Introduction
- A synthetic fluorinated corticosteroid recently introduced to Canada but has been available in the U.S market for a number of years
- Fluticasone propionate is classified as a medium potency topical corticosteroid
- Safety and efficacy has been established in a number of publications
- Low systemic absorption of topical Cutivate and rapid metabolism and elimination of the drug is of advantage Evidence shows that intermittent use, twice weekly, of Cutivate can maintain eczema control. This is a significant advance.
Clinical Experience
- Topical corticosteroids are extensively used. Atopic eczema will be used as a model for discussing this new topical corticosteroid
- A concern with the use of any long term medication is the potential for side effects. Issues to consider are:
- Patient does not always follow instructions resulting in over-use of the drug
- Poor instructions and directions by the doctor
Indications
- Used for all inflammatory and pruritic conditions that are corticosteroid responsive e.g. eczema, psoriasis and dermatitis
- It should not be used in rosacea, acne, or perioral dermatitis. It should be also avoided in viral infections such as herpes simplex and chicken pox, as well as in lesions infected with fungi.
- Prolonged use on the face and folds needs to be avoided
Guidelines of Care for Atopic Dermatitis
- “Topical steroids are the standard of care to which other treatments are to be compared”
- “There are limited data regarding the optimal corticosteroid concentration, duration and frequency of application”
- “Long –term intermittent application of corticosteroid appears safe and effective in two randomized controlled studies”
- Topical corticosteroids first introduced in the 1950’s have been the mainstay of therapy of atopic dermatitis
- “Emollients are a standard of care, steroid-sparing, and useful for both prevention and maintenance therapy”
- Tacrolimus and pimecolimus has been shown to reduce the extent, severity and symptoms of AD in children and adults
- Information is lacking as to the best way that these drugs can be combined with topical corticosteroids to maximise efficacy,minimise side-effects and reduce costs to the patient
Tachyphlaxis and Rebound
- Tachyphlaxis (effectiveness diminishes progressively on continued therapy) and rebound (flare of disease worse than base line on stopping therapy) do not appear to be a problem with Fluticasone propionate
[J. Berth-Jones1, M. Herdman2, E Glazenburg3. on behalf of an International Study Group. 1Coventry, UK, 2GSK, R&D, UK, 1GSK, The Netherlands.]
