Advertisment Novartis
Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
Indexed with Science Citation Index (E) , Web of Science and PubMed
 
Users online: 887  
Home About  Editorial Board  Current Issue Archives Online Early Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
Table of Contents 
REVIEW ARTICLE
Year : 2017  |  Volume : 62  |  Issue : 3  |  Page : 237-250
Use of topical corticosteroids in dermatology: An evidence-based approach


Department of Dermatology, KPC Medical College and Hospital, Kolkata, West Bengal, India

Date of Web Publication12-May-2017

Correspondence Address:
Anupam Das
“PRERANA”, 19, Phoolbagan, Kolkata - 700 086, West Bengal
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijd.IJD_169_17

Rights and Permissions

   Abstract 

Topical corticosteroids (TCs) are the pillars of dermatotherapeutics. These drugs are the “magic molecules,” provided they are used judiciously and appropriately, following a rational prescription. On exhaustive literature search in multiple databases, we found a significant evidence favoring the use of TCs in atopic eczema, localized vitiligo, psoriasis, chronic hand eczema, and localized bullous pemphigoid. However, contrary to conventional wisdom, we did not find any high-level scientific evidence in support of prescribing TCs in cutaneous lichen planus, sarcoidosis, and seborrhoeic dermatitis. Besides, evidence clearly advocates judicious use of mild-to-moderate corticosteroids (if required) in pregnancy and lactation and there is no risk of any fetal abnormality.


Keywords: Meta-analysis, randomized controlled trials, systematic reviews, topical corticosteroids


How to cite this article:
Das A, Panda S. Use of topical corticosteroids in dermatology: An evidence-based approach. Indian J Dermatol 2017;62:237-50

How to cite this URL:
Das A, Panda S. Use of topical corticosteroids in dermatology: An evidence-based approach. Indian J Dermatol [serial online] 2017 [cited 2017 Nov 20];62:237-50. Available from: http://www.e-ijd.org/text.asp?2017/62/3/237/206175

What was known?

  • Topical corticosteroids are the most commonly prescribed drugs by dermatologists in an outpatient setting
  • TCs are being used since ages, in eczema, vitiligo, psoriasis, lichen planus, hand eczema, etc
  • Topical steroid addiction or red burning skin syndrome is increasingly being recognized, due to illegitimate prescriptions by physicians.



   Introduction Top


Since the introduction in early 1950s, topical corticosteroids (TCs) have become the most commonly prescribed drugs by dermatologists in an outpatient setting. These agents form the mainstay of treatment for many skin conditions. If used appropriately, they are safe and effective, and side effects are rare. Not only dermatologistsbut also steroids have been rampantly prescribed by quacks, general physicians, pediatricians, gynecologists, and specialists of innumerable disciplines.

Unfortunately, TCs are increasingly being abused by doctors and patients. Topical steroid addiction and red burning skin syndrome are legitimate clinical entities which are well recognized these days. Sometimes, these terms are used synonymously.[1] As a result, the problem of steroid phobia is being increasingly recognized by physicians worldwide which, sometimes, is associated with simple fear, due to ignorance of the patient. In addition, current advice to patients to apply TC preparations “sparingly” or “thinly” contributes to steroid phobia, increasing the risk of poor clinical response, and treatment failure. Such cautionary advice also overlooks the fact that the vast majority of patients are prescribed TCs of mild potency for which the evidence suggests that the risk of harm is minimal. In the patient's mind, the current advice groups all steroids together regardless of their potential for adverse effects. The advice also tends to reinforce an erroneous concern that the risks from TCs may be similar to those from systemic corticosteroids.[2]

In this article, we have reviewed the various indications of TCs in dermatology with an overview of the evidence available in support of using these drugs in various dermatoses. Wherever possible, we have tried our best to corroborate the evidence, and analyze them in such a manner that both the opposing concerns may be addressed, and we may come up with a balanced view on TC use in clinical dermatology. At the outset, we would like to summarise the levels of evidence. Level I suggests evidence from a systematic review of randomized controlled trials. Level II corroborates with evidence obtained from at least one well-designed Randomized Controlled Trial. Level III takes into consideration, evidences obtained from well-designed controlled trials without randomization. However, Level IV relates to well-designed case-control and cohort studies. Level V considers evidence from systematic reviews of descriptive and qualitative studies. Level VI and VII are poor quality evidences. Level VI considers evidence from a single descriptive or qualitative study and Level VII takes into account, opinion of authorities and/or reports of expert committees.


   Discussion and Evidence Top


Eczema

Eczema is a noninfective, chronic, inflammatory dermatological entity manifesting as inflamed, pruritic, erythematous, and/or asteatotic skin.[3] Numerous therapeutic modalities are available to combat this notorious dermatosis, TCs being the most commonly prescribed ones. However, most of the patients show excellent response to emollients.[4],[5] According to the traditional school of thought, it is advisable to use TCs during acute episode and withdraw them, once the symptoms have been controlled. However, recent authors are of the opinion that proactive approach is better than the more commonly followed reactive approach.[6] As per recent guidelines, it is favorable to use high-dose corticosteroids during the acute flares and continue with low-dose corticosteroids when the episode is under control.

Besides, step-up and step-down approach can be followed which refers to increasing the potency of the steroid in acute flares and lowering the potency in the periods of remission.[7] Overall, a systematic review of the best strategies for using TCs in the treatment of established eczema is, therefore, required.[8]

Here is a brief overview of some of the major randomized controlled trials (RCTs) comparing the use of different TCs in eczema [Table 1].
Table 1: Evidence in favor of using topical corticosteroids in eczema

Click here to view


These studies showed significant improvement in 13%–100% of patients after 1–12 weeks of treatment. Most of the studies found significant improvement with TC in comparison with placebo. However, three studies could not demonstrate a significant difference between placebo and TC. Few RCTs showed that intermittent treatment with a potent TC could reduce the number of flare-ups. Three RCTs and two small randomized within-patient comparison studies have examined the use of wet-wrap bandaging applied over TC. To summarize, we are not in a position to recommend the “best” TC, as till now, not a single RCT has compared all the available preparations of TC of similar potency. Besides, there is no clear RCT evidence supporting the use of twice-daily over once-daily TC administration. However, it is now clear that application of twice-weekly potent TC to stable eczema can reduce the number of flare-ups in adults as well as children although the long-term safety profile of such intermittent or pulse therapy in infants, is absent.[34]

In a systematic review of treatments for atopic eczema, RCTs of TCs collected data on thinning of the skin and suppression of pituitary – adrenal axis. These RCTs could not show any evidence of harm – although the studies were short-term.[35] There is no RCT evidence that skin thinning is a problem with the correct use of TC although the fact that most RCTs are of short duration is a limitation in basing the conclusions solely on RCT-generated evidence in this regard, and other non-RCT evidence should be used to issue firm recommendations.

