What effective corticosteroid ointments are there? Corticosteroid ointments Essential information about pimecrolimus and the mechanism of its anti-inflammatory activity

There is a fairly large group of drugs used in the treatment of dermatological pathologies such as dermatitis, allergic rashes, etc. These drugs are called corticosteroids among pharmacists.

general information

Corticosteroids are hormonal substances produced by the adrenal glands to regulate metabolic processes.

These hormones block the formation of prostaglandins, which, in fact, are the initiators of inflammatory processes. As a result of the correct use of corticosteroids, inflammatory symptoms disappear: itching and soreness are eliminated, swelling disappears, and purulent processes stop.

In addition to the therapeutic effect, glucocorticosteroids can cause adverse reactions associated with suppression of immune activity and atrophy of skin tissue.

Such undesirable effects should be taken into account when using drugs in this group. In the production of ointment products, analogues of human hormones of synthetic origin and various additives are used to enhance the therapeutic properties.

Corticosteroid ointments can be divided into several types:

1. Lungs - made on the basis of prednisolone or hydrocortisone;
2. Moderate – based on prednicarbate, fluocortolone, flumethasone (etc.);
3. Strong - these ointments are based on budesonite, mometasone, betamethasone, methylprednisolone and other corticosteroid hormonal substances (Elocom, Celestoderm B, Sinaflan, etc.);
4. Very strong are flumethasone-based drugs (Dermovate).

There is also a separate group of products of mixed origin, to which, in addition to corticosteroids, additional active ingredients with antifungal or antibacterial action are added, for example, Flucinar, Lorinden, etc.

The drugs of these groups differ from each other in the intensity of their therapeutic effects, so they are selected in accordance with the severity of a particular skin disease.

How to use correctly

Any drug of corticosteroid origin should be used only as prescribed by a doctor. The specialist will determine the duration of such therapy and the number of applications of the drug to the skin per day.

Most often, a single application to the affected area during the day with a thin layer is indicated. The duration of corticosteroid therapy depends on the extent of the disease.

Before you start using any of the drugs, read the instructions for it.

Popular drugs

Corticosteroid drugs in the form of ointment or cream have antipruritic, anti-inflammatory and antiallergic effects. Different dermatoses are treated with hormonal drugs with varying strengths.

For example, exudative psoriatic forms are treated with moderate corticosteroid ointments (Fluorocort, etc.), and more severe forms of pathology require the use of stronger drugs (Celestoderm B or Dermovate, etc.). Let's consider the most common means of this group.

The main active ingredient of the drug is methylprednisolone. Advantan helps suppress allergic and inflammatory reactions on the skin, relieves pain, itching and irritation, reduces erythema and swelling.

The active ingredients of the drug are betamethasone and gentamicin. Belogent has antipruritic, antiproliferative, anti-inflammatory and antiallergic effects.

After application, it quickly affects the skin and reduces pathological symptoms. Gentamicin functions as a bactericidal component that can destroy most pathogenic microorganisms, including strains. Side effects occur very rarely, manifesting themselves as pimples, burning or redness.

Beloderm, Celestoderm B

Instructions, price, reviews: , Celestoderm

The main active ingredient of the cream is betamethasone. The drug has antiallergic, vasoconstrictor, antipruritic, antiproliferative and anti-inflammatory effects.

A more modern analogue of Beloderm is Celestoderm B. This remedy is also based on betamethasone and has an identical effect.

Its use in pediatrics is allowed in patients older than 6 months. Pregnant women can use this drug only in short courses and no more than once a day.

Hydrocortisone

Glucocorticosteroid drug with antiallergic and anti-inflammatory action. The active ingredient is hydrocortisone. The use of ointment is contraindicated during the period of vaccination, as well as infectious, viral and fungal diseases.

Glucocorticosteroid drug of synthetic origin. The main active ingredient is hydrocortisone.

Able to quickly provide antipruritic, anti-edematous and anti-inflammatory effects. If dosages are observed, it does not cause suppression of adrenal activity.

Long-term use of the drug can lead to increased levels of cortisol in the blood, but after stopping Lokoid, cortisol production returns to normal on its own.

Medicinal agent with anti-inflammatory, antifungal, antibacterial effects. The main active ingredients of Lorinden C are flumethasone and clioquinol.

Flumethasone is a glucocorticosteroid with vasoconstrictor and anti-inflammatory, antipruritic and antiallergic, anti-edematous effects. Clioquinol is a substance active against yeast fungi, dermatophytes and gram-positive bacteria.

As a result of this composition, allergic and inflammatory reactions complicated by fungal and antibacterial infections are suppressed.

Prednisolone ointment

The main active component of Sinaflan and its analogue Flucinar is fluocinolone. These drugs have a pronounced anti-inflammatory and antiallergic effect.

They are easily absorbed through the skin, and in children the absorption is much higher than in adult patients. The duration of use of the drugs does not exceed 2 weeks.

Fluorocort

The active ingredient of the ointment is triamcinolone. Accumulating in the skin, this glucocorticosteroid drug reduces the manifestations of exudation and itching, provides anti-edema and anti-allergic effects. The daily dose of the drug is 15 g, the course of therapy is no more than 10 days.

Fucidin G

The main active ingredients of Fucidin G ointment are hydrocortisone and fusidic acid, which is an antibiotic substance. A combined glucocorticosteroid drug with increased anti-inflammatory and antipruritic effects. Approved in pediatrics from 2 years. The duration of treatment is no more than 14 days. Do not confuse with regular Fucidin.

Elokom

Corticosteroid ointment with the active ingredient mometasone. It has an effect similar to other hormonal ointments. It is recommended to apply no more than once a day.

The duration of therapy depends on the tolerability of the drug and side effects. Contraindicated in children under 2 years of age.

Precautionary measures

Corticosteroid drugs can cause a variety of adverse reactions. The use of weak and moderate group drugs contributes to less severity and rare occurrence of undesirable effects. If treatment involves the use of such drugs in high doses or the use of an occlusive dressing or the use of highly active glucocorticosteroids, the following manifestations may occur:

• Increased blood pressure;
• Weight gain;
• Menstrual irregularities;
• Increased swelling;
• Increased blood sugar, even steroid diabetes;
• Gastrointestinal bleeding, formation or exacerbation of gastric ulcers;
• Osteoporosis;
• Increased rate of thrombosis;
• Hypersweating;
• Neurological disorders;
• Skin atrophy;
• Increased hair growth in the facial area;
• Bone necrosis;
• Increased susceptibility to fungal and bacterial infectious processes against the background of secondary immunodeficiency;
• The occurrence of cataracts, glaucoma;
• Acne;
• Slow recovery of damaged tissues;
• Suppression of adrenal activity;
• Tendency to depression, mood swings.

