Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation

In the rat study, where some animals were allowed to litter, developmental delay was observed in the F1 generation at ≥100 micrograms/kg/day and survival was reduced at 400 micrograms/kg/day. No treatment-related effects were observed in F1 reproductive performance or in the F2 generation. In fertility studies, subcutaneous administration of clobetasol propionate to rats at doses of 6.25 to 50 micrograms/kg/day produced no effects on mating, and fertility was only decreased at 50 micrograms/kg/day. In case of systemic absorption (when application is over a large surface area for a prolonged period) metabolism and elimination may be delayed therefore increasing the risk of systemic toxicity.

The greater frequency of decreased hepatic or renal function in the elderly may delay elimination if systemic absorption occurs.
Topical steroid creams are anti-inflammatory medicines which means they reduce redness and inflammation caused by eczema and other skin conditions.
On this page, we’ll be looking at the different types of topical steroid creams available, and their strengths.
A detrimental effect on such activities would not be anticipated from the adverse reaction profile of topical clobetasol.

Examples of intralesional corticosteroids are hydrocortisone acetate and triamcinolone acetonide. In the words of one of our eczema nurses, you should use enough steroid cream to make the skin glisten and continue to use the eczema hydrocortisone cream for a couple of days after the skin has healed. These studies support the long-term safety of TCI and low to mid-potency TCS therapy in children with atopic dermatitis.

Side effects of topical corticosteroids

We aim to post within 14 working days all responses that contribute substantially to the topic investigated, as determined by the Editors. Antihistamines are also useful and there are non-sedating products for use in the daytime like Piriteze and sedating products for the nighttime like Piriton – which can help with sleep. One of the key aims of treatment in atopic dermatitis is to break the itch / scratch cycle.

Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
NICE Guidance on the Frequency of application of topical corticosteroids for atopic eczema (issued August 2004) recommends that corticosteroids should not be applied to the affected skin of people with atopic eczema more than twice a day.
Less potent steroids (such as mild or moderately potent) are usually used in the sensitive areas, and for a shorter length of time (ie. two weeks rather than four).

Care should be taken when using clobetasol propionate to ensure the amount applied is the minimum that provides therapeutic benefit. In more resistant lesions, especially where there is hyperkeratosis, the effect of clobetasol can be enhanced, if necessary, by occluding the treatment area with polythene film. Overnight occlusion only is usually adequate to bring about a satisfactory response. Thereafter improvement can usually be maintained by application without occlusion.

Responses to this report

The needle prick can be uncomfortable and the whole area that can be treated in one go is quite small; therefore, it is usually only used for fairly localised patches and smaller areas of Alopecia Areata. Intralesional corticosteroids are not routinely offered to patients with Alopecia Totalis or Alopecia Universalis. Steroid injections can only be performed by medically qualified practitioners. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids.

Risks (side effects)

As the parent of an eczema child, you know that the mainstay of treatment for eczema is complete emollient therapy – moisturising creams and products that can be added to the bath water, used to wash the skin and then also to moisturise the skin. Instruct patients not to smoke or go near naked flames due to the risk of severe burns. Fabric (clothing, bedding, dressings etc) that has been in contact with this product burns more easily and is a serious fire hazard.

The potential cost-savings on prescribed products are very small at a patient level; although given the large numbers of patients with atopic eczema, cost savings in theory could be substantial. The literature is very limited; that available indicates the clinical effectiveness of once-daily and more frequent where to buy horse steroids application of potent topical corticosteroids is very similar, but it does not offer a basis for favouring either option. The cost-effectiveness of once-daily versus more frequent use will depend on the generalisability of the findings to the specific treatment decision and the relative product prices.

Report suspected reactions on a Yellow Card

If you use them correctly, topical corticosteroids rarely have serious side effects. Following the application of a second dose of 30 g clobetasol propionate cream 0.05% mean peak plasma concentrations were slightly higher than the ointment and occurred 10 hours after application. The safe use of topical corticosteroids during lactation has not been established. Appropriate antimicrobial therapy should be used whenever treating inflammatory lesions which have become infected.

Moderately potent corticosteroid

One good-quality study favoured twice-daily application of fluticasone propionate ointment, while other studies found no significant difference or an improvement in one symptom but not others. The only study comparing very potent corticosteroids found a statistically significant difference in comparative clinical response in favour of three-times daily treatment, but no difference in number of patients with at least a good response. There appears to be little difference in the frequency or severity of short-term events, however data are limited. Topical corticosteroid products included in this review have a wide variation in price; the cost per 30 g/30 ml varies between GBP0.60 and GBP4.88.