Vitiligo

Vitiligo is an acquired pigmentary disorder, attributed to the destruction of melanocytes. Therapeutic modalities which are present include topical and systemic corticosteroids, topical calcineurin inhibitors, photo (chemo) therapy, vitiligo surgery, and depigmentation of normally pigmented skin. Immunosuppressive therapy with highly potent TCs (clobetasol) gives excellent results in cases of localized stable vitiligo.[36],[37],[38]

Herein, we have tabulated the evidence available in favor of using TCs in vitiligo [Table 2].
Table 2: Evidence in favor of using topical corticosteroids in vitiligo

Click here to view


A meta-analysis, an additional systematic review, and several RCTs showed that Class III TCs are effective in comparison with placebo, either alone or in combination with narrowband – ultraviolet B (UVB), or psoralen plus UVA light (using sunlight or artificial light sources), in treating generalized and localized vitiligo. There is some RCT evidence that topical clobetasol propionate is of equivalent effectiveness with tacrolimus in treating this condition. All studies examining the effect of TCs reported adverse effects, with the more frequent being atrophy, telangiectasia, hypertrichosis, and acneiform papules.[55]

Psoriasis

Topical steroids have been used since ages to manage mild-to-moderate plaque psoriasis (scalp and nonscalp). These are available in different potencies and formulations, but their use relies mostly on the basis of individual experience. Here is a brief summary of evidence in favor of using topical steroids in psoriasis [Table 3].[56],[57]
Table 3: Evidence in favor of using topical corticosteroids in psoriasis (nonscalp)

Click here to view


To summarize, both Class III and Class IV TCs are effective in inducing remission in psoriasis; however, Class IV appears superior. It remains unclear whether once- or twice-daily dosing should be recommended, but frequency, as well as duration, should be tapered down in a maintenance phase because of concerns with cutaneous and systemic adverse effects of TCs. Skin atrophy is the most common complication, but it is less of an issue in psoriatics than atopics. However, the continuous use of very potent or ultrapotent TCs may cause irreversible skin atrophy and striae, may cause psoriasis to become unstable, and may have systemic effects when used over a large surface area.[82] The ointment formulations appear to be the most effective, but there are many alternative galenicals to increase feasibility and treatment adherence without losing too much effectiveness of the drugs.

Scalp psoriasis, though, responds to a wide array of topical therapies but TCs form the first line of management, and the response is excellent.[56],[57] The evidence in favor of steroids has been tabulated [Table 4].
Tables 4: Evidence in favor of using topical corticosteroids in psoriasis (scalp)

Click here to view


The results in scalp psoriasis are similar to that seen in chronic plaque psoriasis elsewhere in the body.

Lichen planus

Lichen planus (LP) is a common chronic inflammatory dermatosis associated with disrupted cell-mediated immunity. Cutaneous lesions are often extremely pruritic and require rigorous intervention. Symptomatic oral LP is painful, and complete healing is uncommon, which necessitates active intervention. TCs are conventionally used as first-line therapy in cutaneous LP, but high-level scientific evidence is conspicuous by its absence. However, TCs show good results in oral LP, and the evidence has been summarized below [Table 5].[96],[97],[98],[99]
Table 5: Evidence in favor of using topical corticosteroids in lichen planus

Click here to view


There is no evidence in favor of prescribing TCs in cutaneous LP although it is widely accepted as the first-line treatment for the same.[110] This an indicator of the fact that, like several other more uncommon inflammatory dermatoses, in LP too, the use of TCs is fairly undocumented, but not necessarily unwarranted, as the advent of TC as a group of agents happened in the age of empiricism when the use of medicines was dictated by hypothetical reasoning rather than being guided by evidence generated from RCTs.

Only limited evidence exists for the efficacy of TCs in oral LP. In addition, there is no evidence that topical calcineurin inhibitors are more effective than TCs in oral LP.[111]

Mycosis fungoides

The most common form of cutaneous T-cell lymphoma is mycosis fungoides (MF), which accounts for approximately 60% of cases. Several reviews and guidelines on the management of MF have been published. TCs have been used in the treatment of mild, patch stage MF with good results,[112] but unfortunately, evidence in favor of using them, is lacking.[113] The current evidence-based recommendation is: TCs, especially Class I (potent) compounds, are effective at temporarily clearing patches and plaques in some patients with early-stage IA/IB MF.

Bullous pemphigoid

Bullous pemphigoid (BP) is an acquired common autoimmune blistering dermatosis characterized by the development of autoantibodies against the components of the basement membrane zone of the skin. Interestingly, superpotent topical steroids have emerged as a first-line therapy for limited disease.[114] Two randomized clinical trials have been published in favor of topical steroids, and the summary has been tabulated as under [Table 6].
Table 6: Evidence in favor of using topical corticosteroids in bullous pemphigoid

Click here to view


The two RCTs suggest the use of TCs as the first line for the treatment for both localized and mild disease. Relatively, few and mild side effects are associated with TC use in BP; however, their use in extensive disease may be limited by more side effects and practical factors.

Cutaneous sarcoidosis

Sarcoidosis is a granulomatous disease with multisystem involvement. Topical high potency fluorinated corticosteroids (with or without occlusive dressing) have been successfully used in localized cutaneous sarcoidosis, but high-level scientific evidence is lacking.[117],[118]

Hand eczema

Chronic hand eczema is an extremely common and notorious entity encountered by general physicians and dermatologists. Currently, evidence-based guidelines for the management of this condition is lacking. However, there a few randomized clinical trials favoring the use of TCs [Table 7].
Table 7: Evidence in favor of using topical corticosteroids in hand eczema

Click here to view


There is insufficient data on which to base a choice between short bursts of potent TCs compared with continuous application of mild TCs. There is little evidence of steroid-sparing effect of emollients. There is an insufficient evidence of an additive effect of topical antibacterial agents. In addition, there is a lack of data supporting the superiority of topical calcineurin inhibitors to TCs.[122]

Infantile hemangiomas

Superficial infantile cutaneous hemangiomas are difficult to manage. Two small case series using ultrapotent TCs for periocular hemangiomas have been reported. However, evidence in favor of using this therapy for other sites is lacking. Garzon et al . assessed the cessation of growth, shrinkage or flattening of the lesion, and lightening of the surface color. Seventy-four percent of the cases demonstrated either good or partial response to ultrapotent TCs.[123] In another study by Pandey et al ., mometasone was applied twice daily and compared with intralesional triamcinolone acetonide injections at monthly intervals at 1–2 mg/kg. Topical steroids were found to be a good alternative to intralesional steroids for treating superficial hemangiomas.[124]


   Miscellaneous Conditions Top


Alopecia areata

One RCT demonstrated that potent TCs are marginally more effective than placebo when used continuously for a minimum of 3 months. In observational case series, children between the ages of 3 and 10 years appear most likely to respond.[125]

Anogenital pruritus

In idiopathic cases, TCs may be helpful, but they may mask malignancy and other underlying disease.[126]

Cutaneous lupus erythematosus

All the controlled trials of TC were of short duration, but the evidence supports the use of potent TCs in DLE (Discoid lupus erythematosus). Although TC use may be associated with skin atrophy, it is probably not important in DLE, which produces severe scarring and atrophy in itself.[127]

Melasma

There have been one systematic review [128] and one trial of 17 participants followed for 3 months.[129] Although the study reports that betamethasone was effective as a depigmenting agent (P < 0.05), the numbers were very small, and seven of 16 women in the study found no therapeutic difference between treatment and placebo. There is controversy over the balance between benefits and harms of using TCs in the treatment of melasma, especially since long-term use on the face can cause skin thinning and telangiectasia.