With long courses of corticosteroid therapy, even the patient’s appearance may change:

• Individual areas of fat form, for example on the neck (bull neck), abdomen, chest or face (moon face);
• Muscle tissue atrophy occurs;
• Striae and bruising appear on the skin.

To reduce the risk of unwanted manifestations, you need to monitor your condition and, at the slightest hint of a side effect, adjust the dosage of corticosteroids. In addition, during the course of corticosteroid therapy, it is recommended to limit the water-salt regime and calorie intake, and monitor weight changes.

Features of use in children

For pediatric patients, corticosteroid ointments or creams are prescribed exclusively in short courses and only on small areas. The fact is that children are more sensitive to the side effects of such drugs than adults. Therefore, up to a year in children’s treatment, only the latest generation drugs or drugs with 1% hydrocortisone are used; at 1-5 years of age, moderate strength drugs are used.

Attention! Only a doctor should prescribe the drug, since unauthorized prescription of such drugs can be dangerous for the child.

According to medical prescription, from 2 years of age you can use Metazon long-acting ointment, which is applied to the affected areas 1 r. per day. Advantan is often used against atopic dermatitis in children; it can be treated for a month, but only in small areas, since the ointment has side effects.

Features of use in pregnant women

The use of glucocorticosteroids in pregnant women has an extremely negative effect on the fetus, therefore the use of hormonal ointments during such a period is allowed only for a short course over a small area and only in cases where the expected therapeutic effect is higher than the risk of use.

According to research, the use of strong and very strong hormonal ointments in the treatment of pregnant women can cause placental insufficiency, lack of weight in the fetus or cleft palate. The use of corticosteroid ointments of weak or moderate strength is considered relatively safe and does not contribute to pregnancy problems or increase the risk of malformations.

6 comments

Good afternoon
8 months ago a reddish spot appeared on my temple. Now there is a spot on both the forehead and cheeks with a diameter of 5-10 mm, there is itching. I was treated by a dermatologist, having previously passed all possible tests, everything is in order, it is neither a fungus nor an infection. At first, Fucidin G cream and Claritin + Lactofiltrum were prescribed for 2 weeks, it helped slightly, the spots almost disappeared, but then they appeared again in the same places. The dermatologist prescribed Bepanten and Belogent, which also didn’t help much. I noticed that exacerbation appears after a stressful situation, fatigue, alcohol, sweating or being in a sauna is not allowed. Since December 2016, the dermatologist, throwing up her hands, sent her to a therapist, also passed all possible tests, found nothing, the therapist also threw up her hands...
What can you recommend? One is familiar with being treated against fungal spots on the body with IRUNIN tablets, SEBOZOL Shampoo, Mikospor and Thermikon Spray. It helps him.
Thank you!

• Hello,
  If they did a scraping and the analysis showed nothing, it means it’s not a fungus. Again, since corticosteroids help, the description is more like eczema or dermatitis. Usually in such cases, the acute phase can be relieved with hormonal ointment, but the disease is not completely cured.

Hello, please tell me how to apply diathesis on a 2-year-old child’s cheeks. She constantly scratches these sores and they don’t go away for a long time

• Hello,

  The first thing to do is adjust your diet. Mothers always take this fact with hostility, but without this nothing will help. Hormonal ointment is the last thing to use.

Good evening. I have a rash on my chin and stomach. She was treated with Azithromycin Baneocin ointment and wet lotions based on dimexide and ceftriaxone. There is an improvement, but new rashes still appear. Help with advice please. What else can you try?

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All information is presented for educational purposes. Do not self-medicate, it is dangerous! Only a doctor can make an accurate diagnosis.

Atopic dermatitis is a chronically recurrent skin pathology, which is based on immunological disorders. The clinical picture varies from mild to severe. In its worst cases, atopic dermatitis can interfere with normal growth and development. Treatment consists of adequate skin hydration, avoidance of allergenic precipitants, topical anti-inflammatory drugs, systemic antihistamines, and antibiotic therapy for secondary infections.

What is atopic dermatitis

Although many people call atopic dermatitis eczema, these terms are not equivalent.

Eczema is an example of a skin reaction, of which atopic dermatitis is one type. Other causes of eczematous dermatitis include:

• allergic contact dermatitis;
• irritant contact dermatitis;
• seborrheic dermatitis;
• acute eczema;
• dyshidrotic eczema;
• asthenic eczema;
• chronic lichen.

Eczematous reactions may be classified as acute, subacute, or chronic, depending on historical and physical characteristics.

Pathophysiology of atopic dermatitis

Clinically unaffected skin from patients with atopic dermatitis had increased numbers of T helper type 2 (Th2) cells compared to skin from patients without atopic dermatitis.

Elevated levels of interleukin (IL)-4 and IL-13 (Th2 cytokines) are observed in acute atopic dermatitis lesions, whereas chronic atopic lesions show increased expression of IL-5 (Th2 cytokine) and IL-12 and interferon (IFN)-γ ( Th1 cytokines).

Chronic skin lesions also show greater eosinophil infiltration compared to the skin of patients without atopic dermatitis.

IL-4 enhances T helper cell differentiation along the Th2 pathway, and IL-13 acts as a chemoattractant for Th2 cells to infiltrate atopic dermatitis lesions. IL-13 can also directly induce IL-5 expression and eosinophil infiltration, thereby facilitating the transition from acute lesions to chronic lesions.

In addition, patients with atopic dermatitis have altered levels of skin molecules. Ceramide lipids in the stratum corneum, which are responsible for the functions of water retention and cell permeability, and epidermal proteins, such as filaggrin, are found in very small quantities in the skin of patients with atopic dermatitis compared to the epidermis of healthy people.

Substantial evidence supports the hypothesis of a link between hygiene and the development of atopic dermatitis. An inverse relationship has been found between helminth infections and manifestations of atopic dermatitis when there are no other pathogens.

