Corticosteroid-responsive dermatoses

Updated: August 14, 2024

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Background

Corticosteroid-responsive dermatoses is a skin conditions that improve and treat skin problems with the use of corticosteroids.  

Dermatoses is used to describe skin defect or lesion. Corticosteroids are anti-inflammatory medications used to reduce inflammation and increase the immune response.  

Corticosteroids are available in the form of topical creams, ointments, and lotions. 

Types of Dermatoses:  

Atopic dermatitis 

Contact dermatitis 

Seborrheic dermatitis 

Psoriasis 

Epidemiology

Eczema is seen in 10% to 20% of cases in children and 1% to 3% in adults. While psoriasis affects 2% to 3% individuals of the global population.  

Atopic dermatitis affects 15% to 20% in children and 1% to 3% in adults. 

Skin cancer cases are seen in sun-exposed regions such as Australia, New Zealand, and Europe. Skin diseases cause discomfort, distress, and social stigma that affects patient personal life.  

Anatomy

Pathophysiology

Filaggrin gene mutations give weak skin barrier to produce allergens and inflammation. 

Keratinocyte dysfunction causes skin scaling and thickening. Inflammatory response worsens tissue damage. 

Autoantibodies attack desmoglein in skin cells and causes adhesion loss and blisters.  Genetic mutations disrupt keratinization causes skin barrier dysfunction, increased water loss, and infection vulnerability. 

Etiology

  • Causes of corticosteroid-responsive dermatoses as: 
  • Eczema  
  • Psoriasis 
  • Ichthyosis 
  • Gene Mutations 
  • Contact Dermatitis 
  • Allergens and Irritants 
  • Acne Vulgaris 
  • Skin Cancer 
  • UV Radiation 
  • Herpes Simplex Virus 
  • Dermatophytes 
  • Candida 

Genetics

Prognostic Factors

Severe diseases with large lesions need intensive treatment for improvement. 

Identify and avoid irritant or allergen for better prognosis outcome. 

Early-onset skin conditions are chronic in nature thus difficult to treat. 

E.g., eczema and psoriasis 

Emotional stress can worsen skin conditions and treatment outcomes. 

Clinical History

Corticosteroid responsive dermatoses affect individuals of all age groups from infants to adults. 

Physical Examination

  • Systematic Examination 
  • Assessment of primary and secondary lesions 
  • Nail Examination 
  • Scalp Examination 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

For acute dermatoses: 

Severe itching, pain, redness, and swelling 

For chronic dermatoses: 

Long-lasting, dry and scaly skin, 

Differential Diagnoses

  • Psoriasis 
  • Eczema 
  • Rosacea 
  • Lichen Planus 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Patients should identify and avoid triggers including allergens and irritants. 

It controls symptoms, promotes healing and minimizes recurrence to manage chronic condition.  

Topical corticosteroids are used in the treatment of eczema, psoriasis, and contact dermatitis. 

Oral corticosteroids are indicated to treat severe eczema and lupus erythematosus. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-corticosteroid-responsive-dermatoses

Patient should use mild soaps/lotions and follow good hygiene practices. 

Patient should stay in dry environments to maintain skin moisture and prevent dryness. 

Use long sleeves and skin protecting cloths during summer season or when exposed to sunlight. 

Patient should wear soft and cotton cloths and avoid waring wool/synthetic fibres cloths. 

Proper education and awareness about corticosteroid responsive dermatoses should be provided and its related causes with management strategies. 

Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort.

use-of-topical-corticosteroids

Hydrocortisone: 

It decreases inflammation to stabilize leukocyte lysosomal membranes of destructive acid hydrolases. 

Clobetasol propionate: 

It reduces swelling, redness, itching and rashes caused due to these skin conditions. 

Betamethasone dipropionate: 

It has potent glucocorticoid activity and works as corticosteroid Hormone Receptor Agonist. 

use-of-intervention-with-a-procedure-in-treating-corticosteroid-responsive-dermatoses

Phototherapy is indicated to treat psoriasis, eczema, and vitiligo. 

use-of-phases-in-managing-corticosteroid-responsive-dermatoses

In the initial diagnosis phase, evaluation of medical history, physical examination and diagnostic test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of topical corticosteroids and therapies. 

The regular follow-up visits with the dermatologist are schedule to check the improvement of patients along with treatment response. 

