Version May 2024
Note: Therapy should be discontinued when control is achieved; if no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary.
Corticosteroid-responsive dermatoses: Topical: Cream, gel, ointment: Apply a thin film to affected area twice daily
Plaque psoriasis treatment: Topical: Spray: Apply a thin film to affected area twice daily
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 "Desoximetasone: 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 HPA axis suppression. Therapy should be discontinued when control is achieved. If no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary.
Dermatoses (steroid-responsive, including contact/atopic dermatitis): Topical:
Cream/gel: Children and Adolescents: Apply a thin film to affected area twice daily
Ointment: Children ≥10 years and Adolescents: Apply a thin film to affected area twice daily
There are no dosage adjustments provided in manufacturer's labeling; use caution.
There are no dosage adjustments provided in manufacturer's labeling; use caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%: Endocrine & metabolic: HPA-axis suppression
1% to 10%:
Dermatologic: Local dryness of skin (application site: 3%)
Local: Application site irritation (3%), application-site pruritus (2%)
<1%:
Dermatologic: Atrophic striae, folliculitis (including folliculopustular lesions), hypertrichosis, hypopigmentation, local acneiform eruptions, localized vesiculation, maceration of the skin, miliaria, perioral dermatitis, skin infection (secondary), stinging of the skin (application site)
Local: Application site atrophy, application site burning, application-site dermatitis, application site erythema
Cream, gel, ointment: Hypersensitivity to desoximetasone or any component of the formulation.
Spray: There are no contraindications listed in the manufacturer's labeling.
Canadian labeling: Additional contraindications (not in US labeling): Untreated bacterial, tubercular, fungal, and most viral lesions of the skin (including herpes simplex, vaccinia, and varicella); ophthalmic use.
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.
• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.
• Kaposi's sarcoma: Prolonged treatment with corticosteroids has been associated with the development of Kaposi's sarcoma (case reports); if noted, discontinuation of therapy should be considered (Goedert 2002).
• Ocular effects: Topical corticosteroids, including desoximetasone, may increase the risk of posterior subcapsular cataracts and glaucoma. Avoid contact with eyes. Consider evaluation with ophthalmologist if visual symptoms occur.
• Skin reactions: Local adverse effects (eg, atrophy, striae, telangiectasias, burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, and miliaria) may occur. Reactions may not be reversible and may be more likely to occur with prolonged use, higher potency corticosteroids, and occlusive dressings.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption of topical corticosteroids may cause manifestations of Cushing's syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.
Disease-related concerns:
• Skin infections: Use appropriate antibacterial or antifungal agents to treat concomitant skin infections; discontinue desoximetasone treatment if infection does not resolve promptly.
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 form specific issues:
• Spray: Flammable; avoid heat, flame, or smoking when applying.
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) suppression may occur, particularly in younger children or in patients receiving high doses for prolonged periods; 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.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Cream, External:
Topicort: 0.05% (60 g) [contains cetostearyl alcohol, edetate (edta) disodium]
Topicort: 0.25% (60 g) [contains cetostearyl alcohol]
Generic: 0.05% (15 g, 60 g, 100 g); 0.25% (15 g, 60 g, 100 g)
Gel, External:
Topicort: 0.05% (60 g) [contains alcohol, usp, edetate (edta) disodium, trolamine (triethanolamine)]
Generic: 0.05% (15 g, 60 g)
Liquid, External:
Topicort Spray: 0.25% (100 mL) [contains isopropyl alcohol, levomenthol]
Generic: 0.25% (100 mL)
Ointment, External:
Topicort: 0.05% (60 g, 100 g); 0.25% (60 g)
Generic: 0.05% (60 g, 100 g); 0.25% (15 g, 60 g, 100 g)
Yes
Cream (Desoximetasone External)
0.05% (per gram): $6.12
0.25% (per gram): $2.67 - $6.75
Cream (Topicort External)
0.05% (per gram): $6.80
0.25% (per gram): $7.16
Gel (Desoximetasone External)
0.05% (per gram): $6.13
Gel (Topicort External)
0.05% (per gram): $4.97
Liquid (Desoximetasone External)
0.25% (per mL): $1.73 - $5.91
Liquid (Topicort Spray External)
0.25% (per mL): $6.57
Ointment (Desoximetasone External)
0.05% (per gram): $6.12
0.25% (per gram): $1.20 - $7.76
Ointment (Topicort External)
0.05% (per gram): $6.80
0.25% (per gram): $7.16
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.
Cream, External:
Topicort: 0.05% (20 g, 60 g) [contains edetate (edta) disodium, methylparaben, propylparaben]
Topicort: 0.25% (2 g, 20 g, 60 g) [contains methylparaben, propylparaben]
Gel, External:
Topicort: 0.05% (60 g) [contains alcohol, usp, edetate (edta) disodium, trolamine (triethanolamine)]
Ointment, External:
Topicort: 0.25% (60 g) [contains propylene glycol]
Topical: For external use only; not for oral, ophthalmic, or intravaginal use. Apply to clean, dry skin and rub in gently. Wash hands thoroughly before and after use. Unless otherwise directed by health care professional, do not use with occlusive dressing.
Additional product-specific administration information:
Spray: Avoid use on the face, axilla, groin, or in the presence of atrophy at the treatment site. Avoid heat, flame, or smoking when applying (flammable).
Topical: For external use only. Apply to clean, dry skin and rub in gently. Wash hands thoroughly before and after use. Unless otherwise directed by healthcare professional, do not use with occlusive dressing. Plastic pants or tight-fitting diapers may constitute occlusive dressings.
Cream, gel, ointment: Avoid contact with eyes.
Spray: Avoid contact with eyes. Avoid use on the face, axilla, or groin. Avoid heat, flame, or smoking when applying (flammable).
Corticosteroid-responsive dermatoses: Cream, gel, ointment: Relief of inflammation and pruritic symptoms of corticosteroid-responsive dermatoses.
Plaque psoriasis: Spray: Treatment of plaque psoriasis in patients ≥18 years of age.
Desoximetasone may be confused with dexamethasone
Topicort [US and Canada] may be confused with Topicorten [brand name for clioquinol/flumethasone in Israel]
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 sufficient quantities of desoximetasone are absorbed following topical administration to produce detectable amounts in breast milk. However, systemic corticosteroids are excreted in human 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 the 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).
Hypothalamic-pituitary-adrenal (HPA) axis suppression and adrenal insufficiency, especially in children; ocular symptoms; growth in children.
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. Desoximetasone has intermediate to high range potency (dosage-form dependent).
Absorption: May be increased with occlusion, inflammation, or vary with site of application
Metabolism: Hepatic
Excretion: Urine, feces
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