Perioral dermatitis

There is insufficient evidence (level of evidence: D) on the effects of nonfluorinated steroids in patients with perioral dermatitis. A split-face RCT of hydrocortisone butyrate versus 1% hydrocortisone alcohol cream is available.[130] Two patients with perioral dermatitis showed a moderate rebound of the eruption after withdrawal of topical treatment, in each case on the hydroxybutyrate-treated side of the face. In view of the study design and the small number of patients, it is difficult to draw conclusions.

Seborrheic dermatitis

Even though, TCs are considered to be the first line therapy for the management of seborrheic dermatitis, but, there is absence of high-level evidence supporting the use of TCs. Studies have shown that steroids are superior to placebo in the treatment of mild to moderate seborrheic dermatitis. Besides, there were no statistically significant differences between steroids and calcineurin inhibitors in terms of the assessed outcomes in a few studies. In addition, no statistically significant differences were found between steroids and azoles in their effectiveness in producing total clearance of lesions of seborrheic dermatitis.[131]


   Pregnancy and Lactation Top


Women with skin conditions often need TCs during pregnancy. However, the knowledge about the effects of TCs on the fetus is scarce. The current best evidence supports the use of mild-to-moderate TCs in comparison to potent/superpotent alternatives in pregnancy because of the associated risk of fetal growth restriction with the latter. There is no significantly increased risk of orofacial clefts, preterm delivery, growth retardation, and fetal death when mild-to-moderate TCs are used in pregnancy. However, it must be noted that potent or superpotent TCs should be used as second-line therapy only for the shortest possible duration. Whenever high potency corticosteroids are used, meticulous obstetric care is mandatory because they increase the likelihood of low birth weight baby. Depending on the severity of the dermatoses, women should use TCs of the least potency required, and the duration and amount of application of the drug must be monitored judiciously. The risk of adverse events is increased when areas with high absorption (genitals, eyelids, skin folds, armpits, and vulva) are treated with topical steroids. There is lack of evidence regarding the safety profile of newer lipophilic TCs (mometasone furoate, fluticasone propionate, and methylprednisolone aceponate) with a good therapeutic index. On theoretical grounds, these should be associated a lesser risk of low birth weight, but high-level scientific evidence is lacking, and it is not possible to comment on the adverse effect profile of these newer congeners.[132],[133],[134],[135]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Fukaya M, Sato K, Sato M, Kimata H, Fujisawa S, Dozono H, et al. Topical steroid addiction in atopic dermatitis. Drug Healthc Patient Saf 2014;6:131-8.  Back to cited text no. 1
    
2.
Bewley A; Dermatology Working Group. Expert consensus: Time for a change in the way we advise our patients to use topical corticosteroids. Br J Dermatol 2008;158:917-20.  Back to cited text no. 2
    
3.
Dirven-Meijer PC, Glazenburg EJ, Mulder PG, Oranje AP. Prevalence of atopic dermatitis in children younger than 4 years in a demarcated area in central Netherlands: The West Veluwe Study Group. Br J Dermatol 2008;158:846-7.  Back to cited text no. 3
    
4.
Oranje AP, de Waard-van der Spek FB, Ordonez C, De Raeve L, Spierings M, van der Wouden JC. Emollients for eczema (Protocol). Cochrane Database Syst Rev 2010;8:CD008304.  Back to cited text no. 4
    
5.
Grimalt R, Mengeaud V, Cambazard F; Study Investigators' Group. The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: A randomized controlled study. Dermatology 2007;214:61-7.  Back to cited text no. 5
    
6.
Bieber T. Atopic dermatitis. Ann Dermatol 2010;22:125-37.  Back to cited text no. 6
    
7.
Atopic Eczema in Under 12s: Diagnosis and Management. Available from: https://www.nice.org.uk/guidance/cg57. [Last accessed on 2017 Feb 20].  Back to cited text no. 7
    
8.
Moed H, Yang Q, Oranje AP, Panda S, van der Wouden JC. Different strategies for using topical corticosteroids for established eczema (Protocol) Cochrane Database Syst Rev.2012;10:CD010080.  Back to cited text no. 8
    
9.
Almeyda J, Burt BW. Double blind controlled study of treatment of atopic eczema with a preparation of hydrocortisone in a new drug delivery system versus betamethasone 17-valerate. Br J Dermatol 1974;91:579-83.  Back to cited text no. 9
    
10.
Yasuda T. Clinical experiences with hydrocortisone 17-butyrate. Dermatologica 1976;152 Suppl 1:221-9.  Back to cited text no. 10
    
11.
Fisher M, Kelly AP. Multicenter trial of fluocinonide in an emollient cream base. Int J Dermatol 1979;18:660-4.  Back to cited text no. 11
    
12.
Lassus A. Clinical comparison of alclometasone dipropionate cream 0.05% with hydrocortisone butyrate cream 0.1% in the treatment of atopic dermatitis in children. J Int Med Res 1983;11:315-9.  Back to cited text no. 12
    
13.
Andersen BL, Andersen KE, Nielsen R, Stahl D, Niordson A, Roders GA. Treatment of dry atopic dermatitis in children. A double-blind comparison between mildison Lipocream™ (1% hydrocortisone) and Uniderm™ (1% hydrocortisone) ointment. Clin Trials J 1988;25:278-84.  Back to cited text no. 13
    
14.
Vernon HJ, Lane AT, Weston W. Comparison of mometasone furoate 0.1% cream and hydrocortisone 1.0% cream in the treatment of childhood atopic dermatitis. J Am Acad Dermatol 1991;24:603-7.  Back to cited text no. 14
    
15.
Rafanelli A, Rafanelli S, Stanganelli I, Marchesi E. Mometasone furoate in the treatment of atopic dermatitis in children. J Eur Acad Dermatol Venereol 1993;2:225-30.  Back to cited text no. 15
    
16.
Marchesi E, Rozzoni M, Pini P, Cainelli T. Comparative study of mometasone furoate and betamethasone dipropionate in the treatment of atopic dermatitis. G Ital Dermatol Venereol 1994;129:IX-XII.  Back to cited text no. 16
    
17.
Koopmans B, Lasthein Andersen B, Mork NJ, Austad J, Suhonen RE. Multicentre randomized double-blind study of locoid lipocream fatty cream twice daily versus locoid lipocream once daily and locobase once daily. J Dermatol Treat 1995;6:103-6.  Back to cited text no. 17
    
