Corticosteroids - Topical: Nursing pharmacology

Definitions & Key takeaways

Topical corticosteroids are a group of medications used in the treatment of various skin conditions, such as psoriasis, eczematous rashes, lichen sclerosis, bullous pemphigoid, pemphigus foliaceous, and urticaria. They work by suppressing the inflammatory response, thus reducing inflammation and itching in the affected area.

Common topical corticosteroids include hydrocortisone, triamcinolone, and betamethasone clobetasol. Some side effects of topical corticosteroids include skin irritation, dryness, and redness. Long-term can also cause thinning of the skin, stretch marks, and increased risk of infections.

While caring for a client on a topical corticosteroid, nursing considerations include applying the medication to intact skin using a clean technique, as well as monitoring for side effects such as the development of infection or irritation at the application site. Client teaching is focused on how to apply the medication as directed and to report symptoms of systemic absorption or if the affected area does not respond to treatment.

Chapters:

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Introduction0:00–0:35

Corticosteroids, also commonly known as steroids, are a group of anti-inflammatory medications used to treat a variety of conditions in almost all healthcare fields!
In this video, we’re going to focus on topical corticosteroids used for dermatological conditions, including psoriasis, eczematous rashes, lichen sclerosus, bullous pemphigoid, and pemphigus foliaceus.
They can also be used to relieve the symptoms of urticaria or pruritic lesions, such as those caused by allergic reactions, insect bites, or poison ivy.Alright, now topical corticosteroids can be classified according to their potency into low, intermediate, or high potency.

Topical corticosteroids0:35–1:01

Low potency corticosteroids include hydrocortisone; while intermediate potency corticosteroids include triamcinolone and certain betamethasone formulations; and finally, high potency corticosteroids include stronger betamethasone formulations and clobetasol.
Most of the topical corticosteroids are available in different formulations, including ointments, creams, gels, or lotions.

Mechanism of action1:01–1:40

Once applied to the skin, topical corticosteroids reduce inflammation locally by acting on glucocorticoid receptors of skin cells and white blood cells, ultimately decreasing their production of inflammatory mediator molecules, such as prostaglandins and leukotrienes, as well as increasing their production of anti-inflammatory molecules.In addition, topical corticosteroids cause local vasoconstriction of cutaneous blood vessels, which also helps reduce inflammation.
Common side effects of topical corticosteroids include stinging, itching, and skin irritation with the first few applications.

Side effects1:40–2:40

Over time, they may lead to impaired wound healing and collagen formation, as well as skin atrophy, stretch marks, telangiectasia, and easy bruising.
Prolonged use can also cause facial dermatoses like acne, rosacea, and perioral dermatitis. Additionally, they can increase the risk of developing skin infections, as well as alter the appearance of previously existing ones.
If corticosteroid therapy is suddenly discontinued, clients may experience a rebound flare of their condition. Finally, a rare but potentially serious side effect of topical corticosteroids, especially high potency ones, is systemic absorption, which can cause symptoms of hypercortisolism, such as acne, mood changes, muscle weakness, weight gain, and hyperglycemia; and may even cause suppression of the hypothalamic-pituitary-adrenal axis.Precautions for topical corticosteroids include untreated bacterial, viral, or fungal skin infections, as well as active facial dermatoses, like acne, rosacea, and perioral dermatitis.Now, if your client is prescribed a topical corticosteroid, start by performing a baseline assessment of the affected skin.

Contraindications and cautions2:40–2:53

Nursing considerations & client education2:53–4:35

Before applying the medication, be sure that the skin area is free of any open blisters, cuts, or burns, as well as signs of an existing bacterial or fungal infection, like redness, swelling, or pus.Next, teach your client to apply the cream or ointment to the affected skin area exactly as directed.
Let them know that the medication can cause side effects like burning, itching, dryness, or irritation. Remind them to avoid direct sunlight on the affected area, since the medication can make the skin more prone to sunburn.
Then, stress the importance of reporting signs that their medication is being absorbed systemically, such as weight gain, mood changes, muscle weakness, or new acne.
Finally, advise them to contact their healthcare provider if the affected area worsens or does not improve with treatment.
Okay, when you’re applying a topical corticosteroid, remember to wear clean gloves to protect your own skin from the medication.
Use a gloved finger, tongue blade, or cotton-tipped applicator, being careful to avoid the client’s eyes and mucous membranes.
After application, leave the skin area either uncovered or just lightly covered, to decrease the risk of systemic absorption.
During treatment, monitor for any side effects of the medication. If your client develops signs or symptoms of an infection, such as an unexplained fever, or if the affected area worsens, notify the healthcare provider right away.
Finally, be sure to reassess your client’s skin for the desired therapeutic effect. Alright, as a quick recap … Topical corticosteroids are used to treat dermatological conditions, such as psoriasis, eczematous rashes, lichen sclerosus, bullous pemphigoid, pemphigus foliaceus, and urticaria.

Review4:35–5:26

These medications suppress the inflammatory response, so should not be used when there’s an untreated bacterial, viral, or fungal infection.
While caring for a client who is prescribed a topical corticosteroid, nursing considerations include applying the medication to intact skin using clean technique, as well as monitoring for side effects such as development of infection or irritation at the application site, and monitoring for the desired therapeutic effect.
Finally, client teaching is focused on how to apply the medication as directed, and to report symptoms of systemic absorption or if the affected area does not respond to treatment.