Medication

 

desoximetasone 

Gels

Topically applied

every 12 hours


Apply a thin film topically to the affected area



urea and hydrocortisone 

Administer to the affected region every 6 to 12 hours; stop treatment once control is established
If there is no improvement after two weeks, re-evaluate the diagnosis



fluocinonide 

Apply a slight coating topically once daily or every 12 hours as needed



prednicarbate 

Apply cream or lotion every 12 hours; stop treatment when control is attained.
If there is no improvement after two weeks, re-evaluate the diagnosis Do not use it for more than three weeks



hydrocortisone probutate topical 

Medium-potency corticosteroid used to treat dermatoses' inflammatory and itchy symptoms
Depending on the severity of the condition, just apply a small amount (daily or twice a day) to the affected area



fusidic acid and betamethasone 

Indicated for Secondary infection in corticosteroid-responsive dermatoses
:

Apply to the affected area twice daily. Do not exceed 14 days of treatment.



neomycin/fluocinolone 

Apply a thin layer to the affected area up to two to four times in a day
Dosing modification
Renal Impairment
No dose modification required
Hepatic Impairment
No dose modification required



halometasone 

Apply to the areas of affected skin as ointment/cream of concentration 0.05 %



betamethasone + gentamicin 

Apply to the affected area twice or thrice a day



betamethasone + neomycin 

Apply a tiny amount to the affected region twice or thrice a day.
Once the improvement has occurred, apply once daily or less often.



fluocortolone 

- 100

Topical

0.25% caproate or 0.25% of pivalate or alcohol-containing cream to be applied on the affected area twice daily



clobetasol propionate 

Cream/foam: Apply a thin coat to the affected regions every 12 hours and gently massage it in. Do not apply more than 50 g/week.
Lotion: Apply to damaged skin areas twice a day and rub in; do not use more than 50 g per week



halometasone 

Apply to the areas of affected skin as ointment/cream of concentration 0.05%



fluocinolone acetonide 

Apply gel, cream, solution or ointment 2 to 4 times a day on the basis of severity of the disease



fluclorolone 

Apply 0.2 % ointment or cream one-two times a day



fluclorolone 

Apply 0.2 % ointment or cream one-two times a day



fluocinolone topical 

Dosing considerations
Use caution while using some plastic films since they may be flammable.:

Cream, ointment, solution: apply a thin coating to the afflicted region between two and four times each day



fluticasone (topical) 

apply thin film ointment to the affected area twice a day



amcinonide 

Apply a thin film onto the affected area every 8-12 hours



betamethasone and gentamicin 

Apply to the affected area twice or thrice a day



 

desoximetasone 

Gels

Topically applied

every 12 hrs


<18 years: Not recommended
>18 years: Apply a thin film topically to the affected area



urea and hydrocortisone 

Administer to the affected region every 6 to 12 hours; stop treatment once control is established
If there is no improvement after two weeks, re-evaluate the diagnosis



fluocinonide 

Apply a slight coating topically once daily or every 12 hours as needed



prednicarbate 

<12 months: Safety and efficacy not established
>12 months: Apply cream every 12 hours
>10 years: Apply the ointment every 12 hours
Do not use it for more than three weeks
Keep dosages to the absolute lowest required for effective treatment
If there is no improvement after two weeks, re-evaluate the diagnosis



clocortolone 

Apply the least amount of cream on the affected area, as children are prone to systemic toxicity



fusidic acid and betamethasone 

Indicated for Secondary infection in corticosteroid-responsive dermatoses
:

Children more than 6 years and adults:
Apply to the affected area twice daily. Do not exceed 14 days of treatment.



neomycin/fluocinolone 

For Children and Adolescents:
Apply a thin layer to the affected area up to two to four times in a day



betamethasone + gentamicin 

Apply to the affected area twice or thrice a day



betamethasone + neomycin 

Apply a tiny amount to the affected region twice or thrice a day.
Once the improvement has occurred, apply once daily or less often.



clobetasol propionate 

Below 12 years
Safety and efficacy not established
Above 12 years (cream/foam)
Apply a thin layer to the affected regions every 12 hours and gently massage it in. Do not apply more than 50 g per week.



clobetasol propionate 

Scalp:

Below 12 years
Safety and efficacy not established
Above 12 years (foam)
Apply to affected area in scalp every 12hr for 2 weeks; should not exceed 50 g or 50 mL per week



fluocinolone topical 

Dosing considerations
Use caution while using some plastic films since they may be flammable. :

Children and adolescents
Cream, ointment, solution: apply a thin coating to the afflicted region between two and three times each day



amcinonide 

Apply a thin film onto the affected area every 12 hours
Avoid the face and use the minimum amount necessary



betamethasone + gentamicin 

Apply to the affected area twice or thrice a day



 

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Corticosteroid-responsive dermatoses

Updated : August 14, 2024

Mail Whatsapp PDF Image



Corticosteroid-responsive dermatoses is a skin conditions that improve and treat skin problems with the use of corticosteroids.  