18.
Jorizzo J, Levy M, Lucky A, Shavin J, Goldberg G, Dunlap F, et al. Multicenter trial for long-term safety and efficacy comparison of 0.05% desonide and 1% hydrocortisone ointments in the treatment of atopic dermatitis in pediatric patients. J Am Acad Dermatol 1995;33:74-7.  Back to cited text no. 18
    
19.
Bleehen SS, Chu AC, Hamann I, Holden C, Hunter JA, Marks R. Fluticasone propionate 0.05% cream in the treatment of atopic eczema: A multicentre study comparing once-daily treatment and once-daily vehicle cream application versus twice-daily treatment. Br J Dermatol 1995;133:592-7.  Back to cited text no. 19
    
20.
Wolkerstorfer A, Strobos MA, Glazenburg EJ, Mulder PG, Oranje AP. Fluticasone propionate 0.05% cream once daily versus clobetasone butyrate 0.05% cream twice daily in children with atopic dermatitis. J Am Acad Dermatol 1998;39(2 Pt 1):226-31.  Back to cited text no. 20
    
21.
Lebwohl M, Lane A, Savin R, Drake L, Berman B, Lucky A, et al . A comparison of once-daily application of mometasone furoate 0.1% cream compared with twice-daily hydrocortisone valerate 0.2% cream in pediatric atopic dermatitis patients who failed to respond to hydrocortisone. Int J Dermatol 1999;38:604-6.  Back to cited text no. 21
    
22.
Prado de Oliveira ZN, Cuce LC, Arnone M. Comparative evaluation of efficacy, tolerability and safety of 0.1% topical momethasone furoate and 0.05% desonide in the treatment of childhood atopic dermatitis. An Bras Dermatol 2002;77:25-33.  Back to cited text no. 22
    
23.
Hanifin J, Gupta AK, Rajagopalan R. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol 2002;147:528-37.  Back to cited text no. 23
    
24.
Torok HM, Maas-Irslinger R, Slayton RM. Clocortolone pivalate cream 0.1% used concomitantly with tacrolimus ointment 0.1% in atopic dermatitis. Cutis 2003;72:161-6.  Back to cited text no. 24
    
25.
Kirkup ME, Birchall NM, Weinberg EG, Helm K, Kennedy CT. Acute and maintenance treatment of atopic dermatitis in children-two comparative studies with fluticasone propionate (0.05%) cream. J Dermatolog Treat 2003;14:141-8.  Back to cited text no. 25
    
26.
Beattie PE, Lewis-Jones MS. A pilot study on the use of wet wraps in infants with moderate atopic eczema. Clin Exp Dermatol 2004;29:348-53.  Back to cited text no. 26
    
27.
Hebert AA, Cook-Bolden FE, Basu S, Calvarese B, Trancik RJ; Desonide Hydrogel Study Group. Safety and efficacy of desonide hydrogel 0.05% in pediatric subjects with atopic dermatitis. J Drugs Dermatol 2007;6:175-81.  Back to cited text no. 27
    
28.
Msika P, De Belilovsky C, Piccardi N, Chebassier N, Baudouin C, Chadoutaud B. New emollient with topical corticosteroid-sparing effect in treatment of childhood atopic dermatitis: SCORAD and quality of life improvement. Pediatr Dermatol 2008;25:606-12.  Back to cited text no. 28
    
29.
Peserico A, Städtler G, Sebastian M, Fernandez RS, Vick K, Bieber T. Reduction of relapses of atopic dermatitis with methylprednisolone aceponate cream twice weekly in addition to maintenance treatment with emollient: A multicentre, randomized, double-blind, controlled study. Br J Dermatol 2008;158:801-7.  Back to cited text no. 29
    
30.
Glazenburg EJ, Wolkerstorfer A, Gerretsen AL, Mulder PG, Oranje AP. Efficacy and safety of fluticasone propionate 0.005% ointment in the long-term maintenance treatment of children with atopic dermatitis: Differences between boys and girls? Pediatr Allergy Immunol 2009;20:59-66.  Back to cited text no. 30
    
31.
Trookman NS, Rizer RL. Randomized controlled trial of desonlde hydrogel 0.05% versus desonide ointment 0.05% in the treatment of mild-to-moderate atopic dermatitis. J Clin Aesthet Dermatol 2011;4:34-8.  Back to cited text no. 31
    
32.
Rubio E, Martinez-Mir I, Morales-Olivas FJ, Aragones AM, Larrea VP, Sese AB. et. al. Allergic diseases of the skin and drug allergies – 2015. Randomized controlled, double blind trial of topical twice weekly fluticasone propionate maintenance treatment to reduce risk of relapse in mild or moderate atopic dermatitis in children. The World Allergy Organization Journal. 2013;6(Suppl 1). p. 102.  Back to cited text no. 32
    
33.
Ruzicka T, Willers C, Wigger-Alberti W. Efficacy and patient-reported outcomes of a new mometasone cream treating atopic eczema. Skin Pharmacol Physiol 2012;25:305-12.  Back to cited text no. 33
    
34.
Thomas K, Charman C, Nankervis H, Ravenscroft J, Williams HC. Atopic eczema. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle RP, et al ., editors. Evidence-Based Dermatology. 3rd ed. Chichester: Wiley Blackwell; 2014. p. 13-8.  Back to cited text no. 34
    
35.
Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1-191.  Back to cited text no. 35
    
36.
Forschner T, Buchholtz S, Stockfleth E. Current state of vitiligo therapy – Evidence-based analysis of the literature. J Dtsch Dermatol Ges 2007;5:467-75.  Back to cited text no. 36
    
37.
Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, et al. Interventions for vitiligo. Cochrane Database Syst Rev 2015;2:CD003263.  Back to cited text no. 37
    
38.
Njoo MD, Spuls PI, Bos JD, Westerhof W, Bossuyt PM. Nonsurgical repigmentation therapies in vitiligo. Meta-analysis of the literature. Arch Dermatol 1998;134:1532-40.  Back to cited text no. 38
    
39.
Kandil E. Treatment of vitiligo with 0-1 per cent betamethasone 17-valerate in isopropyl alcohol – A double-blind trial. Br J Dermatol 1974;91:457-60.  Back to cited text no. 39
    
40.
Clayton R. A double-blind trial of 0-05% clobetasol proprionate in the treatment of vitiligo. Br J Dermatol 1977;96:71-3.  Back to cited text no. 40
    
41.
Khalid M, Mujtaba G, Haroon TS. Comparison of 0.05% clobetasol propionate cream and topical Puvasol in childhood vitiligo. Int J Dermatol 1995;34:203-5.  Back to cited text no. 41
    
42.
Westerhof W, Nieuweboer-Krobotova L, Mulder PG, Glazenburg EJ. Left-right comparison study of the combination of fluticasone propionate and UV-A vs. either fluticasone propionate or UV-A alone for the long-term treatment of vitiligo. Arch Dermatol 1999;135:1061-6.  Back to cited text no. 42
    
43.
Lepe V, Moncada B, Castanedo-Cazares JP, Torres-Alvarez MB, Ortiz CA, Torres-Rubalcava AB. A double-blind randomized trial of 0.1% tacrolimus vs. 0.05% clobetasol for the treatment of childhood vitiligo. Arch Dermatol 2003;139:581-5.  Back to cited text no. 43
    
