Current treatment guidelines for topical corticosteroids

The effectiveness of a topical corticosteroid is related to various factors which should be considered when planning treatment. The most relevant factor is the potency of the drug. Another important factor is the absorption through the skin, which is influenced by marked regional variations in percutaneous penetration, hydration and the degree of inflammation present, types of dressings, the solubility of the drug and the age of the patient. Multiple daily applications do not lead to better or faster resolution of the disease. Intermittent therapy with treatment-free intervals, when the vehicle alone is applied, can be as effective as continuous treatment. The choice of a topical corticosteroid depends not only on the severity or activity of the disease, but also on the age of the subject, the body site affected and the extent of the surface area to be treated. In addition, the choice of vehicle depends on the type of lesion and on the body region afflicted. Combinations of a corticosteroid with other agents can be useful, but they are recommended in only a few specific indications. Treatment guidelines for topical corticosteroids must therefore take into account a number of factors which will influence the clinician's ultimate decision in providing care for the patient with steroid-responsive dermatoses.