Dermocorticoïdes

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introducedon :

  • Topical steroids (DC) were used in dermatology from years 1950, their use has been a therapeutic revolution in dermatology
  • Currently there are twenty different molecules, which are classified according to their anti-inflammatory activity (from "low" to "very strong")
  • Their use should, however, follow rules that allow, in the vast majority of cases, to avoid adverse effects

Actions biological :

  • Vasoconstriction
  • Effect anti-inflammatory : it is the most sought therapeutic effect, DC reduces erythema and edema of any inflammatory causes,  targets are multiple :  leucocytes,  macrophages, chemical mediators ...
  • Effect antimitotique (antiprolifératif) :

At level epidermal : DC have atrophying effect

At level dermal : the strongest inhibit the growth of fibroblasts and decrease the synthesis of collagen and elastic fibers DC

  • Effect immunosuppressive : DC decrease Langerhans cells and reduce their antigen presentation capacity
  • Tachyphylaxie (acute tolerance) : it proves the strength (tolerance) treatment during prolonged and uninterrupted application

classifiedion :

Activity / Level DCI Specialty
Very strong / IV

Bétaméthasone dipropionate

Clobetasol propionate

Diprolène®

Clotasol®

Strong / IV

Bétaméthasone dipropionate

Acéponate d’hydrocortisone

Hydrocortisone butyrate

desonide

Diprosone® / Bétasone®

Efficort®

Locoïd®

Locatop®

moderate / II desonide Locapred®
Low / I Hydrocortisone Hydracort® / Cortiderm®

PharmacociNetique :

  • bioavailability cutaneous (dermal) : depends on several factors :

factors related at DC : lipid solubility and concentration, nature of the excipient (penetration favored by ointment), presence of adjuvants (salicylic acid and urea)

factors related at the skin : epidermal alteration (penetration enhancement), proper hydration (better distribution), anatomic site (depending on the thickness of the stratum corneum), age (greater absorption in the elderly and premature), skin temperature (penetration enhancement with increased local heat)

factors related at mode d’application : surface d’application, contact time, occlusion (multiplies dermal 10)

  • Effect tank : it is the accumulation of a DC in the stratum corneum of the epidermis and then be gradually released into the deeper layers. It disappears when the stratum corneum is pathological

modalities of use of the DC :

  • Choice of level business : depend on :

Type and surface from the Dermatose : avoid strong DC on large surfaces

Seat of the injury : DC low to moderate on the thin skin (face)

Age of patient : DC low to moderate in children

  • Choice from the form galenic : depends on the nature and location of the lesions

Crème : has very broad indications

Ointment : used to dry dermatoses, hyperplasiques, keratosic. To avoid the folds

Gel : useful for oozing lesions and folds

Lotion : suitable for hairy areas

  • Rules dosing : one application per day is usually sufficient, unless epidermal alteration (2x/j).

For prolonged treatment, avoid abrupt stop exposing the rebound effect (recurrence of symptoms),  gradually reduce the power of the treatment,  either by spacing applications (1 day / 2 and /3) either by using a lower-level DC

indicatedions :

This is symptomatic and non-etiological

  • Corticoïde alone :

Among the indications anti-inflammatory : Allergic contact dermatitis (contact dermatitis +++), atopic dermatitis, irritant contact dermatitis, photosensibilisation (anti-inflammatory effect on sunburn), various pruritus (except for scabies +++), other (lichen localized plane, insect bites, dyshidrose)

For  the  effects  antiprolifératifs :  lichenification (DC suppresses itching and decreases the infiltration), psoriasis, hypertrophic scars and keloids

Other  indications :  seborrheic dermatitis,  scleroderma sclerosis,  Slade,  vitiligo, dermatitis bulleuse

  • In association :

With acid salicylic (Diprosalic®) : for squamous dermatoses

With the Daivonex® (derivative of vitamin D) : Daivobet®

With the antifungals and the antibiotics : this association is not justified

Againstindicatestions :

infectious viral dermatoses, bacterial, fungal and parasitic (except for scabies eczématisée), ulcerated dermatitis, facial dermatoses (acne, rosacea)

Effects secondary :

  • Local :

Atrophy : epidermal (reversible, epidermis end in "cigarette paper", face +++), dermal (definitive,  delayed healing,  pseudo-scars,  telangiectasia,  purpura easy bruising

dermatitis rosacéiformes of face : induced acne, worsening of rosacea or dermatitis Perioral

Infections  skin :  worsening infection (herpes),  Secondary infection dermatitis

eye : glaucoma, cataract / hormone : hypertrichose, sebaceous hyperplasia

Divers :   infant gluteal granuloma (seat dermatitis in infants), hypopigmentation, Allergic contact dermatitis to the CS or excipient

  • systemic : rares, is observed especially in infants and children (application on large surfaces or under occlusion), the effects are the same as those observed after systemic corticosteroid therapy (braking of the hypothalamus-pituitary-adrenal axis, syndrome cushingoïde)