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.
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 commercial preparations 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 Suppresion and also Systemic Effects, under Cautions.)
Administration
Topical Administration
Apply topically as a 0.1% cream, ointment, or lotion.
For dermatologic use only; avoid contact with the eyes.
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 or ointment sparingly in a thin film and rub into affected area.
Apply a few drops of lotion to the affected area by holding the nozzle of the bottle close to the affected area and squeezing gently; massage lightly until absorbed.
After a favorable response is achieved, frequency of application may be decreased to the minimum necessary to maintain control and to avoid relapse; discontinue if possible.
Administration with Occlusive Dressing
Occlusive dressings may be used for severe or resistant dermatoses. (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 escape of excess moisture. For added moisture in dry lesions, cover cream, ointment, or lotion with a dampened cloth before applying the plastic film or briefly soak the affected area in water before applying mometasone 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 mometasone 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.)
Administer the least amount of topical preparations that provides effective therapy. (See Pediatric Use under Cautions.)
Corticosteroid-responsive Dermatoses
Topical
Children ≥2 years of age: Apply 0.1% cream or ointment sparingly to affected area, usually once daily; safety and efficacy for >3 weeks not established. Cream and ointment also have been applied twice daily.
Children ≥12 years of age: Apply a few drops of 0.1% lotion to affected area once daily.
Discontinue when control is achieved; if improvement does not occur within 2 weeks, consider reassessment of the diagnosis.
Adults
Corticosteroid-responsive Dermatoses
Topical
Apply 0.1% cream or ointment sparingly to affected area, usually once daily. Cream and ointment also have been applied twice daily.
Apply a few drops of 0.1% lotion to affected area once daily.
Discontinue when control is achieved; if improvement does not occur within 2 weeks, consider reassessment of the diagnosis.
Prescribing Limits
Pediatric Patients
Corticosteroid-responsive Dermatoses
Topical
Children ≥2 years of age: Safety and efficacy of therapy with 0.1% cream or ointment for >3 weeks have not been established.
Drug Info Tools