44.
Agarwal S, Ramam M, Sharma VK, Khandpur S, Pal H, Pandey RM. A randomized placebo-controlled double-blind study of levamisole in the treatment of limited and slowly spreading vitiligo. Br J Dermatol 2005;153:163-6.  Back to cited text no. 44
    
45.
Lim-Ong M, Leveriza RM, Ong BE, Frez ML. Comparison between narrow-band UVB with topical corticosteroid and narrow-band UVB with placebo in the treatment of vitiligo: A randomized controlled trial. J Philippine Dermatol Soc 2005;14:17-25.  Back to cited text no. 45
    
46.
Kumaran MS, Kaur I, Kumar B. Effect of topical calcipotriol, betamethasone dipropionate and their combination in the treatment of localized vitiligo. J Eur Acad Dermatol Venereol 2006;20:269-73.  Back to cited text no. 46
    
47.
Sanclemente G, Garcia JJ, Zuleta JJ, Diehl C, Correa C, Falabella R. A double-blind, randomized trial of 0.05% betamethasone vs. topical catalase/dismutase superoxide in vitiligo. J Eur Acad Dermatol Venereol 2008;22:1359-64.  Back to cited text no. 47
    
48.
Sassi F, Cazzaniga S, Tessari G, Chatenoud L, Reseghetti A, Marchesi L, et al. Randomized controlled trial comparing the effectiveness of 308-nm excimer laser alone or in combination with topical hydrocortisone 17-butyrate cream in the treatment of vitiligo of the face and neck. Br J Dermatol 2008;159:1186-91.  Back to cited text no. 48
    
49.
Wazir SM, Paracha MM, Khan SU. Efficacy and safety of topical mometasone furoate 0.01% vs. tacrolimus 0.03% and mometasone furoate 0.01% in vitiligo. J Pak Assoc Dermatol 2010;20:89-92.  Back to cited text no. 49
    
50.
Köse O, Arca E, Kurumlu Z. Mometasone cream versus pimecrolimus cream for the treatment of childhood localized vitiligo. J Dermatolog Treat 2010;21:133-9.  Back to cited text no. 50
    
51.
Yaghoobi R, Omidian M, Bagherani N. Original article title: “Comparison of therapeutic efficacy of topical corticosteroid and oral zinc sulfate-topical corticosteroid combination in the treatment of vitiligo patients: A clinical trial”. BMC Dermatol 2011;11:7.  Back to cited text no. 51
    
52.
Xing C, Xu A. The effect of combined calcipotriol and betamethasone dipropionate ointment in the treatment of vitiligo: An open, uncontrolled trial. J Drugs Dermatol 2012;11:e52-4.  Back to cited text no. 52
    
53.
Kathuria S, Khaitan BK, Ramam M, Sharma VK. Segmental vitiligo: A randomized controlled trial to evaluate efficacy and safety of 0.1% tacrolimus ointment vs. 0.05% fluticasone propionate cream. Indian J Dermatol Venereol Leprol 2012;78:68-73.  Back to cited text no. 53
    
54.
Akdeniz N, Yavuz IH, Gunes Bilgili S, Ozaydin Yavuz G, Calka O. Comparison of efficacy of narrow band UVB therapies with UVB alone, in combination with calcipotriol, and with betamethasone and calcipotriol in vitiligo. J Dermatolog Treat 2014;25:196-9.  Back to cited text no. 54
    
55.
Manriquez JJ, Niklitschek SM. Vitiligo. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R. et al ., editors. Evidence-Based Dermatology. 3rd ed. Wiley-Blackwell Publishers. 2014. pp.44-9.  Back to cited text no. 55
    
56.
Castela E, Archier E, Devaux S, Gallini A, Aractingi S, Cribier B, et al. Topical corticosteroids in plaque psoriasis: A systematic review of efficacy and treatment modalities. J Eur Acad Dermatol Venereol 2012;26 Suppl 3:36-46.  Back to cited text no. 56
    
57.
Samarasekera EJ, Sawyer L, Wonderling D, Tucker R, Smith CH. Topical therapies for the treatment of plaque psoriasis: Systematic review and network meta-analyses. Br J Dermatol 2013;168:954-67.  Back to cited text no. 57
    
58.
Kuokkanen K. Comparison of 0.25% desoxymethasone ointment with 0.05% fluocinonide ointment in psoriasis. Curr Med Res Opin 1976;4:703-5.  Back to cited text no. 58
    
59.
Fabry H, Yawalkar SJ. A comparative multicentre trial of halometasone ointment and fluocortolone plus fluocortolone caproate ointment in the treatment of psoriasis. J Int Med Res 1983;11 Suppl 1:26-30.  Back to cited text no. 59
    
60.
Jegasothy B, Jacobson C, Levine N, Millikan L, Olsen E, Pinnell S, et al. Clobetasol propionate versus fluocinonide creams in psoriasis and eczema. Int J Dermatol 1985;24:461-5.  Back to cited text no. 60
    
61.
Jacobson C, Cornell RC, Savin RC. A comparison of clobetasol propionate 0.05 percent ointment and an optimized betamethasone dipropionate 0.05 percent ointment in the treatment of psoriasis. Cutis 1986;37:213-4, 216, 218-20.  Back to cited text no. 61
    
62.
Blum G, Yawalkar S. A comparative, multicenter, double blind trial of 0.05% halobetasol propionate ointment and 0.1% betamethasone valerate ointment in the treatment of patients with chronic, localized plaque psoriasis. J Am Acad Dermatol 1991;25(6 Pt 2):1153-6.  Back to cited text no. 62
    
63.
Goldberg B, Hartdegen R, Presbury D, Smith EH, Yawalkar S. A double-blind, multicenter comparison of 0.05% halobetasol propionate ointment and 0.05% clobetasol propionate ointment in patients with chronic, localized plaque psoriasis. J Am Acad Dermatol 1991;25(6 Pt 2):1145-8.  Back to cited text no. 63
    
64.
Bernhard J, Whitmore C, Guzzo C, Kantor I, Kalb RE, Ellis C, et al. Evaluation of halobetasol propionate ointment in the treatment of plaque psoriasis: Report on two double-blind, vehicle-controlled studies. J Am Acad Dermatol 1991;25(6 Pt 2):1170-4.  Back to cited text no. 64
    
65.
Katz HI, Gross E, Buxman M, Prawer SE, Schwartzel EH, Gibson JR. A double-blind, vehicle-controlled paired comparison of halobetasol propionate cream on patients with plaque psoriasis. J Am Acad Dermatol 1991;25(6 Pt 2):1175-8.  Back to cited text no. 65
    
66.
Olsen EA. Efficacy and safety of fluticasone propionate 0.005% ointment in the treatment of psoriasis. Cutis 1996;57 2 Suppl: 57-61.  Back to cited text no. 66
    