Symptoms of atopic dermatitis in children

Common symptoms of atopic dermatitis include:

• Redness and rash.
• The skin is very dry or scaly.
• Open, crusty or festering ulcers.

In babies and toddlers, atopic dermatitis usually begins on the face, elbows and knees - places that are easily scratched when they crawl. The irritation may spread to other areas of the body, but it is not present in the diaper area, where moisture is retained, which in this case protects the skin.

In older children, atopic dermatitis usually appears in the creases of the elbows, hands, and/or knees. A rash or redness behind your child's ears, legs, or scalp may also be a sign of atopic dermatitis.

In infants and children, the skin may appear red, dry, and scaly. Scratches are often present. If the skin becomes infected, a yellow crust or very small purulent lesions will form on it. Your baby's skin may also become thicker (called lichenification) from too much scratching and rubbing. The manifestations and causes of atopic dermatitis may differ in each child.

Atopic dermatitis in children

Depending on the severity of symptoms, atopic dermatitis can be treated with topical medications (ointments) applied to the skin;

• phototherapy is a form of light treatment;
• immunosuppressants, which affect the immune system.

Atopic dermatitis, asthma and allergies

Atopic dermatitis can coexist with other known diseases. These other conditions are called "comorbidities."

Atopic dermatitis is part of a group of allergic conditions. “atopic” actually means allergy. Allergic reactions include asthma, hay fever and food allergies. If a child has one of these conditions, the likelihood of developing another atopic condition increases.

Contact dermatitis is also considered atopic, although its relationship with asthma and hay fever is unknown.

About 50 percent of children with moderate to severe atopic dermatitis develop allergic asthma.

Symptoms of allergic asthma include:

• Cough
• Wheezing sound in the bronchi
• Irregular breathing
• Feeling of heaviness in the chest

If you think your child is exhibiting symptoms of allergic asthma, contact your doctor.

75 percent of children with moderate to severe atopic dermatitis develop allergic rhinitis or hay fever.

Symptoms of hay fever include:

• lacrimation;
• stuffy nose and throat;
• feeling of stuffiness;
• runny nose;
• ear pressure;
• fatigue.

Contact your doctor if you cannot get rid of these symptoms with cold medicine or if your symptoms become severe.

One third of children with atopic dermatitis also have food allergies. A food allergy is defined as a reaction that occurs within 30 minutes of eating a food. It is characterized by environmental symptoms:

• swelling of the face, lips;
• swelling of the throat (a dangerous condition requiring medical attention);
• vomiting and diarrhea.
• In atopic children, allergies are most often caused by the following foods:
• peanut;
• eggs;
• milk with lactose;

If you suspect your child has a food allergy, see an allergist who specializes in identifying these reactions in children.

Differential diagnosis of atopic dermatitis

During diagnostics, the doctor can identify the following pathologies:

• Contact dermatitis.
• Seborrheic dermatitis.
• Drug reactions.
• Infantile psoriasis.
• Scabies.
• Lack of microelements - zinc / biotin.
• Ichthyosis.
• Severe dermatitis, multiple allergies and metabolic wasting syndrome (SAM).
• Primary immunodeficiency diseases and Omenn syndrome.
• Hypereosinophilic lymphocyte syndrome (HLS).
• Cutaneous T-cell lymphoma.

Epidemiology

Atopic dermatitis occurs in approximately 10-20% of children and 2% of adults. Children with concurrent asthma or hay fever have a 30-50% incidence of developing atopic dermatitis.

International indicators

1-year prevalence rates of atopic dermatitis in children ranged from 2% in Iran and China to approximately 20% in Australia, England and Scandinavia.

Interestingly, among populations migrating from small-populated areas to large cities, the prevalence of atopic dermatitis is increased, which strengthens the assumption of an environmental component as one of the causes of the skin disease.

Race

No clear racial bias was identified.

Floor

Men and women are affected with equal frequency and severity.

Age

Atopic dermatitis can occur in people of any age, but often begins in children between 2 and 6 months of age. Ninety percent of patients with atopic dermatitis have disease onset before age 5 years.

Seventy-five percent of people experience marked improvement in their disease by age 14, but the remaining 25% continue to have relapses as adults.

A recent study found that the prevalence of atopic dermatitis in children under 2 years of age was 18.6%.

Treatment. Basic approach

The goals of atopic dermatitis prevention are to improve quality of life and prevent infectious complications while minimizing possible side effects of medications. Optimal control of all aspects of skin disease, including itching, is best achieved through hydration, restoring the skin barrier, and controlling skin inflammation.

Because atopic dermatitis is a chronic, relapsing disorder with flares occurring at variable intervals, a comprehensive home treatment plan is critical to successful prevention, including measures to control acute flares.

Prevention of chronic dermatitis requires extensive patient education on the clinical features and differential diagnosis of the disorder, its natural history, review of potential disease triggers, discussion of types of medications and potential side effects, and provision of an individualized and comprehensive treatment plan based on the underlying pathophysiology.

Treatment plans should focus on the main key points: skin hydration and emollients to address barrier dysfunction and topical (or rarely systemic immunosuppressants) to suppress skin inflammation.

Antimicrobials should also be included in the treatment of patients with recurrent infection, and ways to reduce exposure to potential triggers should be considered for treatment success. Enforced attention to treatment plan details, regular follow-up to adjust treatment plans for moderate to severe cases, and extensive education are critical to successful disease prevention. A multidisciplinary approach to treating atopic dermatitis helps manage moderate to severe cases.

Hydration and use of occlusive moisturizers

As already mentioned, pathology of the skin barrier is the main feature of atopic dermatitis, leading to transepidermal water loss and xerosis.

The reduced levels of ceramide observed in atopic skin reduce the water binding capacity and potentiate this problem.

Treatment Recommendations: Experts recommend regular moisturizing of the skin with soaks and the use of occlusive topical ointments and creams for optimal control. This strategy has demonstrated effectiveness and a reduction in the need for topical and systemic immunosuppressants (corticosteroid effect).

In our experience, regular daily baths (15 minutes in warm plain water without soap) with immediate application of occlusive ointments and subsequent skin care treatments throughout the day are the most important aspects of treatment. In extreme cases, you can use a wet towel to moisturize the skin.

