Dermocorticoids

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I- Introduction:

Dermocorticoids (DCTCs) are steroids used locally – topical;

  • Mostly used for their anti-inflammatory and antiprolifeferative actions.
  • Classification based on the level of activity (from 1 low to 4 very strong) estimated based on vasoconstriction and comparative therapeutic trials.
  • DCTCs are a symptomatic treatment, not an etiological one.
  • Prescription in practice combines choice

– class (function of diagnosis, topography and age),

– galenic,

– the rate of application (less than or equal to twice a day),

– the amount needed depending on the surface to be treated.

  • Follow-up is necessary in cases of chronic dermatitis, especially in children.

II- Mechanisms of action:

1- Link to receivers:

DCTCs pass through the cytoplasmic membrane by simple diffusion and bind to a specific receptor of the steroid receptor superfamily.

2- The receptor complex-DCTC passes through the nuclear membrane

3- Action on the transcript:

  • Interaction with a nuclear catcher site
  • Change in gene expression to transcription modification.
  • Action on genes intervening on proliferation: anti-proliferation action
  • Action on genes involved in cytokine synthesis (IL-1, TNF…): immunosuppressive action.
  • Also inhibit the release of arachidonic acid: an[forerunner of many molecules involved in the & rsquo; inflammation (leukotrienes)]ti-inflammatory action.

III- Pharmacodynamic properties:

DCTCs have 3 main activities observed in therapeutics

1- Anti-inflammatory:

  • This is the most sought-after therapeutic effect of DCTCs.
  • The targets are multiple: leukocytes, macrophages and endogenous chemical mediators.
  • Vasoconstriction of dermal vessels to decrease erythema and edema regardless of the cause of inflammation.

2- Antimitotic – Antiprolifeferative:

  • Due to a non-specific action on the cell cycle
  • Epidermis: atrophying effect and inhibiting epidermal healing.
  • Dermis: The strongest DCTCs inhibit the growth of fibroblasts and decrease collagen synthesis.

3- Immunosuppressive:

  • Result of their anti-inflammatory action
  • but also a decrease in the number of Langerhans cells and their ability to present antigens.

IV- Pharmacokinetics:

1- Bioavailability:

a)- Nature of the excipient:

  • ointments: made up of fat excipient to occlusive effect to increase penetration;
  • Creams: less occlusive effect, but are more pleasant use;
  • Gels and lotion: penetrating power< crème.></ crème.>

b)- Additives:

  • Keratolytics (Exp: Ac salicylic) and moisturizers (Exp: urea) increase the penetration of DCTC.

c) Occlusion:

  • Increase DCTC penetration (up to X 10);
  • Obtained using plastic films;
  • Used to treat thick or hyperkeratosic lesions;
  • Increases the risk of infection.

d)- Dermatosis tO be treated (skin condition):

  • The penetration increases in dermatoses where the alteration of the epidermal barrier is important (GIVES, erythrodermia…)

e) TopographY:

  • Absorption is different from one point of tegument to another;
  • Important in the folds
  • Less in areas where the skin layer is thick (palms, plants)

(f) Age:

  • Penetration is high in preterm infants and elderly people;
  • Absorption is important in children due to a high surface-to-weight ratio.

2- Tank effect:

  • There is an accumulation of DCs in the corneal layer.
  • It is responsible for a gradual release
  • This justifies a single daily application.

3- Tachyphylaxis:

  • it is the appearance of resistance to treatment during prolonged and uninterrupted applications.