67.
Roberts DT. Comparison of fluticasone propionate ointment, 0.005%, and betamethasone-17,21-dipropionate ointment, 0.05%, in the treatment of psoriasis. Cutis 1996;57 2 Suppl: 27-31.  Back to cited text no. 67
    
68.
Sears HW. A double-blind, randomized, placebo-controlled evaluation of the efficacy and safety of hydrocortisone buteprate 0.1% cream in the treatment of psoriasis. Adv Ther 1997;14:140-9.  Back to cited text no. 68
    
69.
Peharda V, Gruber F, Prpic L, Kastelan M, Brajac I. Comparison of mometasone furoate 0.1% ointment and betamethasone dipropionate 0.05% ointment in the treatment of psoriasis vulgaris. Acta Dermatovenerol Croat 2000;8:223-6.  Back to cited text no. 69
    
70.
Stein LF, Sherr A, Solodkina G, Gottlieb AB, Chaudhari U. Betamethasone valerate foam for treatment of nonscalp psoriasis. J Cutan Med Surg 2001;5:303-7.  Back to cited text no. 70
    
71.
Green L, Sadoff W. A clinical evaluation of tazarotene 0.1% gel, with and without a high- or mid-high-potency corticosteroid, in patients with stable plaque psoriasis. J Cutan Med Surg 2002;6:95-102.  Back to cited text no. 71
    
72.
Lebwohl M, Sherer D, Washenik K, Krueger GG, Menter A, Koo J, et al. A randomized, double-blind, placebo-controlled study of clobetasol propionate 0.05% foam in the treatment of nonscalp psoriasis. Int J Dermatol 2002;41:269-74.  Back to cited text no. 72
    
73.
Gottlieb AB, Ford RO, Spellman MC. The efficacy and tolerability of clobetasol propionate foam 0.05% in the treatment of mild to moderate plaque-type psoriasis of nonscalp regions. J Cutan Med Surg 2003;7:185-92.  Back to cited text no. 73
    
74.
Decroix J, Pres H, Tsankov N, Poncet M, Arsonnaud S. Clobetasol propionate lotion in the treatment of moderate to severe plaque-type psoriasis. Cutis 2004;74:201-6.  Back to cited text no. 74
    
75.
Lowe N, Feldman SR, Sherer D, Weiss J, Shavin JS, Lin YL, et al. Clobetasol propionate lotion, an efficient and safe alternative to clobetasol propionate emollient cream in subjects with moderate to severe plaque-type psoriasis. J Dermatolog Treat 2005;16:158-64.  Back to cited text no. 75
    
76.
Koo J, Blum RR, Lebwohl M. A randomized, multicenter study of calcipotriene ointment and clobetasol propionate foam in the sequential treatment of localized plaque-type psoriasis: Short- and long-term outcomes. J Am Acad Dermatol 2006;55:637-41.  Back to cited text no. 76
    
77.
Jarratt MT, Clark SD, Savin RC, Swinyer LJ, Safley CF, Brodell RT, et al. Evaluation of the efficacy and safety of clobetasol propionate spray in the treatment of plaque-type psoriasis. Cutis 2006;78:348-54.  Back to cited text no. 77
    
78.
Angelo JS, Kar BR, Thomas J. Comparison of clinical efficacy of topical tazarotene 0.1% cream with topical clobetasol propionate 0.05% cream in chronic plaque psoriasis: A double-blind, randomized, right-left comparison study. Indian J Dermatol Venereol Leprol 2007;73:65.  Back to cited text no. 78
    
79.
Mraz S, Leonardi C, Colón LE, Johnson LA. Different treatment outcomes with different formulations of clobetasol propionate 0.05% for the treatment of plaque psoriasis. J Dermatolog Treat 2008;19:354-9.  Back to cited text no. 79
    
80.
Tiplica GS, Salavastru CM. Mometasone furoate 0.1% and salicylic acid 5% vs. mometasone furoate 0.1% as sequential local therapy in psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009;23:905-12.  Back to cited text no. 80
    
81.
Fleming C, Ganslandt C, Guenther L, Johannesson A, Buckley C, Simon JC, et al. Calcipotriol plus betamethasone dipropionate gel compared with its active components in the same vehicle and the vehicle alone in the treatment of psoriasis vulgaris: A randomised, parallel group, double-blind, exploratory study. Eur J Dermatol 2010;20:465-71.  Back to cited text no. 81
    
82.
Nast A, Spuls P, Nijsten T. Treatment of psoriasis. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R. et al ., editors. Evidence-Based Dermatology. 3rd ed. Wiley-Blackwell Publishers. 2014. pp.175-99.  Back to cited text no. 82
    
83.
Willis I, Cornell RC, Penneys NS, Zaias N. Multicenter study comparing 0.05% gel formulations of desoximetasone and fluocinonide in patients with scalp psoriasis. Clin Ther 1986;8:275-82.  Back to cited text no. 83
    
84.
Olsen EA, Cram DL, Ellis CN, Hickman JG, Jacobson C, Jenkins EE, et al. A double-blind, vehicle-controlled study of clobetasol propionate 0.05% (Temovate) scalp application in the treatment of moderate to severe scalp psoriasis. J Am Acad Dermatol 1991;24:443-7.  Back to cited text no. 84
    
85.
Klaber MR, Hutchinson PE, Pedvis-Leftick A, Kragballe K, Reunala TL, Van de Kerkhof PC, et al. Comparative effects of calcipotriol solution (50 micrograms/ml) and betamethasone 17-valerate solution (1 mg/ml) in the treatment of scalp psoriasis. Br J Dermatol 1994;131:678-83.  Back to cited text no. 85
    
86.
Katz HI, Lindholm JS, Weiss JS, Shavin JS, Morman M, Bressinck R, et al. Efficacy and safety of twice-daily augmented betamethasone dipropionate lotion versus clobetasol propionate solution in patients with moderate-to-severe scalp psoriasis. Clin Ther 1995;17:390-401.  Back to cited text no. 86
    
87.
Franz TJ, Parsell DA, Halualani RM, Hannigan JF, Kalbach JP, Harkonen WS. Betamethasone valerate foam 0.12%: A novel vehicle with enhanced delivery and efficacy. Int J Dermatol 1999;38:628-32.  Back to cited text no. 87
    
88.
Feldman SR, Ravis SM, Fleischer AB Jr., McMichael A, Jones E, Kaplan R, et al. Betamethasone valerate in foam vehicle is effective with both daily and twice a day dosing: A single-blind, open-label study in the treatment of scalp psoriasis. J Cutan Med Surg 2001;5:386-9.  Back to cited text no. 88
    
89.
Andreassi L, Giannetti A, Milani M; Scale Investigators Group. Efficacy of betamethasone valerate mousse in comparison with standard therapies on scalp psoriasis: An open, multicentre, randomized, controlled, cross-over study on 241 patients. Br J Dermatol 2003;148:134-8.  Back to cited text no. 89
    
90.
Pauporte M, Maibach H, Lowe N, Pugliese M, Friedman DJ, Mendelsohn H, et al. Fluocinolone acetonide topical oil for scalp psoriasis. J Dermatolog Treat 2004;15:360-4.  Back to cited text no. 90
    
