Selection of an effective topical corticosteroid

Emerging Trends in the Use of Topical Antifungal-Corticosteroid Combinations

“…There is an abundance of topical corticosteroids available in a variety of potencies and formulations [ 36 , 37 , 38 , 53 , 81 , 82 , 83 ]. It is important to indicate that desirable and successful corticosteroid treatment depends on a range of parameters: (a) accurate diagnosis; (b) consideration of the corticosteroid’s delivery vehicle formulation; (c) potency; (d) frequency of application; (e) duration of treatment; (f) effectiveness; and (g) safety and potential adverse effects [ 36 ] ( Figure 1 ).…”

“…Australasian guidelines favour the BNF classification system [ 51 , 53 , 86 ] of four classes; (however, in ascending order of potency) Class I: mild to Class IV: very potent [ 82 , 86 ]. According to the Australasian guidelines, the choice of potency will largely be guided by the following factors: (1) patient’s age—children often require a shorter duration of treatment and a lower potency corticosteroid; (2) body site of application, and skin condition and severity; (3) topical corticosteroid used (e.g., molecular structure, percentage and formulation) and amount (e.g., by using the fingertip unit method); and (4) method of application (e.g., occlusive dressing versus wet dressing; occlusive dressing increases potency with better efficacy and effect, whereas wet dressing intensifies the effect by improved permeability of topical corticosteroid) [ 38 ]. Such guidelines should be strictly followed as indicated for a particular product in order to minimise and even completely avoid any adverse effects [ 89 ].…”

“…In addition, other variables such as the body application site or use of a dressing may alter the effect of the corticosteroid. Generally speaking, the actions of a corticosteroid are impacted in accordance with the following principles: (a) ointments penetrate skin slightly better than creams as they occlude the skin and enhance hydration and absorption [ 38 ]; (b) thin skin (e.g., the face and eyelid) absorb corticosteroids more readily than areas with thick skin (e.g., the trunk, hand and foot) [ 38 , 53 ]; and (c) intertriginous areas (e.g., the axilla, groin and breast folds) retain topical corticosteroids longer, with increased absorption [ 38 ].…”

“…Adverse effects are rare if topical corticosteroids are used correctly and according to established recommendations and guidelines. However, misuse or prolonged use of topical corticosteroids may cause some adverse effects [ 36 , 38 , 90 , 91 ]. To reduce the risk, the least potent corticosteroid should be used for the shortest time, while still maintaining effectiveness.…”

“…There are five main classes of antifungals: (1) azoles (e.g., miconazole); (2) allylamines (e.g., terbinafine); (3) polyenes (e.g., nystatin); (4) echinocandins (e.g., caspofungin); and (5) antimetabolites (e.g., flucytosine) that are readily used to combat a spectrum of mycoses including dermatomycoses and candidiases [ 25 , 34 , 35 ]. Today, these antifungals [ 22 , 34 , 35 ] are often combined with corticosteroids (see Section 2 ) of varying potencies [ 36 , 37 , 38 ] in order to simultaneously alleviate inflammation [ 39 , 40 , 41 ], diminish the itch-scratch cycle [ 39 , 40 , 41 , 42 ], limit spreading and subsequently suppress fungal infection [ 39 , 40 , 41 ]. The combination of topical antifungal actives with corticosteroids represents a potentially hugely beneficial treatment strategy for fungal infection, as the inflammatory component of the infection can often exacerbate the condition and impede its resolution.…”