V- Classification:

There are four levels of power. Examples of DCCCs available in Algeria:

boarding schoolional common name

Trade name

Class 4: Very sin

Clobétasol propionate

Betamethasone dipropionate

Dermoval® / Clotasol

Diprolene®

Class 3: Strong

Betamethasone dipropionate

Mometasone furoate

Hydrocortisone aceponate

Hydrocortisone butyrate

Diprosone® / Betasone

Cortisaf®

Locoïd®

Efficort

Class 2: Moderate

Desonide

Locapred®

class 1: Low

Hydrocortisone

Hydracort® / cortiderm

WE- Tuems of use:

1- Forithis Of DCTC actappearedY:

a)- Dermatosis tO be treated:

  • DCTC Class 4: Resistant Lesions (Exp :psoriasis)
  • Chronic dermatosis:
  • Start with the strongest DCTC, able to control symptoms.
  • Then adapts the strength of the DC according to the response.

b)- The surface to be treated and tOat:

  • Classes 4 and 3 should be avoided on the face and creases.

c) Patient age:

  • Classes 4 and 3 should be avoided in children.

2- Choicit's thef the excipient:

  • Ointment: dry dermatoses, keratosic.
  • Cream: very broad indications: oozing lesions and in the creases.

3- Rhythm and application technique:

  • One app a day is usually enough. In some erosive dermatoses, two applications per day may initially be needed (disappearance of the tank effect).
  • A gradual shutdown is often achieved either by spacing applications or by using a lower level DCTC.
  • Occlusion is reserved for thick and/or hyperkeratosic, resistant and limited-surface lesions.
  • The dose not to be exceeded is about 30 g/week of class 3 finished product in maintenance in an adult.

4- Monitorsng treatment:

  • Quantification of the number of tubes used
  • Tracking the growth curve in children (long-term TRT)

VII- Indications:

DCTCs are a symptomatic and non-etiological treatment.

1- For their antiinflammatory effect:

  • Contact eczema associated with allergen expulsion;
  • Atopic dermatitis. It is a long-term treatment, requiring monitoring.
  • Other eczemas: varicose eczema, nummular, dysidrosis,
  • Photosensitizations: DCTCs have an anti-inflammatory effect on sunburn. They can be useful for other photodermatosis.
  • Lichen localized plane / localized psoriasis …
  • Insect bites.

2- For their anti-prole offerative effect:

  • Psoriasis: They may be associated with salicylic acid in very hyperkeratic lesions.
  • Lichenification: THE DCTC removes pruritus and decreases infiltration. It is best to use a Level 4 DC.

3- For their immuneOsuppressive effect:

  • Pemphigoid bubble: use of a Class 4 DCTC.

VIII- Intraleslevel injections:

  • Indication:
  • Some localized lesions after failure of powerful topicals
  • Hypertrophic scars and keloids
  • Side effects: Ditto, but atrophy may be pronounced.

IX- Corticosteroids in combination:

  • The combination of a DCTC with salicylic acid increases penetration and the keratolytic effect. It is interesting for scaly dermatoses.
  • Associations in the same preparation of a DCTC and an anti-infective (antiseptic, antibiotic, antifungal) are never justified at any awareness risk.

X- Side effects of dermocorticoids:

1- Atrophy:

  • Epidermal, reversible: epidermal thinning in &quot;cigarette paper&quot;, fragility at the slightest trauma
  • Dermal: delayed healing, telangiectasies, purpura- ecchymotic, stretch marks (not reversible)

2- facial dermatitis:

  • Acne induced
  • Worsening rosacea
  • Rosacea cortisonée
  • Peroral dermatitis

3- Skin infections:

  • Aggravation of an infection (herpes, dermatophytoses, scabies…) Secondary infection of dermatosis (infrequent)

4- Eye side effects:

  • Glaucoma
  • Cataract

5- Hormonal effects:

  • Hypertrichosis
  • Sebaceous hyperplasia
  • Generals: rare

6- Uncontrolled cause dermatoses:

  • Rebound phenomenon
  • Dependence

7- Various:

  • Hypopigmentation
  • Infant gluteal granuloma
  • Allergic contact eczema to DC or excipient

XI-CONTRAINDICATIONS:

  • Viral, bacterial, fungal and parasitic infectious dermatoses;
  • Ulcerated dermatoses;
  • Facial dermatologists.

Teachers. CHEHAD