91.
Jarratt M, Breneman D, Gottlieb AB, Poulin Y, Liu Y, Foley V. Clobetasol propionate shampoo 0.05%: A new option to treat patients with moderate to severe scalp psoriasis. J Drugs Dermatol 2004;3:367-73.  Back to cited text no. 91
    
92.
Reygagne P, Mrowietz U, Decroix J, de Waard-van der Spek FB, Acebes LO, Figueiredo A, et al. Clobetasol propionate shampoo 0.05% and calcipotriol solution 0.005%: A randomized comparison of efficacy and safety in subjects with scalp psoriasis. J Dermatolog Treat 2005;16:31-6.  Back to cited text no. 92
    
93.
Jemec GB, Ganslandt C, Ortonne JP, Poulin Y, Burden AD, de Unamuno P, et al. A new scalp formulation of calcipotriene plus betamethasone compared with its active ingredients and the vehicle in the treatment of scalp psoriasis: A randomized, double-blind, controlled trial. J Am Acad Dermatol 2008;59:455-63.  Back to cited text no. 93
    
94.
Buckley C, Hoffmann V, Shapiro J, Saari S, Cambazard F, Milsgaard M. Calcipotriol plus betamethasone dipropionate scalp formulation is effective and well tolerated in the treatment of scalp psoriasis: A phase II study. Dermatology 2008;217:107-13.  Back to cited text no. 94
    
95.
van de Kerkhof PC, Hoffmann V, Anstey A, Barnes L, Bolduc C, Reich K, et al. A new scalp formulation of calcipotriol plus betamethasone dipropionate compared with each of its active ingredients in the same vehicle for the treatment of scalp psoriasis: A randomized, double-blind, controlled trial. Br J Dermatol 2009;160:170-6.  Back to cited text no. 95
    
96.
Cribier B, Frances C, Chosidow O. Treatment of lichen planus. An evidence-based medicine analysis of efficacy. Arch Dermatol 1998;134:1521-30.  Back to cited text no. 96
    
97.
Cheng S, Kirtschig G, Cooper S, Thornhill M, Leonardi-Bee J, Murphy R. Interventions for erosive lichen planus affecting mucosal sites. Cochrane Database Syst Rev 2012;2:CD008092.  Back to cited text no. 97
    
98.
Lodi G, Carrozzo M, Furness S, Thongprasom K. Interventions for treating oral lichen planus: A systematic review. Br J Dermatol 2012;166:938-47.  Back to cited text no. 98
    
99.
Zakrzewska JM, Chan ES, Thornhill MH. A systematic review of placebo-controlled randomized clinical trials of treatments used in oral lichen planus. Br J Dermatol 2005;153:336-41.  Back to cited text no. 99
    
100.
Voûte AB, Schulten EA, Langendijk PN, Kostense PJ, van der Waal I. Fluocinonide in an adhesive base for treatment of oral lichen planus. A double-blind, placebo-controlled clinical study. Oral Surg Oral Med Oral Pathol 1993;75:181-5.  Back to cited text no. 100
    
101.
Rodstrom PO, Hakeberg M, Jontell M, Nordin P. Erosive oral lichen planus treated with clobetasol propionate and triamcinolone acetonide in orabase: A double-blind clinical trial. J Dermatol Treat 1994;5:7-10.  Back to cited text no. 101
    
102.
Hegarty AM, Hodgson TA, Lewsey JD, Porter SR. Fluticasone propionate spray and betamethasone sodium phosphate mouthrinse: A randomized crossover study for the treatment of symptomatic oral lichen planus. J Am Acad Dermatol 2002;47:271-9.  Back to cited text no. 102
    
103.
Campisi G, Giandalia G, De Caro V, Di Liberto C, Aricò P, Giannola LI. A new delivery system of clobetasol-17-propionate (lipid-loaded microspheres 0.025%) compared with a conventional formulation (lipophilic ointment in a hydrophilic phase 0.025%) in topical treatment of atrophic/erosive oral lichen planus. A Phase IV, randomized, observer-blinded, parallel group clinical trial. Br J Dermatol 2004;150:984-90.  Back to cited text no. 103
    
104.
Conrotto D, Carbone M, Carrozzo M, Arduino P, Broccoletti R, Pentenero M, et al. Ciclosporin vs. clobetasol in the topical management of atrophic and erosive oral lichen planus: A double-blind, randomized controlled trial. Br J Dermatol 2006;154:139-45.  Back to cited text no. 104
    
105.
Yoke PC, Tin GB, Kim MJ, Rajaseharan A, Ahmed S, Thongprasom K, et al. A randomized controlled trial to compare steroid with cyclosporine for the topical treatment of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;102:47-55.  Back to cited text no. 105
    
106.
Laeijendecker R, Tank B, Dekker SK, Neumann HA. A comparison of treatment of oral lichen planus with topical tacrolimus and triamcinolone acetonide ointment. Acta Derm Venereol 2006;86:227-9.  Back to cited text no. 106
    
107.
Gorouhi F, Solhpour A, Beitollahi JM, Afshar S, Davari P, Hashemi P, et al. Randomized trial of pimecrolimus cream versus triamcinolone acetonide paste in the treatment of oral lichen planus. J Am Acad Dermatol 2007;57:806-13.  Back to cited text no. 107
    
108.
Carbone M, Arduino PG, Carrozzo M, Caiazzo G, Broccoletti R, Conrotto D, et al. Topical clobetasol in the treatment of atrophic-erosive oral lichen planus: A randomized controlled trial to compare two preparations with different concentrations. J Oral Pathol Med 2009;38:227-33.  Back to cited text no. 108
    
109.
Ghabanchi J, Bahri Najafi R, Haghnegahdar S. Treatment of oral inflammatory diseases with a new mucoadhesive prednisolone table versus triamcinolone acetonide paste. IRCMJ 2009;11:155-9.  Back to cited text no. 109
    
110.
Fazel N. Cutaneous lichen planus: A systematic review of treatments. J Dermatolog Treat 2015;26:280-3.  Back to cited text no. 110
    
111.
Le Cleach L, Chosidow O. Lichen planus. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R. et al., editors. Evidence-Based Dermatology. 3rd ed. Wiley-Blackwell Publishers. 2014. pp.200-5.  Back to cited text no. 111
    
112.
Kim EJ, Hess S, Richardson SK, Newton S, Showe LC, Benoit BM, et al. Immunopathogenesis and therapy of cutaneous T cell lymphoma. J Clin Invest 2005;115:798-812.  Back to cited text no. 112
    
113.
Trautinger F, Knobler R, Willemze R, Peris K, Stadler R, Laroche L, et al. EORTC consensus recommendations for the treatment of mycosis fungoides/Sézary syndrome. Eur J Cancer 2006;42:1014-30.  Back to cited text no. 113
    
114.
García-Romero MT, Werth VP. Randomized controlled trials needed for bullous pemphigoid interventions. Arch Dermatol 2012;148:243-6.  Back to cited text no. 114
    