The frequency of baths can be increased to two or three times a day during acute symptoms of the disease. At the same time, showers are not as effective at moisturizing the skin and are not a good alternative to a bath.

Applying emollients to dry skin immediately after a bath is necessary to create a barrier against water loss to restore the stratum corneum; such prophylaxis reduces the need for topical corticosteroids. Ointments for atopics are more effective than creams. Lotions are not effective for atopic dermatitis: high water content causes evaporation and further dehydration of the skin, and irritants such as fragrances and preservatives can irritate intact skin. While ointments such as Vaseline or hydrated Vaseline are more occlusive than creams and are generally more effective; In some cases, ointments may be poorly tolerated in some patients and may lead to occlusive folliculitis.

Creams are often better tolerated on hot, humid days. There is no clear evidence that new creams containing ceramide improve patient outcomes.

Treatment of atopic dermatitis: corticosteroids

To combat the causes of inflammation in atopic dermatitis, corticosteroids are the most effective treatment, used as needed to treat acute flares and, in more severe cases, to maintain disease control.

Corticosteroids reduce inflammation, itching and prevent infection of the skin by Staphylococcus aureus (Staphylococcus aureus). Particularly in children, great care must be taken when using the least potent topical corticosteroid to minimize potential side effects while reducing inflammation.

For moderate to severe atopic dermatitis, the comprehensive treatment plan for eczema should include instructions for stepwise adjustments to the effectiveness of corticosteroids based on the severity of the acute phase of the disease.

When using corticosteroids of moderate and high potency, a gradual dose reduction is necessary to prevent exacerbation of drug withdrawal symptoms. The physician is responsible for informing the patient and his or her loved ones about the strength and effect of prescribed medications, potential systemic and local side effects, and strategies for dosage adjustment. Any issues of “steroid phobia” that may limit compliance with regular medication use should be openly discussed. As noted earlier, aggressive skin hydration and the use of emollients are steroid-friendly.

Topical corticosteroids are available in a wide range of dosages, from the least potent Group 1 preparations (eg, hydrocortisone 1% ointment), to the most effective Group 7 preparations (eg, clobetasol propionate 0.05% ointment).

The more effective the use of a topical corticosteroid, the higher the risk of systemic and local side effects, especially with long-term use over large areas of the body. There are several excipients available for each corticosteroid, including ointments, creams, and lotions. Moreover, for a topical corticosteroid, ointments are more effective than creams, which are more effective than lotions. In general, ointments are preferred because they provide the necessary occlusive barrier to maintain skin hydration and promote better absorption of the corticosteroid. Ointments also contain fewer preservatives.

Topical corticosteroids, which are less effective, should be used for areas of the body with thinner skin, greater likelihood of absorption, and a higher risk of local side effects. These include the face, eyelids and genitals. Other areas of the body may require shorter courses of corticosteroids with greater effectiveness to control flare-ups of dermatitis.

Corticosteroids for atopic dermatitis in children

The choice of topical corticosteroid is based on disease severity, distribution, and patient age. For infants and young children, corticosteroids should be used on all areas of the skin. It should be noted that Flaticasone 0.05% cream is approved for short-term use in children ≥3 months, and mometasone cream and ointment are approved for children ≥2 years; both can be used once daily as needed for atopic dermatitis flare-ups.

Discussing the results of using topical corticosteroids and topical skin emollients is key to successful results. The topical corticosteroid should be applied first to the irritated areas in a thin layer. A topical emollient (ointment or cream) should be applied after the medication in a thick layer to all unaffected areas of the skin, avoiding areas with a topical steroid. Applying an emollient to areas of topical corticosteroid application dilutes the drug and unnecessarily spreads it to unaffected areas of the skin. Particularly in young children, there is a tendency to vigorously rub in both the topical steroid and the emollient; Friction should be avoided. It is also important to ensure a sufficient amount of the drug, taking into account the severity and extent of the disease.

Local side effects include skin atrophy, striae, acne, telangiectasia and secondary infections. The main systemic side effect is suppression of adrenal function.

Systemic corticosteroids should be avoided in the treatment of atopic dermatitis, even in severe disease. Although systemic corticosteroids provide rapid improvement in atopic dermatitis flares, cessation usually results in a significant inflammatory response leading to another, often more severe, flare of disease. Given the chronic relapsing course of atopic dermatitis and the significant side effects of long-term systemic corticosteroid treatment, true recovery is rare.

Topical calcineurin inhibitors

The anti-inflammatory effect of topical calcineurin inhibitors is due to the selective blocking of cytokine transcription in activated T cells. The use of topical calcineurin inhibitors does not result in skin atrophy, making this class of medications effective, especially in controlling eyelid and facial dermatitis. Calcineurin inhibitors may also be useful as a steroid-lowering agent for patients who require long-term anti-inflammatory treatment. It has also been demonstrated to be effective as a maintenance treatment when applied to areas of frequent inflammation three times per week.

There are two topical calcineurin inhibitors:

Pimecrolimus (Elidel) is available as a 1% cream and is approved for use in children 2 years of age and older.

Tacrolimus (Protopic) is available as a 0.03% or 0.1% ointment. The 0.03% ointment size is approved for children 2 years of age and older, and the 0.1% ointment is approved for children ≥16 years of age.

In 2005, a warning was added to this class of drugs that the active ingredients may cause skin cancer. However, analysis of data from the Calcineurin Inhibitor Task Force on AAAAI and ACAAI did not reveal a clear association with drug use and skin cancer.

Antimicrobials

Staphylococcal colonization in patients with atopic dermatitis is common. Treatment of infection should be based on antimicrobial susceptibility to ensure elimination of potentially antibiotic-resistant organisms.

The use of bleach baths in the treatment of dermatitis has been reported and is included in pediatric treatment guidelines for atopic dermatitis. Among children 6 months to 17 years of age with moderate-severe atopic dermatitis and secondary staphylococcal infections, use of diluted bleach baths twice a week and use of intranasal mupirocin twice a day for 5 days, repeated monthly for a 3-month period, showed a significant improvement in the course of the disease compared to placebo.

Because of evidence of intrafamilial transmission of staphylococci, treatment of family members with intranasal mupirocin should also be considered.

Antihistamines are generally ineffective in treating the itching associated with atopic dermatitis.

