Version May 2024
Corticosteroid-responsive dermatoses: Topical: Apply sparingly, do not use occlusive dressings. Therapy should be discontinued when control is achieved; consider reassessment of diagnosis if no improvement is seen within 2 weeks.
Cream, ointment: Apply a thin film to affected area once daily.
Lotion, solution: Apply a few drops to affected area once 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. Use with caution as elderly patients may be more susceptible to systemic effects.
(For additional information see "Mometasone (topical): Pediatric drug information")
Note: Discontinue therapy when control is achieved; reassess diagnosis if no improvement is seen in 2 weeks
Corticosteroid-responsive dermatoses:
Cream, ointment: Children ≥2 years and Adolescents: Topical: Apply a thin film to affected area once daily; do not use in pediatric patients for >3 weeks
Lotion, solution: Children ≥12 years and Adolescents: Topical: Apply a few drops to affected area once daily; massage lightly into skin
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%:
Central nervous system: Paresthesia (lotion, infants & children: ≤3%, cream, children: 1%)
Dermatologic: Dyschromia (loss of normal skin markings: ≤6%), taut and shiny skin (≤6%), folliculitis (lotion: 3%; cream, children: <1%), telangiectasia (≤3%), dermatologic disorders (2%), bacterial skin infection (infants & children: ≤2%), epidermal thinning (≤2%)
Endocrine & metabolic: Decreased cortisol (infants & children: lotion: ≤6%, cream and ointment: ≤2%), endocrine disease (lotion: 2%)
Gastrointestinal: Xerostomia (infants & children: 2%)
Hematologic & oncologic: Bruise (1%)
Local: Application site burning (2%), application site pruritus (≤2%)
Frequency not defined:
Central nervous system: Tingling of skin
Dermatologic: Acne rosacea, furunculosis, skin atrophy, stinging of the skin (application site)
<1%, postmarketing, and/or case reports: Acneiform eruption, cataract, cutaneous candidiasis, glaucoma, skin depigmentation
Hypersensitivity to mometasone furoate or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): viral (eg, herpes or varicella) lesions of the skin, fungal or bacterial skin infections, parasitic infections, skin manifestations relating to tuberculosis or syphilis, eruptions following vaccinations, acne vulgaris, rosacea, pruritus without inflammation; ophthalmic use; use with occlusive dressings
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 and is usually diagnosed by failure to heal rather than clinical exacerbation; discontinue use if irritation occurs and treat appropriately.
• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.
• Ocular effects: Topical corticosteroids, including mometasone, may increase the risk of posterior subcapsular cataracts and glaucoma. Monitor for ocular changes. Avoid contact with eyes.
• 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.
Special populations:
• Older adult: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
• Pediatric: Not for treatment of diaper dermatitis. Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing 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:
• Appropriate use: Avoid use of topical preparations with occlusive dressings or on weeping or exudative lesions.
The extent of percutaneous 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. Infants and small children may be more susceptible to HPA axis suppression, intracranial hypertension, Cushing syndrome, or other systemic toxicities due to larger skin surface area to body mass ratio.
Open-label safety studies conducted in infants and children 6 to 23 months of age with atopic dermatitis demonstrated a high incidence of adrenal suppression when topical mometasone furoate products were applied once daily for approximately 3 weeks over a mean BSA of ~40%. Of the patients with normal baseline adrenal function, adrenal suppression occurred in 16% of patients using the cream, 27% of patients using the ointment, and 29% of patients using the lotion/solution. Follow-up testing 2 to 4 weeks after discontinuation of therapy demonstrated suppressed HPA axis function in 1 of 5 patients who used the cream, 3 of 8 patients who used the ointment, and 1 of 8 patients who used the lotion/solution. Due to a higher BSA to weight ratio, pediatric patients are at a greater risk of HPA axis suppression and Cushing syndrome compared to adults. Application of topical steroids over >20% of BSA in pediatric patients increases risk of HPA axis suppression.
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, as furoate:
Elocon: 0.1% (50 g [DSC]) [contains soybean lecithin]
Generic: 0.1% (15 g, 45 g)
Ointment, External, as furoate:
Generic: 0.1% (15 g, 45 g)
Solution, External, as furoate:
Generic: 0.1% (30 mL, 60 mL)
Yes
Cream (Mometasone Furoate External)
0.1% (per gram): $1.94
Ointment (Mometasone Furoate External)
0.1% (per gram): $1.23 - $1.73
Solution (Mometasone Furoate External)
0.1% (per mL): $0.97 - $1.00
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, as furoate:
Elocom: 0.1% (15 g, 50 g) [contains soybean lecithin]
Generic: 0.1% (15 g, 50 g)
Lotion, External:
Elocom: 0.1% (75 mL) [contains isopropyl alcohol, propylene glycol]
Generic: 0.1% (30 mL, 60 mL, 75 mL)
Ointment, External, as furoate:
Elocom: 0.1% (50 g) [contains propylene glycol monostearate]
Generic: 0.1% (15 g, 50 g)
Apply sparingly. Avoid mucous membranes; manufacturer labeling recommends avoiding application to the eyes, face, underarms, and groin (including diaper area). Do not wrap, cover, or bandage affected area.
Cream, ointment: Apply thin film to affected area.
Lotion, solution: Apply a few drops to affected area and massage lightly until medication disappears.
Topical: Apply sparingly; avoid contact with eyes. Do not apply to face, underarms, or groin. Do not wrap or bandage or use occlusive dressings to affected area, unless directed by the physician. Do not use for treatment of diaper dermatitis or in diaper area. Wash hands after application.
Cream, ointment: Apply thin film to affected area.
Lotion, solution: Hold tip of bottle close to affected area and gently squeeze bottle to apply a few drops to affected area.
Corticosteroid-responsive dermatoses: Relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses (medium potency topical corticosteroid)
Elocon lotion may be confused with ophthalmic solutions. Manufacturer's labeling emphasizes the product is NOT for use in the eyes.
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]).
Substrate of CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Mometasone (Topical). Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Corticosteroids (Topical). Risk C: Monitor therapy
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).
It is not known if sufficient quantities of mometasone are absorbed following topical administration to produce detectable amounts in breast milk; however, systemic corticosteroids are present in breast milk.
Although the manufacturer recommends that caution be used, 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 and then clean nipples prior to the next feeding (Vestergaard 2019).
Adrenal suppression with extensive/prolonged use (ACTH stimulation test, morning plasma cortisol test, urinary free cortisol test); response to treatment; ocular changes
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. Mometasone has intermediate range potency.
Absorption: Cream: 0.4% (increased by inflammation); Lotion, ointment, solution: 0.7% (increased by inflammation)
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