Topical therapy generally preferred over systemic therapy; fewer associated adverse systemic effects.
Topical therapy generally only controls manifestations of dermatoses; eliminate cause if possible.
Topical efficacy may be increased by using a higher concentration or occlusive dressing therapy. (See Administration with Occlusive Dressing under Dosage and Administration.)
Response may vary from one topical corticosteroid preparation to another.
Anti-inflammatory activity may vary considerably depending on the vehicle, drug concentration, site of application, disease, and individual patient.
Manufacturer states that gel should not be used for the treatment of diaper dermatitis.
Desonide cream, ointment, and lotion are considered to have low to medium potency.
Dosage and Administration
General
Consider location of the lesion and the condition being treated when choosing a dosage form.
Creams are suitable for most dermatoses, but ointments may also provide some occlusion and are usually used for the treatment of dry, scaly lesions.
Lotions are probably best for treatment of weeping eruptions, especially in areas subject to chafing (e.g., axilla, foot, groin). Lotions, gels, and aerosols may be used on hairy areas, particularly the scalp.
Formulation affects percutaneous penetration and subsequent activity; extemporaneous preparation or dilution of commercially available products with another vehicle may decrease effectiveness.
Patients applying a topical corticosteroid to a large surface area and/or to areas under occlusion should be evaluated periodically for evidence of hypothalamic-pituitary-adrenal (HPA)-axis suppression by appropriate endocrine testing (e.g., ACTH stimulation, plasma cortisol, urinary free cortisol). (See Hypothalamic-Pituitary-Adrenal Axis Suppression and also Systemic Effects, under Cautions.)
Administration
Topical Administration
For dermatologic use only; avoid contact with eyes and other mucous membranes. Not for oral or intravaginal use.
Apply aerosol foams, creams, gels, lotions, and ointments topically to the skin or scalp.
The area of skin to be treated may be thoroughly cleansed before topical application to reduce the risk of infection; however, some clinicians believe that, unless an occlusive dressing is used, cleansing of the treated area is unnecessary and may be irritating.
Apply cream, gel, lotion, or ointment sparingly in a thin film and rub gently into the affected area.
After a favorable response is achieved, frequency of application or concentration (strength) may be decreased to the minimum necessary to maintain control and to avoid relapse; discontinue if possible.
Foam
Shake can; invert and dispense the smallest amount necessary to cover affected area with a thin layer.
Do not dispense directly onto the face; dispense in hands and then gently massage into affected area(s) of the face.
For areas other than the face, dispense directly onto the affected area(s).
Lotion
Shake well.
Administration with Occlusive Dressing
Occlusive dressings may be used for severe or resistant dermatoses (e.g., psoriasis). (See Occlusive Dressings under Cautions.)
Soak or wash the affected area to remove scales; apply a thin film of cream, lotion, or ointment; rub gently into the lesion; and apply another thin film. Cover affected area with a thin, pliable plastic film and seal it to adjacent normal skin with adhesive tape or hold in place with a gauze or elastic bandage.
If affected area is moist, incompletely seal the edges of the plastic film or puncture the film to allow excess moisture to escape. For added moisture in dry lesions, apply cream, ointment, or lotion and cover with a dampened cloth before the plastic film is applied or briefly soak the affected area in water before application of the drug and plastic film.
Thin polyethylene gloves may be used on the hands and fingers, plastic garment bags may be used on the trunk or buttocks, a tight shower cap may be used for the scalp, or whole-body suits may be used instead of plastic film to provide occlusion.
Frequency of occlusive dressing changes depends on the condition being treated; cleansing of the skin and reapplication of the corticosteroid are essential at each dressing change.
Occlusive dressing is usually left in place for 12–24 hours and therapy is repeated as needed. Although occlusive dressing may be left in place for 3–4 days at a time in resistant conditions, most clinicians recommend intermittent use of occlusive dressings for 12 hours daily to reduce the risk of adverse effects (particularly infection) and systemic absorption and for greater convenience.
The drug and an occlusive dressing may be used at night, and the drug or a bland emollient may be used without an occlusive dressing during the day.
In patients with extensive lesions, sequential occlusion of only one portion of the body at a time may be preferable to whole-body occlusion. (See Occlusive Dressings under Cautions.)
Dosage
Pediatric Patients
Administer the least amount of topical preparations that provide effective therapy. (See Pediatric Use under Cautions.)
Corticosteroid-responsive Dermatoses
Topical (Foam and Gel)
Children ≥3 months of age: Apply twice daily.
Discontinue when control is achieved; if improvement does not occur within 4 weeks, consider reassessment of the diagnosis.
Topical (Ointment)
Apply sparingly 2–3 times daily, according to the severity of the condition. (See Pediatric Use under Cautions.)
Adults
Corticosteroid-responsive Dermatoses
Topical (Cream, Lotion, and Ointment)
Apply sparingly 2–3 times daily, according to the severity of the condition.
Discontinue when control is achieved; if improvement does not occur within 2 weeks, consider reassessment of the diagnosis.
Topical (Foam and Gel)
Apply twice daily.
Discontinue when control is achieved; if improvement does not occur within 4 weeks, consider reassessment of the diagnosis.
Prescribing Limits
Pediatric Patients
Corticosteroid-responsive Dermatoses
Topical (Foam and Gel)
Children ≥3 months of age: Maximum 4 consecutive weeks.
Adults
Corticosteroid-responsive Dermatoses
Topical (Cream, Lotion, and Ointment)
Maximum 2 weeks.
Topical (Foam and Gel)
Maximum 4 consecutive weeks.
Special Populations
Hepatic Impairment
No specific dosage recommendations at this time.
Renal Impairment
No specific dosage recommendations at this time.
Geriatric Patients
Select dosage with caution usually starting at the low end of the dosage range, because of age-related decreased in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.
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