Pruritus is the most common feature of atopic dermatitis and the most detrimental to quality of life. Scratching perpetuates skin inflammation through the release of TSLP and other mediators, continuing the cycle of inflammation and itching.

As already discussed, pruritus in atopic dermatitis is the result of a number of mediators, including neuropeptides and cytokines, namely IL-31. As a result, antihistamines are usually ineffective in controlling itching.

A double-blind, randomized, crossover study demonstrated lack of efficacy in the treatment of pruritus with oral antihistamines, and histamine stimulation did not produce pruritus in patients with atopic dermatitis.

Despite the individual benefits of oral antiistamines, serious side effects have been identified among children.

Until more effective treatments are developed, treatment for itching should focus on eliminating skin inflammation and restoring skin barrier function.

Wet wrap

Wrap therapy was originally described over 20 years ago and consists of applying diluted topical corticosteroids and emollients after a bath, then offering the patient a damp towel, followed by dry, clean clothing.

Wet wraps may be used in patients with moderate to severe disease that does not respond well to standard skin care. Wet wraps soothe the skin, promote hydration, prevent scratching, and increase absorption of topical corticosteroids. Wet wraps with diluted topical corticosteroids are effective in clinical trials for controlling acute periods of dermatitis and maintaining the patient's condition for short periods of a few weeks.

In patients with severe atopic dermatitis, we have found that wet wraps result in remission of the disease, after which a normal skin care regimen is indicated for 1 year.

Wet wraps may cause skin maceration, folliculitis, and increased absorption of topical corticosteroids and should therefore only be used under close medical supervision. Regular skin care is critical for wet wrap treatments, especially the liberal use of emollients.

Systemic immunosuppressants

For patients with severe atopic dermatitis who do not respond to standard therapy, systemic immunosuppressants are a treatment option. Systemic immunosuppressants that have been reported include cyclosporine, myophenolate mofetil, azathioprine, and methotrexate. None of these therapies has a direct effect on restoring barrier function. In our experience, systemic immunosuppressants are not optimally effective unless careful attention is paid to hydration and aggressive use of emollients.

Atopic dermatitis: disease prognosis

Key points

Atopic dermatitis is a complex disorder resulting from the interaction of genes and environment

Defective skin barrier function and immune dysregulation are of paramount importance in disease pathogenesis

Itching is universal, is a serious contributing factor and does not respond well to antihistamines

Effective treatment requires therapy aimed at restoring both skin barrier function and control of inflammation

Educating patients about treatment options, the importance of therapy for underlying blemishes, and providing a comprehensive skin care plan is essential.

Atopic dermatitis persists into adulthood in 20-40% of people with manifestations of the pathology in childhood. Many children develop severe atopic dermatitis over time and experience itching or inflammation of the skin only when exposed to exogenous irritants.

Corticosteroids pharmacists name a wide group of drugs used in the treatment of allergic rashes, dermatological diseases, etc. The adrenal cortex produces hormonal substances called corticosteroids or glucocorticoids.

Prostaglandins, which are the source of inflammatory processes, are blocked by these hormones. If you use corticosteroids correctly, you can prevent the symptoms of the inflammatory process: eliminate pain and itching, stop purulent processes, and remove swelling.

Naturally occurring corticosteroids

Corticosteroids are the general name for hormones produced by the adrenal cortex. These hormones include mineralocorticoids and glucocorticoids. The human adrenal cortex produces hydrocortisone and cortisone, which are fundamental, and the mineralocorticoid is aldosterone. These hormones perform many important functions in the body. Glucocorticoids have an anti-inflammatory effect and are classified as steroids. They regulate the metabolism of fats, carbohydrates and proteins. Puberty is also controlled by these hormones. They also control kidney function, the body’s response to stress, and contribute to the normal course of pregnancy.

Main indications for the use of glucocorticoids:

When transplanting organs and tissues, glucocorticoids are used, because they have an immunosuppressive effect necessary to suppress the rejection reaction, as well as for various autoimmune diseases.

Aldosterone is used in the treatment of:

Corticosteroids are deactivated in the liver and then excreted in the urine. Aldosterone is responsible for the exchange of potassium and sodium. Na + is retained in the body, K + ions are excreted in increased quantities precisely under the influence of this mineralocorticoid - aldosterone.

Synthetic corticosteroids

Synthetic corticosteroids have found wide use in practical medicine, since they have the properties of natural corticosteroids, i.e. the ability to suppress the inflammatory process. Their antiallergic, antitoxic, antishock and immunosuppressive properties are used. At the same time, it has no effect on the infection itself, i.e., on the causative agents of the disease. The infection recurs after discontinuation of the drug.

The use of corticosteroids leads to stress and tension. And this, in turn, affects the state of the immune system. Immunity decreases, because only in a state of relaxation is immunity at a sufficiently high level. It can be concluded that due to the use of synthetic corticosteroids, the disease becomes protracted and the regeneration process is blocked. In addition, under their influence the functions of the adrenal glands are disrupted, because the functions of natural corticosteroids are impaired. Under the influence of these drugs, the work of other endocrine glands is also disrupted and the hormonal balance of the body is affected.

With all this, these drugs eliminate (suppress) inflammation, and also have a remarkable analgesic property.

Glucocorticoids began to be used as medicines in the 40s. XX century. Scientists back in the late 30s. The twentieth century proved that the adrenal cortex produces steroid hormones. In 1937, a mineralocorticoid, deoxycorticosterone, was isolated from the adrenal cortex; in the 40s. - glucocorticoids cortisone and hydrocortisone. Hormones such as cortisone and hydrocortisone have shown good results in the treatment of many diseases and therefore they began to be used as medicines. After some time they were synthesized.

Cortisol (hydrocortisone) is the most active glucocorticoid produced in the human body. Less active are 11-deoxycortisol, cortisone, 11-dehydrocorticosterone, corticosterone.

The most widely used drugs are hydrocortisone and cortisone. However, it is worth noting that cortisone causes strong side reactions and therefore is currently used much less frequently, because More effective and safe drugs have appeared. Currently, natural hydrocortisone or its esters (hydrocotrisone acetate and hydrocortisone hemisuccinate) are used.