Dermatoses is used to describe skin defect or lesion. Corticosteroids are anti-inflammatory medications used to reduce inflammation and increase the immune response.  

Corticosteroids are available in the form of topical creams, ointments, and lotions. 

Types of Dermatoses:  

Atopic dermatitis 

Contact dermatitis 

Seborrheic dermatitis 

Psoriasis 

Eczema is seen in 10% to 20% of cases in children and 1% to 3% in adults. While psoriasis affects 2% to 3% individuals of the global population.  

Atopic dermatitis affects 15% to 20% in children and 1% to 3% in adults. 

Skin cancer cases are seen in sun-exposed regions such as Australia, New Zealand, and Europe. Skin diseases cause discomfort, distress, and social stigma that affects patient personal life.  

Filaggrin gene mutations give weak skin barrier to produce allergens and inflammation. 

Keratinocyte dysfunction causes skin scaling and thickening. Inflammatory response worsens tissue damage. 

Autoantibodies attack desmoglein in skin cells and causes adhesion loss and blisters.  Genetic mutations disrupt keratinization causes skin barrier dysfunction, increased water loss, and infection vulnerability. 

  • Causes of corticosteroid-responsive dermatoses as: 
  • Eczema  
  • Psoriasis 
  • Ichthyosis 
  • Gene Mutations 
  • Contact Dermatitis 
  • Allergens and Irritants 
  • Acne Vulgaris 
  • Skin Cancer 
  • UV Radiation 
  • Herpes Simplex Virus 
  • Dermatophytes 
  • Candida 

Severe diseases with large lesions need intensive treatment for improvement. 

Identify and avoid irritant or allergen for better prognosis outcome. 

Early-onset skin conditions are chronic in nature thus difficult to treat. 

E.g., eczema and psoriasis 

Emotional stress can worsen skin conditions and treatment outcomes. 

Corticosteroid responsive dermatoses affect individuals of all age groups from infants to adults. 

  • Systematic Examination 
  • Assessment of primary and secondary lesions 
  • Nail Examination 
  • Scalp Examination 

For acute dermatoses: 

Severe itching, pain, redness, and swelling 

For chronic dermatoses: 

Long-lasting, dry and scaly skin, 

  • Psoriasis 
  • Eczema 
  • Rosacea 
  • Lichen Planus 

Patients should identify and avoid triggers including allergens and irritants. 

It controls symptoms, promotes healing and minimizes recurrence to manage chronic condition.  

Topical corticosteroids are used in the treatment of eczema, psoriasis, and contact dermatitis. 

Oral corticosteroids are indicated to treat severe eczema and lupus erythematosus. 

Dermatology, General

Patient should use mild soaps/lotions and follow good hygiene practices. 

Patient should stay in dry environments to maintain skin moisture and prevent dryness. 

Use long sleeves and skin protecting cloths during summer season or when exposed to sunlight. 

Patient should wear soft and cotton cloths and avoid waring wool/synthetic fibres cloths. 

Proper education and awareness about corticosteroid responsive dermatoses should be provided and its related causes with management strategies. 

Appointments with a dermatologist and preventing recurrence of disorder is an ongoing life-long effort.

Dermatology, General

Hydrocortisone: 

It decreases inflammation to stabilize leukocyte lysosomal membranes of destructive acid hydrolases. 

Clobetasol propionate: 

It reduces swelling, redness, itching and rashes caused due to these skin conditions. 

Betamethasone dipropionate: 

It has potent glucocorticoid activity and works as corticosteroid Hormone Receptor Agonist. 

Dermatology, General

Phototherapy is indicated to treat psoriasis, eczema, and vitiligo. 

In the initial diagnosis phase, evaluation of medical history, physical examination and diagnostic test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of topical corticosteroids and therapies. 

The regular follow-up visits with the dermatologist are schedule to check the improvement of patients along with treatment response. 

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