fluocinonide

Action and Spectrum

Actions and Spectrum: 

fluocinonide is a high-potency synthetic corticosteroid that is an anti-inflammatory and anti-pruritic agent when applied topically. It has a selective and potent action on the glucocorticoid receptor, leading to the formation of a glucocorticoid-receptor complex that translocates to the nucleus of the target cells. The complex modulates gene expression in the nucleus, leading to decreased production of pro-inflammatory cytokines and chemokines and increased production of anti-inflammatory proteins. 

The overall mechanism of action of fluocinonide can be summarized as follows: 

• Suppression of the immune system: fluocinonide suppresses the immune system by reducing the production and release of pro-inflammatory cytokines and chemokines. This action helps to reduce inflammation and symptoms associated with various skin disorders. 
• Inhibition of cell proliferation: fluocinonide inhibits cell proliferation and differentiation, which is helpful in the treatment of psoriasis, seborrheic dermatitis, and other hyperproliferative skin disorders. 
• Anti-pruritic effect: fluocinonide has an anti-pruritic effect, which helps to relieve itching associated with skin disorders. 

fluocinonide is effective against a broad spectrum of skin disorders, including: 

An eczema is a group of skin conditions that cause the skin to become dry, itchy, and inflamed. 

• Psoriasis: This chronic skin condition causes cells to build up rapidly on the skin’s surface, resulting in scaling and redness 
• Contact dermatitis: This type of skin inflammation occurs because of contact with an irritant or allergen. 
• Atopic dermatitis: This type of eczema is characterized by dry, itchy skin and often occurs in people with a family history of allergies. 
• Seborrheic dermatitis: This is a skin condition that causes scaly patches, red skin, and dandruff. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Striae 

Pigmentation changes 

Intracranial hypertension 

Maceration of the skin 

Folliculitis 

Cushing’s syndrome 

Hyperglycemia 

Irritation 

Skin atrophy 

Acneform lesions 

HPA suppression (with higher potency used >2 wk) 

Hypopigmentation 

Miliaria 

Hyperglycemia 

Telangiectasia 

Burning 

Glycosuria 

Black Box Warning

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Hypersensitivity: fluocinonide is contraindicated in individuals with known hypersensitivity to any of its components. 
• Viral skin infections: fluocinonide should not be used in individuals with viral skin infections, such as herpes simplex, varicella, and vaccinia, as it may worsen the condition or lead to the spread of the virus. 
• Fungal skin infections: fluocinonide should not be used in individuals with fungal skin infections, such as tinea, as it may exacerbate or spread the fungus. 
• Bacterial skin infections: fluocinonide should not be used in individuals with bacterial skin infections, as it may mask the symptoms and delay appropriate treatment. 
• Acne vulgaris: fluocinonide should not be used to treat acne vulgaris, as it may exacerbate the condition. 
• Rosacea: fluocinonide should not be used to treat rosacea, as it may exacerbate the condition. 
• Perioral dermatitis: fluocinonide should not be used to treat perioral dermatitis, as it may exacerbate the condition. 
• fluocinonide is not recommended for children under 12, as its safety and efficacy have not been established in this population. 

Caution: 

• Long-term use: fluocinonide should be used for the shortest duration possible to avoid the risk of adverse effects associated with prolonged use. 
• High potency: fluocinonide is a high-potency corticosteroid, and its use in high doses or for prolonged periods may lead to systemic absorption, which can cause various side effects, such as Cushing’s syndrome, adrenal suppression, and hyperglycemia. 
• Skin irritation: fluocinonide may cause skin irritation, such as burning, itching, and redness, mainly when applied to sensitive areas or in high concentrations. 
• Use during pregnancy and lactation: fluocinonide should be used during pregnancy and lactation only if needed and under the supervision of a healthcare professional. 
• Use in children: fluocinonide should be used with caution in children, as they may be more susceptible to systemic effects, such as adrenal suppression and growth retardation. 
• Interactions with other medications: fluocinonide may interact with other medications, such as immunosuppressants and antifungal agents, leading to an increased risk of adverse effects. 
• Use in the elderly: Elderly patients may be more susceptible to the side effects of fluocinonide, and therefore, it should be used with caution in this population. 