Corticosteroid and glucocorticosteroid drugs

Ointments are made from synthetic analogues of natural human hormones. In addition, some chemicals are added to corticosteroids, giving them certain properties, for example, with a short-term and weak effect or, conversely, with a longer and more powerful effect. Glucocorticoids, in addition to their therapeutic effect, also cause side effects. Skin tissue may atrophy and immune activity may be affected.

There are 4 conventional types of ointments:

1. Made on the basis of hydrocortisone or prednisolone - light;
2. Based on fluocortolone, prednicarbate, flumethasone - moderate;
3. Strong - made on the basis of mometasone, budenosite, methylprednisolone, betamethasone and other corticosteroid hormonal substances;
4. Very strong - drugs made on the basis of flumethasone (Dermovate).

There is also a group of products of mixed origin.

“Weak” and “strong” hormonal ointments

As mentioned earlier, people have learned to create synthetic hormones by regulating their properties (potency) by adding certain chemicals to the molecules of human hormones.

By the strength of ointments, doctors mean the degree of effect of the ointment on the affected area skin and therefore how quickly the skin condition will improve. The more anti-inflammatory properties the ointment has, the faster the damaged area of ​​skin will return to normal.

As a rule, the stronger the hormonal drugs, the more side effects they cause. The positive side of strong drugs is the ability to cope with serious illnesses, but the negative side is the presence of side effects. Accordingly, with weak hormonal ointments the opposite is true.

There are special preparations intended for topical use that have a weak effect, because... poorly absorbed. In the treatment of skin diseases, many combination drugs containing corticosteroids are used. These drugs, like glucocorticoids, promote tissue regeneration; they contain antimicrobial and antifungal substances or components.

How to use corticosteroid ointments correctly

Any corticosteroid drug should be used only by doctor's prescription. Experts will determine the duration of use of such a drug, as well as the frequency of its application to the skin per day. As practice shows, apply a similar preparation to the affected area of ​​skin once a day. The duration of treatment with a corticosteroid drug depends on the degree of the disease. You must read the instructions for the drug before you start using it.

Ointments or creams based on hormones have antiallergic, antipruritic and anti-inflammatory effects. Different forms of skin diseases are treated with drugs that differ in strength and are based on hormones.

The use of hormonal ointments and creams for the treatment of psoriasis

Hormonal ointments for psoriasis are medications that are used during exacerbation of the disease. Such ointments contain glucocorticosteroid hormones. These medicinals are quite quickly stop itching, reduce inflammation, and stop cell proliferation in areas of inflammation.

Ointments and creams based on glucocorticosteroids differentiated by the strength of impact. Children or adults with minor skin lesions are prescribed weak hormonal drugs. Weak products are made on the basis of hydrocortisone with different concentrations. Part moderately strong drugs include the following glucocorticosteroids: fluocortolone, prednisolone, prednicarbate. It is used when the disease has become chronic and involves lichenification of the skin. Strong ointments include halomethasone, betamethasone, mometasone, budesonide, dexamethasone, triamcinolone, flumethasone. Their used for extensive skin lesions.

Glucocorticoid drugs are distinguished by generation and by strength of action. The older the generation, the less effective and at the same time the small number of side effects, and the later the generation - on the contrary, high efficiency is inherent, but side effects also increase. In the treatment of psoriasis The most preferred drugs are the fourth generation of glucocorticoids: furoate, mometasone, methylprednisolone aceponate, hydrocortisone butyrate. These drugs do not contain fluorine atoms, which reduces the number and severity of side effects.

When using hormonal drugs to treat psoriasis, side effects. They arise due to a number of factors, including: use in large quantities, unsystematic and long-term use, as well as the individual characteristics of the organism. The main danger is addiction to the drug, which leads to an increase in dose. In turn, this leads to an overdose, and subsequently to withdrawal syndrome. After stopping taking the drug, the body begins to reproduce its own hormones after some time.

Medicines of the glucorticoid group are taken only under the supervision of a doctor- due to a large number of side effects. Used during an exacerbation in small quantities.

From the skin possible side effects such as hypertrichosis, skin atrophy, pyoderma, folliculitis, hypopigmentation, stretch marks, rosacea, pustular rash, increased itching, burning, irritation, dryness, etc.

There may also be side effects from the liver. The use of hormones of synthetic origin leads to a decrease in the efficiency of the liver, which in turn has an adverse effect on digestion and the entire body as a whole. This is largely why during hormonal therapy it is recommended to follow a gentle diet and additionally take sorbents and hepatoprotectors.

The kidneys also suffer if glucorticoids are used incorrectly. Due to impaired calcium metabolism, kidney stones form, the blood is poorly filtered, and the permeability of cell membranes decreases. Cardiovascular activity also suffers, and the development of arterial hypertension is also possible.

Hormonal creams or ointments for psoriasis are usually used 1-3 times a day. The course of treatment is 5–7 days with a further reduction in dosage. Another treatment tactic is also possible: first, strong drugs are prescribed for the first 2-4 days of treatment, and then weaker ones.

Corticosteroid drugs (CS) are analogues of glucocorticoid hormones. True hormones are produced by the adrenal glands. The substances support metabolic processes and relieve inflammation, swelling, pain and other symptoms.

Medicinal substitutes for natural hormones are used in dermatology, urology, and virology.

Classification of corticosteroid ointments

Experts divide corticosteroid ointments into four types:

• Weak - containing prednisolone or hydrocortisone.
• Moderate - with prednicarbate, flumethasone or fluocortolone.
• Strong - containing mometasone, betamethasone and budesonide.
• Very strong - the composition is based on the compound clobetasol propionate.

Combined drugs with CS additionally contain antibacterial and fungicidal components. Examples are Belosalik and Flucinar.

According to the sphere of influence, corticosteroids are divided into 2 groups:

The goal of corticosteroid therapy is to block prostaglandins, substances that trigger inflammatory mechanisms in the body. There are many prostaglandins, and not all of them are harmful to health. Modern CS act selectively only on those parts of the body that need medical attention.

In case of renal failure and potassium deficiency in the body, the use of the drugs in question is prohibited. Contraindications to the use of corticosteroid ointments also include hypothyroidism, tuberculosis, diabetes mellitus, hypertension and serious mental disorders.

Scope of application of corticosteroid ointments

The property of corticosteroids to quickly relieve swelling, itching and inflammation is widely used in the treatment of skin diseases.

