage forms may contain propylene glycol; in neonates, large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures, and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
DesOwen: 0.05% (60 g)
Tridesilon: 0.05% (60 g [DSC]) [contains cetyl alcohol, methylparaben]
Generic: 0.05% (15 g, 60 g)
Foam, External:
Verdeso: 0.05% (100 g) [contains cetyl alcohol, propylene glycol]
Gel, External:
Desonate: 0.05% (60 g [DSC]) [contains edetate (edta) disodium dihydrate, methylparaben, propylene glycol, propylparaben]
DesRx: 0.05% (60 g [DSC]) [contains edetate (edta) disodium, methylparaben, propylene glycol, propylparaben]
Generic: 0.05% (60 g)
Lotion, External:
Generic: 0.05% (59 mL, 118 mL)
Ointment, External:
Generic: 0.05% (15 g, 60 g)
May be product dependent
Cream (Desonide External)
0.05% (per gram): $5.35
Cream (DesOwen External)
0.05% (per gram): $10.33
Foam (Verdeso External)
0.05% (per gram): $13.25
Gel (Desonide External)
0.05% (per gram): $11.34
Lotion (Desonide External)
0.05% (per mL): $5.02
Ointment (Desonide External)
0.05% (per gram): $1.55 - $5.35
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External:
Tridesilon: 0.05% ([DSC])
Generic: 0.05% (15 g, 60 g, 454 g)
Ointment, External:
Tridesilon: 0.05% ([DSC])
Generic: 0.05% (15 g, 60 g)
For topical use only; not for oral, ophthalmic, or intravaginal use. For use on the face, dispense desonide in hands and gently massage into affected areas of the face; for areas other than the face, desonide may be dispensed directly on the affected area. Wash hands after use (unless hands are part of the treatment area). Do not use on open wounds; apply sparingly using smallest amount needed to adequately cover the affected area. Use of occlusive dressings is not recommended; do not use in the treatment of diaper dermatitis. Avoid contact with eyes or other mucous membranes.
Foam, lotion: Shake well before use. Dispense by inverting can upside down (upright actuation will cause loss of propellant). Foam is flammable; patients should not smoke during or immediately following application.
Topical: For topical use only; not for oral, ophthalmic, or intravaginal use. Avoid contact with eyes or other mucous membranes. Do not use on open wounds; apply sparingly using smallest amount needed to adequately cover the affected area. Use of occlusive dressings is not recommended. Wash hands after use (unless hands are part of the treatment area).
Foam: Shake well before use. For use on the face, dispense desonide in hands and gently massage into affected areas of the face; for areas other than the face, desonide may be dispensed directly on the affected area. Foam is flammable; avoid fire, flame, and/or smoking during or immediately following application.
Gel: Should not be routinely used on the underarm or groin areas of pediatric patients; do not use in the treatment of diaper dermatitis.
Lotion: Shake well before use.
Atopic dermatitis (foam and gel): Treatment of mild to moderate atopic dermatitis in patients 3 months and older
Corticosteroid-responsive dermatoses (cream, ointment, and lotion): Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
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 (eg, integrity of skin, use of occlusion) 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, and/or 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, arm pit, skin folds, vulva) (Chi 2017), and caution should be used when applying to areas prone to striae formation (eg, abdomen, breast, thighs) (Vestergaard 2019).
It is not known if desonide is present in breast milk following topical application; however, systemically administered corticosteroids are present in breast milk.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother. Topical corticosteroids are generally considered acceptable for use in patients who are breastfeeding (Butler 2014; WHO 2002).
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 (ACTH stimulation test, AM plasma cortisol test, urinary free cortisol test); signs of bacterial or fungal infection; ocular symptoms
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. Desonide has low range potency.
Absorption: Dependent on formulation, amount applied and nature of skin at application site; may be increased with inflammation or occlusion
Metabolism: Hepatic
Excretion: Primarily urine; bile
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