Potential systemic side effects
- Potential systemic side effects could be the same as those seen with the use of systemic corticosteroids.
- In reality this would be most unusual(rare) in the course of normal use of Eumovate®.
- Infants, children and patients with liver and renal disease are more at risk for possible systemic effects and local atrophy.
Potential local side effects
- Epidermal atrophy – this has not been documented in short-term use with Eumovate®
- Steroid addiction/rebound
- Glaucoma/cataracts
- Allergic or irritant contact dermatitis in response to a corticosteroid See www.eczemaguide.ca for more information.
Predictors of side effects from topical corticosteroids
- Using moderately potent, potent or very potent steroids
- too long
- too often
- too much
- under occlusion
- on the face, folds, genitals, inner thighs
- on patients who are too young and too old
- over too extensive an area
General tips for minimizing side effects of topical corticosteroids
- Frequent and abundant moisturizing minimizes the need for medication and is thus steroid sparing.
- Maintenance therapy with weaker topical corticosteroid
- Treat secondary infections, which may lead to the need for less topical corticosteroid
- Use potent or very potent topical corticosteroids only:
- on thick lesions
- for 2-3 weeks
- once daily application in the early evening for the best effect
- if maintenance is required, use on weekends only
- Use moderately potent topical corticosteroids only:
- for 2-3 weeks
- on body (not face, folds)
- on thick lesions
Allergies
Topical steroids can be divided into 4 groups in terms of allergy, i.e., if a patient is allergic to one in the group, don’t use another one from the same group. Eumovate is a part of the following group (for more information about the other groups, see www.eczemaguide.ca):
- Hydrocortisone-17-butyrate
- Hydrocortisone-17-valerate
- Aclometasone dipropionate
- Betamethasone valerate
- Betamethasone dipropionate
- Prednicarbate
- Clobetasone-17-butyrate
- Clobetasol-17-propionate
- Fluocortolone caproate
- Cluocortolone pivalate
- Fluprednidene acetate.
[Warner M, Camisa C. Topical Corticosteroids..In: Comprehensive Dermatologic Drug Therapy, Wolverton SE, Editor..Philadelphia: W.B. Saunders Company, 2001; pp 548-77.]
Monitoring
- A follow-up visit and patient education are the most effective methods for ensuring that the patient’s benefits are optimized and adverse events are minimized. Monitoring for systemic side effects is rarely necessary when using moderate-strength topical corticosteroids.
- The test of choice for screening and monitoring adrenal suppression is the 8am plasma cortisol. Definitive diagnosis requires the metyrapone test.
[Drug Information for the HealthCare Professional, 23rd Edition, Volume I. USP DI 2003 Micromedex.]