Dermatologists know all the indications for the use of corticosteroid ointments associated with damage to the epidermis:

• Psoriasis.
• Allergy.
• Hives.
• Vitiligo.
• Systemic lupus erythematosus (corticosteroid ointment may be used to treat the lips).
• Ringworm, including pink Zhiber and.

Corticosteroids are used to treat esophagitis and gastritis. In this case, the drugs eliminate heartburn and pain when swallowing food. They also help restore damaged mucous tissue. The CS group is actively used in dental practice and in the treatment of paresis (facial nerve paralysis).

Urologists prescribe corticosteroid ointments for men for phimosis. This disease leads to an abnormal narrowing of the foreskin, which causes difficulty in exposing the glans penis and performing hygienic measures. The use of CS allows patients to be successfully treated without surgery.

Corticosteroid ointments are also used in ophthalmology for eyes affected by iritis, conjunctivitis, and iridocyclitis. But the indications do not end there, since artificial hormones are useful for certain blood diseases and oncopathologies, arthritis, pneumonia, sinusitis, neurological disorders, bronchial asthma and viral infections.

Children with dermatitis are very rarely treated with corticosteroids. Up to 5 years of age, children are prescribed Dermatol, a drug in which the concentration of hydrocortisone does not exceed 1%. For patients over 5 years of age, a stronger corticosteroid, such as Mometasone, is prescribed.

It is undesirable to use corticosteroid ointments during pregnancy, as they worsen the woman’s immunity and provoke diseases of the hematopoietic system in the fetus. Expectant mothers are prescribed such medications extremely rarely.

Corticosteroid ointments: principle of action

The active components of corticosteroid ointments are quickly absorbed by the skin. Together with auxiliary substances, they are introduced into the structure of the epidermis and act on the affected areas.

Synthesized hormones enter the systemic circulation in small concentrations and are almost completely excreted in the urine after processing by the liver and kidneys. The drugs accelerate the process of skin regeneration.

They are applied to the skin once a day without applying an occlusive dressing. Otherwise, the medicinal substances will be absorbed into the bloodstream, which is undesirable for the patient. The doctor determines the duration of therapy individually, taking into account the complexity of the pathology.

It is necessary to understand that the ointment only alleviates the symptoms of the disease. Actions that corticosteroid ointment does not have are antihistamine and anti-infective. The external application does not affect the source of the disease. It only temporarily eliminates the inflammatory process. The root cause should be eliminated with other medications.

The main factors that influence the rate of penetration of ointment components into the skin are the total thickness of the epidermis, its level of humidity and temperature. The descending sequence of penetration is determined by experts in the following order:

• Mucous tissues.
• Scrotum.
• The area of ​​skin under the mammary glands.
• Armpits.
• Crotch folds.
• Eyelids.
• The entire surface of the face.
• Back.
• Breast.
• Legs and shins.
• Hands and forearms.
• Back of hands and feet.
• Nail plates.

The best corticosteroid ointments: review with prices

Doctors select the appropriate corticosteroid ointment for a particular patient from the list:

• Advantan.
• Belogent.
• Celestoderm B.
• Beloderm.
• Hydrocortisone.
• Lokoid.
• Lorinden C.
• Prednisolone ointment.

Advantan

The active component of the drug is methylprednisolone. There are no side effects even with long-term use.

Advantan suppresses the allergic reaction, reduces swelling, relieves itching and irritation, and stops the inflammatory process. The price of corticosteroid ointment varies from 600 to 1200 rubles.

Belogent

The ointment contains betamethasone and gentamicin. The substances work to relieve itching and inflammation and provide an antiproliferative effect.

Belogent is inexpensive, 200 - 400 rubles. Side effects are rare (burning, rash, redness of the treated area).

Celestoderm B

It also contains betamethasone and, like Belogent, relieves itching and inflammation.

Celestoderm B regulates skin cell division (proliferation), constricts blood vessels and has an antihistamine effect. Side effects are rare. The cost of ointment with corticosteroids is 250 – 350 rubles.

Beloderm

Corticosteroid ointment with betamethasone has antiproliferative and antiallergic properties.

Relieves uncomfortable symptoms of skin diseases. Constricts blood vessels. Beloderm is prescribed to children from 6 years of age. The price of the ointment is 250 rubles. There are practically no side effects.

Hydrocortisone

Ointment with cortisone eliminates the inflammatory process.

Costs on average 100 rubles. Side effects appear only against the background of vaccination, viral and fungal diseases.

Lokoid

The active component of corticosteroid ointment, hydrocortisone, quickly relieves inflammation, relieves itching and swelling.

Lokoid is on sale at a price of 350 rubles. A side effect is an increase in cortisol levels in the blood.

Lorinden C

The external preparation contains two active ingredients - flumethasone and clioquinol.

Their task is to quickly remove inflammation and neutralize harmful pathogens in the form of bacterial and fungal strains. In case of intolerance to the components, side effects are manifested by itching and rashes on the body. Lorinden C costs about 400 rubles.

Prednisolone ointment

The drug formula is based on prednisolone.

The substance acts as an anti-inflammatory agent, eliminates exudation and allergy symptoms. Does not cause side effects. You can buy the ointment for 100 rubles.

There are other corticosteroid ointments, the advisability of which is considered by a doctor.

These are Nasonex against allergic rhinitis, Flucinar and Sinaflan for adolescents, Fluorocort, Fucidin and Fucidin G. Children from 2 years of age are prescribed Fucidin G.

Side effect information

With prolonged and improper use of corticosteroid ointments, the patient may experience serious side effects and develop complications. The most harmless of them are stretch marks on the body.

More dangerous will be:

• Osteoporosis.
• Psycho-emotional disorders.
• Improper functioning of the adrenal glands.
• Hypertension.
• Diabetes.
• Edema.
• Hyperhidrosis.

Patients suffering from serious skin diseases, including chronic diseases, are well aware of the existence of corticosteroids (corticoids or CS).

Drugs in this group are referred to for the treatment of allergic rashes, various dermatitis.

Those who are prescribed corticosteroids for the first time are afraid: is the doctor recommending too strong a medicine?