Pregnancy / Lactation

Pregnancy consideration: C 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

fluocinonide is a potent synthetic corticosteroid with anti-inflammatory, anti-pruritic, and vasoconstrictive properties. It exerts its pharmacological effects by binding to intracellular glucocorticoid receptors, leading to the inhibition of pro-inflammatory cytokines and the activation of anti-inflammatory genes. This action leads to the suppression of the immune response and the reduction of inflammation, swelling, redness, and itching. 

Pharmacodynamics: 

• The pharmacodynamics of fluocinonide is related to its anti-inflammatory and immunosuppressive actions. As a potent synthetic corticosteroid, fluocinonide binds to intracellular glucocorticoid receptors and modulates gene expression, leading to various pharmacological effects. 
• The anti-inflammatory effects of fluocinonide are related to the inhibition of pro-inflammatory cytokines, such as interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). These cytokines are released by various immune cells, such as macrophages, monocytes, and T cells, in response to inflammation, infection, or injury. fluocinonide inhibits the expression and release of these cytokines, reducing inflammation, swelling, and redness. 
• The immunosuppressive effects of fluocinonide are related to T-cell activation and proliferation inhibition. T cells play a crucial role in the immune response by recognizing and eliminating foreign antigens. However, excessive activation of T cells can lead to autoimmune diseases or hypersensitivity reactions. fluocinonide inhibits T-cell activation and proliferation, leading to a reduction in the immune response. 

Pharmacokinetics: 

Absorption 

fluocinonide is rapidly absorbed through the skin when applied topically. Occlusions, such as plastic wrap or an occlusive dressing can enhance its absorption. 

Distribution 

After absorption, fluocinonide is distributed throughout the body. However, due to its high potency, only small amounts of the drug are required to achieve therapeutic effects. The drug binds strongly to plasma proteins, and the body’s metabolic processes influence its distribution.

Metabolism 

fluocinonide undergoes extensive metabolism in the liver, converting it into various metabolites. These metabolites are then excreted from the body. 

Elimination and Excretion 

The metabolites of fluocinonide are primarily excreted in the urine, with a small amount being excreted in the feces. The drug has a relatively short elimination half-life of approximately 2.5 hours. 

Adminstartion

Administration: 

fluocinonide is a prescription medication available in different forms, such as creams, ointments, gels, and solutions for topical application. The appropriate method of administration will depend on the condition being treated and the severity of the symptoms. Here are some general guidelines for the administration of fluocinonide: 

• Clean and dry the affected area before applying fluocinonide. 
• Apply a thin layer of the medication to the affected area and gently rub it into the skin. 
• Wash your hands thoroughly after applying fluocinonide, unless you treat your hands. 
• Do not cover the treated area with bandages, dressings, or other occlusive dressings, unless directed by your doctor. 
• Do not apply fluocinonide to areas of the skin that are broken, infected, or have open wounds. 
• Follow your doctor’s instructions carefully, and do not use more than the recommended dose or for a longer duration than advised. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: fluocinonide 

Pronunciation: [ FLOO-oh-SIN-oh-nide ] 

Why do we use fluocinonide? 

fluocinonide is a potent synthetic corticosteroid primarily used to treat various skin conditions that cause inflammation, itching, and discomfort. Here are some of the most common uses of fluocinonide: 

• Eczema: fluocinonide is used to treat eczema, a condition characterized by inflamed, itchy, and red skin. 
• Psoriasis: fluocinonide treats psoriasis, a chronic skin condition that causes scaly patches. 
• Dermatitis: fluocinonide is used to treat contact dermatitis, a type of skin inflammation caused by exposure to an irritant or allergen. 
• Rashes: fluocinonide is used to treat various rashes, including those caused by insect bites, poison ivy, or other skin irritants. 
• Lupus: fluocinonide can treat the skin symptoms associated with lupus, an autoimmune disorder that can cause skin rashes and lesions.