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),
– 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[précurseur de nombreuses molécules impliquées dans l’inflammation (leucotriènes)]ti-inflammatory action.
III- Pharmacodynamic properties:
DCTCs have 3 main activities observed in therapeutics
- 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.
- Derme: The strongest DCTCs inhibit the growth of fibroblasts and decrease collagen synthesis.
- Result of their anti-inflammatory action
- but also a decrease in the number of Langerhans cells and their ability to present antigens.
a)- Nature of the excipient:
- Pommades: 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.>
- Keratolytics (Exp: Ac salicylic) and moisturizers (Exp: urea) increase the penetration of DCTC.
- 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 (DA, erythrodermia…)
- 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)
- 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.
- it is the appearance of resistance to treatment during prolonged and uninterrupted applications.
There are four levels of power. Examples of DCCCs available in Algeria:
International common name
Class 4: Very strong
Class 3: Forte
Class 2: Moderate
Class 1: Low
1- Choice of DCTC activity:
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 the seat:
- 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- Choice of the excipient:
- Pommade: 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- Monitoring treatment:
- Quantification of the number of tubes used
- Tracking the growth curve in children (long-term TRT)
DCTCs are a symptomatic and non-etiological treatment.
1- For their anti–inflammatory 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-proliferative 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 immunosuppressive effect:
- Pemphigoid bubble: use of a Class 4 DCTC.
VIII- Intralesional injections:
- 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:
- Epidermal, reversible: epidermal thinning in "cigarette paper", 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:
5- Hormonal effects:
- Sebaceous hyperplasia
- Generals: rare
6- Uncontrolled cause dermatoses:
- Rebound phenomenon
- Infant gluteal granuloma
- Allergic contact eczema to DC or excipient
- Viral, bacterial, fungal and parasitic infectious dermatoses;
- Ulcerated dermatoses;
- Facial dermatologists.
Professor AS. CHEHAD