Known to Russians from popular TV shows, Dr. Myasnikov is convinced: if the problem is serious, hormone-containing drugs must be used, and only then, gradually, move on to easier medications. The main thing is to strictly follow the doctor’s recommendations.

Corticosteroids are found in every body; they are produced by the adrenal glands and participate in metabolic processes.

Pharmacists managed to synthesize this substance and create drugs aimed at suppressing various painful symptoms in the body.

Corticosteroids are conventionally divided into two groups, the difference between which is in the scope of their effect.

The first group consists of glucocorticoid hormones, they are responsible for carbohydrate, protein, and fat metabolism. You can find out more about what glucocorticosteroids are, and also view the list of medications.

The second group includes mineralocorticoid hormones, they participate in water-salt metabolism. When prescribing corticosteroid medications to a patient, the doctor usually means glucocorticoids.

Corticosteroid therapy aims to block the formation of substances in the body called prostaglandins, which trigger the onset of the inflammatory process.

The difficulty in the work of pharmacists was that prostaglandins are found in different cells and tissues of the body and are endowed with all sorts of functions, not all of which cause harm to human health.

The main advantage of modern drugs is their selective effect on the body, aimed only at those areas that require medical intervention.

By the way, corticosteroid injections are now successfully used in veterinary medicine for dogs and cats if they have to deal with severe inflammation.

Due to the ability of corticosteroid drugs to relieve swelling and inflammation, and soothe itching, they are often prescribed for the treatment of skin diseases.

Another area of ​​application of drugs in this group is urology. Used for phimosis(this is the name for a disease in which the opening of the foreskin narrows significantly) corticosteroids help the patient avoid surgery.

With esophagitis (a disease of the esophagus), the damaged mucous membrane is restored faster, the symptoms of heartburn and pain during swallowing are eliminated. The medicine is also effective for gastritis.

Corticosteroids are prescribed for rheumatism, for arthritis, sinusitis, bronchial asthma and pneumonia, for certain blood diseases and the presence of neoplasms, for the treatment of otitis and eye diseases (for example, conjunctivitis, iritis, iridocyclitis), various viral infections and neurological problems.

Medicines in this group are actively also used in dentistry, as well as for the treatment of patients diagnosed with facial paralysis.

Ointments and creams made on the basis of corticosteroids are divided into 4 groups depending on what hormones are included in the preparations.

These classes are: weak, moderate, strong and very strong. Combination drugs are included in a separate category.

Weak

Ointments and creams in this class are made using prednisolone and hydrocortisone.

Moderate

The drugs in this class are based on components such as prednicarbate and flumethasone.

Strong

Potent drugs of this class are based on synthetic hormonal drugs halomethasone, metazone, betamethasone, methylprednisolone.

Very strong

This group of drugs is based on clobetasol propionite.

Combined

This group (or rather, a subclass) includes drugs that, along with corticosteroids, contain substances that can resist bacterial and fungal infections.

Examples of a combination drug are Flucinar and Belosalik ointments.

Release forms

Given the wide range of uses of corticosteroids for the treatment of various diseases, pharmacists have provided a sufficient variety of forms of these drugs:

• oral corticosteroids (for oral administration) – tablets, capsules;
• for injections - liquid preparations in ampoules;
• for local use (topical preparations) - ointments, creams, gels, liniments, powders;
• inhaled corticosteroids – aerosol, spray;
• nasal and intranasal agents – spray, nasal drops;
• for the eyes – eye drops.

The choice among the many corticosteroid drugs should be left to the doctor: he better understands the patient’s health status and knows what effect this or that medicine will have on the body, what the mechanism of action is, possible consequences and complications from the use of drugs in this group, especially if they are expected to be taken for a long time.

However, treatment can become more effective if the patient has sufficient information about the medications that are prescribed to him.

Here are the best drugs most often prescribed:

When purchasing medications at a pharmacy, you should accurately indicate their names.

For example, in addition to the drug Fucidin G, there is simply Fucidin. And these are not substitute drugs; each of them has its own, special purpose.

Your doctor will tell you how to take the medicine correctly and how to use it to maximize the benefits. But some general rules are worth remembering.

If the doctor prescribed pills, it is advisable to take the first one at 6 a.m., the next one no later than 2 p.m.: it is according to this “schedule” that natural corticosteroids would enter the blood.

Taking the medication should be combined with meals. By the way, some changes need to be made to the menu, enriching it with proteins. But there should be a minimum amount of carbohydrates and salt in dishes.

Additionally, you will need calcium supplements and vitamin D - this will help protect the body from osteoporosis. Liquids should be drunk up to one and a half liters per day. Alcohol is strictly contraindicated.

Injections are given strictly according to the doctor’s instructions- in the dosage and quantity indicated in the recipe. Overdoses are especially dangerous as they can lead to adverse reactions.

The optimal duration of treatment with corticosteroid drugs is from five to seven days, and the longest is up to three months.

However, doctors treat such long periods with great caution, so that irreversible processes do not begin to occur in the body and the functions of any organs are not impaired.

The doctor selects a treatment method individually for each patient. She may be:

Use by children and women during pregnancy

The risk of adverse reactions to drugs in this group is especially high in children. If a doctor prescribes a corticosteroid ointment for a child, it is for a minimal course and for treating very small areas of skin.

Children under one year of age are allowed drugs containing no more than one percent hydrocortisone.

Starting from the age of two, you can use Metazon ointment - it has a prolonged effect, so lubricating the affected area of ​​skin once a day is enough. Advantan ointment is effective for atopic dermatitis.

During pregnancy hormonal drugs are used only in situations where the expected result of treatment “overrides”, and significantly, the possible risk from using this medicine.

It is advisable to use ointments of weak or moderate strength that are less dangerous for the expectant mother.

We invite you to watch a video about the use of local glucocorticosteroids for atopic dermatitis in children:

Contraindications to the use of corticosteroids are:

Problems can also arise from illiterate use of drugs, violation of dosages and timing of treatment.

Among the side effects: loss of skin elasticity, acne, active growth of facial hair, formation of stretch marks, areas lacking natural pigmentation.

There is also a risk of weakened immunity, weight gain, swelling, increased blood sugar, and, in women, menstrual irregularities.

Sometimes uncontrolled use of corticosteroids leads to eye diseases, depression, and the patient’s appearance may even change as a result of atrophy of individual muscles or fat deposits on the face.