Topical fluticasone propionate lotion does not cause HPA axis suppression

Hebert, Adelaide A.; Friedlander, Sheila Fallon; Allen, David B.

doi:10.1016/j.jpeds.2006.05.008

Cited by 23 publications

(15 citation statements)

References 12 publications

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“…Tacrolimus ointment is frequently indicated for the face, and its guidance‐based administration should be positively considered. Adverse reactions: With respect to systemic adverse reactions, previous studies reported that the application of potent topical corticosteroids induced adrenal hypofunction in some patients . However, neither adrenal hypofunction nor a growth disorder was observed in patients treated with weak topical corticosteroids . If these preparations are adequately used, the incidence of systemic adverse reactions is low, and safety is high.…”

Section: Chapter Imentioning

confidence: 99%

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016

Saeki,

Nakahara,

Tanaka

et al. 2016

The Journal of Dermatology

155

181

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Atopic dermatitis (AD) is a disease characterized by relapsing eczema with pruritus as a primary lesion. Most patients have an atopic predisposition. The definitive diagnosis of AD requires the presence of all three features: (i) pruritus; (ii) typical morphology and distribution of the eczema; and (iii) chronic and chronically relapsing course. The current strategies to treat AD in Japan from the perspective of evidence-based medicine consist of three primary measures: (i) the use of topical corticosteroids and tacrolimus ointment as the main treatment for the inflammation; (ii) topical application of emollients to treat the cutaneous barrier dysfunction; and (iii) avoidance of apparent exacerbating factors, psychological counseling and advice about daily life. The guidelines present recommendations to review clinical research articles, evaluate the balance between the advantages and disadvantages of medical activities, and optimize medical activity-related patient outcomes with respect to several important points requiring decision-making in clinical practice.

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Section: Chapter Imentioning

confidence: 99%

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016

Saeki,

Nakahara,

Tanaka

et al. 2016

The Journal of Dermatology

155

181

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“…Fluticasone formulations have been shown to be safe and effective in the treatment of AD in adults and children when used for up to 4 weeks. 19,20 Fluticasone has low potential for systemic absorption due to its high lipophilicity, high glucocorticoid receptor binding and activation, and rapid metabolism …”

Section: Topical Corticosteroidsmentioning

confidence: 99%

Topical Corticosteroids and Topical Calcineurin Inhibitors in the Treatment of Atopic Dermatitis: Focus on Percutaneous Absorption

Pariser

2009

American Journal of Therapeutics

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The 2 primary classes of drugs used to treat atopic dermatitis (AD) are topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs). For maximum efficacy, topical agents must efficiently penetrate the skin but, for optimal safety, should not be absorbed into the bloodstream. TCSs, a mainstay in AD treatment for more than 50 years, can potentially be absorbed into the systemic circulation, particularly when used on young children, for prolonged periods, or on areas of thin and sensitive skin, such as the eyelids, face, and flexures. There is a risk of cutaneous and systemic adverse events, including suppression of the hypothalamic-pituitary-adrenal axis and related sequelae, especially when potent or superpotent TCSs are used for extended periods. Ideally, TCSs should be used for short periods (2-4 weeks), but clinical reality often necessitates longer use. TCIs also effectively and safely treat AD, with the most commonly observed local adverse events being skin irritation and burning. These agents have demonstrated good penetration of the skin with minimal systemic absorption, as evidenced by low blood concentrations, and can be used safely on thin and sensitive skin. The use of mid-potency TCSs to treat acute flares involving skin of normal thickness, followed by the introduction of TCIs for maintenance therapy, constitutes an appropriate application of both drug classes. Pharmacists with a clear understanding of how both types of agents affect the systemic circulation have the opportunity to inform patients and caregivers about benefits and limitations of different therapeutic agents, address patient concerns about adverse events, and help patients understand how to use medical therapies appropriately.

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“… The listed references form a basis of attribution of scores to FP. A: 28,33 ; B: 33,54,59,61,72 ; C: 31–33,38 ; D: 31–34 ; E: 42,43 . …”

Section: Calculation Of the Therapeutic Index Of Fpmentioning

confidence: 99%

“…In contrary, betamethasone valerate 0.1% cream and hydrocortisone‐17 butyrate 0.01% cream cause a mean decrease in skin thickness of 15–16% and 13%, respectively, when applied twice daily 39 . In addition, the results of a paediatric safety trial enrolling children with moderate to severe AD are unsuggestive of a clinically relevant skin atrophy caused by FP treatment 31,32 …”

mentioning

confidence: 99%

Topical fluticasone propionate: intervention and maintenance treatment options of atopic dermatitis based on a high therapeutic index

Schöllmann

2011

Acad Dermatol Venereol

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Fluticasone propionate (FP), a medium potent glucocorticoid (class III) of carbothioate nature with a favourable benefit/risk ratio, has emerged as a standard medication for the topical treatment of inflammatory skin disorders, in particular atopic dermatitis (AD). FP is available as a 0.05% cream and a 0.005% ointment formulation. The glucocorticoid is characterized by high lipophilicity, high affinity binding to the glucocorticoid receptor and a rapid hepatic biotransformation. Though skin blanching following topical application of FP surpasses that given with glucocorticoids of medium strength, clinical trials show a low potential of FP for local and systemic adverse effects. Even in paediatric patients with AD as well as in difficult-to-treat areas like face, eyelids and intertriginous areas, FP proved to be both effective and safe. Thus, the therapeutic effects of FP clearly outweigh the unwanted effects. Correspondingly, a therapeutic index of 2.0 can be attributed to this glucocorticoid. In this respect, topical FP does not differ from other topical glucocorticoids with increased benefit-to-risk ratio, e.g. prednicarbate, methylprednisolone aceponate and mometasone furoate. However, randomized controlled trials do not only support conventional intervention but also innovative maintenance treatment.

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Topical fluticasone propionate lotion does not cause HPA axis suppression

Cited by 23 publications

References 12 publications

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016

Clinical Practice Guidelines for the Management of Atopic Dermatitis 2016

Topical Corticosteroids and Topical Calcineurin Inhibitors in the Treatment of Atopic Dermatitis: Focus on Percutaneous Absorption

Topical fluticasone propionate: intervention and maintenance treatment options of atopic dermatitis based on a high therapeutic index

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