115.
Joly P, Roujeau JC, Benichou J, Picard C, Dreno B, Delaporte E, et al. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med 2002;346:321-7.  Back to cited text no. 115
    
116.
Joly P, Roujeau JC, Benichou J, Delaporte E, D'Incan M, Dreno B, et al. A comparison of two regimens of topical corticosteroids in the treatment of patients with bullous pemphigoid: A multicenter randomized study. J Invest Dermatol 2009;129:1681-7.  Back to cited text no. 116
    
117.
Volden G. Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing. Acta Derm Venereol 1992;72:69-71.  Back to cited text no. 117
    
118.
Baughman RP, Lower EE. Evidence-based therapy for cutaneous sarcoidosis. Clin Dermatol 2007;25:334-40.  Back to cited text no. 118
    
119.
Faghihi G, Iraji F, Shahingohar A, Saidat A. The efficacy of '0.05% Clobetasol +2.5% zinc sulphate' cream vs. '0.05% Clobetasol alone' cream in the treatment of the chronic hand eczema: A double-blind study. J Eur Acad Dermatol Venereol 2008;22:531-6.  Back to cited text no. 119
    
120.
Agarwal US, Besarwal RK. Topical clobetasol propionate 0.05% cream alone and in combination with azathioprine in patients with chronic hand eczema: An observer blinded randomized comparative trial. Indian J Dermatol Venereol Leprol 2013;79:101-3.  Back to cited text no. 120
[PUBMED]  [Full text]  
121.
Gola M, D'Erme AM, Milanesi N. Clinical efficacy of two topical corticosteroids in the management of chronic hand eczema. G Ital Dermatol Venereol 2015;150:293-6.  Back to cited text no. 121
    
122.
Christoffers WA, Schuttelaar ML, Coenraads PJ. Hand eczema. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R. et al ., editors. Evidence-Based Dermatology. 3rd ed. Wiley-Blackwell Publishers. 2014. pp.117-26.  Back to cited text no. 122
    
123.
Garzon MC, Lucky AW, Hawrot A, Frieden IJ. Ultrapotent topical corticosteroid treatment of hemangiomas of infancy. J Am Acad Dermatol 2005;52:281-6.  Back to cited text no. 123
    
124.
Pandey A, Gangopadhyay AN, Sharma SP, Kumar V, Gupta DK, Gopal SC. Evaluation of topical steroids in the treatment of superficial hemangioma. Skinmed 2010;8:9-11.  Back to cited text no. 124
    
125.
Olsen E, Hordinsky M, McDonald-Hull S, Price V, Roberts J, Shapiro J, et al. Alopecia areata investigational assessment guidelines. National Alopecia Areata Foundation. J Am Acad Dermatol 1999;40(2 Pt 1):242-6.  Back to cited text no. 125
    
126.
Oztas MO, Oztas P, Onder M. Idiopathic perianal pruritus: Washing compared with topical corticosteroids. Postgrad Med J 2004;80:295-7.  Back to cited text no. 126
    
127.
Jessop S, Whitelaw D. Cutaneous lupus erythematosus. In: Williams HC, Bigby M, Herxheimer A, Naldi L, Rzany B, Dellavalle R. et al ., editors. Evidence-Based Dermatology. 3rd ed. Wiley-Blackwell Publishers. 2014. pp.523-30.  Back to cited text no. 127
    
128.
Rajaratnam R, Halpern J, Salim A, Emmett C. Interventions for melasma. Cochrane Database Syst Rev 2010;7:CD003583.  Back to cited text no. 128
    
129.
Neering H. Treatment of melasma (chloasma) by local application of a steroid cream. Dermatologica 1975;151:349-53.  Back to cited text no. 129
    
130.
Sneddon I. A trial of hydrocortisone butyrate in the treatment of rosacea and perioral dermatitis. Br J Dermatol 1973;89:505-8.  Back to cited text no. 130
    
131.
Kastarinen H, Oksanen T, Okokon EO, Kiviniemi VV, Airola K, Jyrkka J. et. al. Topical anti-inflammatory agents for seborrhoeic dermatitis of the face or scalp. Cochrane Database of Systematic Reviews 2014;5:CD009446.  Back to cited text no. 131
    
132.
Chi CC, Kirtschig G, Aberer W, Gabbud JP, Lipozencic J, Karpati S, et al. Evidence-based (S3) guideline on topical corticosteroids in pregnancy. Br J Dermatol 2011;165:943-52.  Back to cited text no. 132
    
133.
Chi CC, Mayon-White RT, Wojnarowska FT. Safety of topical corticosteroids in pregnancy: A population-based cohort study. J Invest Dermatol 2011;131:884-91.  Back to cited text no. 133
    
134.
Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids:A UK population-based cohort study. JAMA Dermatol 2013;149:1274-80.  Back to cited text no. 134
    
135.
Chi CC, Kirtschig G, Aberer W, Gabbud JP, Lipozencic J, Karpati S, et al. Updated evidence-based (S2e) European Dermatology Forum guideline on topical corticosteroids in pregnancy. J Eur Acad Dermatol Venereol 2017. [Epub ahead of print].  Back to cited text no. 135
    

What is new?

  • Twice-weekly application of potent topical corticosteroids. (TCs) in stable eczema significantly reduces the number of flares. Moreover, skin thinning and suppression of the pituitary – adrenal axis are not seen if TCs are used judiciously and appropriately
  • Class III TCs are highly effective in the management of generalized or localized stable vitiligo. Long-term use must be avoided because of the risks of steroid-induced adverse effects
  • Both Class III and Class IV TCs are effective in inducing remission in psoriasis (both scalp and nonscalp)
  • TCs are widely used as first.line therapy in cutaneous lichen planus. (LP), but high-level scientific evidence is categorically absent. There is not a single-randomized controlled trial. (RCT) supporting the use of TCs in cutaneous LP. However, there are evidence in favor of prescribing TCs in oral LP
  • Interestingly, TCs have emerged as the first.line treatment for both localized and mild bullous pemphigoid
  • In chronic hand eczema, TCs have been found to be beneficial, but the choice between short bursts of potent TCs versus continuous application of mild TCs, is difficult, due to lack of evidence
  • Evidence in favor of using TCs in mycosis fungoides, cutaneous sarcoidosis, infantile hemangiomas, seborrhoeic dermatitis is lacking
  • In pregnancy and lactation, mild.to.moderate TCs can be safely prescribed, without the fear of associated risk of preterm labor and fetal growth restriction, provided TCs are not applied for a long duration and over areas with high absorption rates. Potent or superpotent TCs should be used only as second-line therapy because of risk of developing low birth weight baby.



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

Top
Print this article  Email this article
 
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (352 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
    Discussion and E...
    Miscellaneous Co...
    Pregnancy and La...
    References
    Article Tables

 Article Access Statistics
    Viewed1479    
    Printed36    
    Emailed0    
    PDF Downloaded163    
    Comments [Add]    

Recommend this journal

Epiduo