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Topical corticosteroids: Nursing Pharmacology

Notes

Notes

TOPICAL CORTICOSTEROIDS
DRUG NAME
hydrocortisone 0.5–2.5% (Ala-Cort, Ala-Scalp, Anusol HC Cetacort, Procort, Cortizone-5, Cortizone-10, Procort, Texacort)
triamcinolone 0.025–0.1% (Kenalog, Triderm);
betamethasone 0.1% (Beta-Val, Dermabet, Luxiq, Valnac)

betamethasone 0.05% (Diprolene, Diprolene AF, Sernivo);
clobetasol 0.05% (Clobex, Cormax, Olux, Olux-E, Temovate, Temovate-E)

CLASS
Low potency topical corticosteroids
Intermediate potency topical corticosteroids
High potency topical corticosteroids
MECHANISM OF ACTION
  • Decreased production of inflammatory mediator molecules (e.g., prostaglandins, leukotrienes)
  • Increased production of anti-inflammatory molecules
  • Vasoconstriction of cutaneous blood vessels
INDICATIONS
  • Psoriasis
  • Eczematous rashes (contact dermatitis, atopic dermatitis)
  • Lichen sclerosus
  • Bullous pemphigoid, pemphigus foliaceus
  • Symptomatic relief for burning or pruritic lesions (allergic reactions, insect bites, poison ivy)
ROUTE(S) OF ADMINISTRATION
  • TOP
SIDE EFFECTS
  • Stinging, itching, and skin irritation after the application (short-term)
  • Skin atrophy, stretch marks, easy bruising, delayed wound healing (long-term)
  • HPA axis suppression (rare)
CONTRAINDICATIONS AND CAUTIONS
  • Untreated fungal, viral, or bacterial skin infections
  • Active facial dermatoses: acne, rosacea, or perioral dermatitis
NURSING CONSIDERATIONS: TOPICAL CORTICOSTEROIDS
ASSESSMENT AND MONITORING
All topical corticosteroids
Assess
  • Baseline assessment of the affected skin
    • Free of open blisters, cuts, or burns
    • No signs of bacterial or fungal infection; e.g., redness, swelling, or pus

Administration
  • Wear clean gloves
  • Administer with gloved finger, tongue blade, or cotton-tipped applicator
  • Leave site uncovered

Monitor
  • Side effects
  • Report signs of infection; worsening condition
  • Evaluate therapeutic effect
CLIENT EDUCATION
All topical corticosteroids
  • Correct self-administration
  • Side effects: burning, itching, dryness, or irritation
  • Avoid direct sunlight on the affected area
  • Report: signs of systemic absorption; e.g., weight gain, mood changes, muscle weakness, new acne; if the affected area worsens or does not improve with treatment
Transcript

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.

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.

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.

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.

Sources
  1. "Basic and Clinical Pharmacology 12/E" McGraw Hill Professional (2012)
  2. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  3. "Topical corticosteroids in dermatology" Indian Journal of Dermatology, Venereology, and Leprology (2016)
  4. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  5. "Comparison of representative topical corticosteroid preparations (classified according to the United States system)" UpToDate (2021)
  6. "Topical corticosteroids: Use and adverse effects" UpToDate (2021)
  7. "Choosing Topical Corticosteroids" American Family Physician (2009)