Generally, once or twice daily application is recommended for most topical steroids regardless of the potency (1)
- more frequent applications may be necessary in skin with thick stratum corneum
- intermittent scheduling (e.g. - every other day, weekends only) can be used as maintenance therapy of chronic conditions
- very potent or potent preparations should be managed by dermatologists (2)
- nonmedicated emollient creams or ointments can be used daily as a substitute during drug free intervals (1)
Topical steroids are generally used in short bursts to treat exacerbations of a disease so the duration of treatment is generally between 3 - 7 days (3)
- regular use for more than four weeks is not recommended for any topical corticosteroid without review
- use of potent preparations regularly for more than 7 days should be avoided (2)
- repeat prescriptions should be under supervision and the patient should be reviewed regularly (2)
- tolerance and tachyphylaxis may occur in response to chronic use of topical steroids (4)
Clinicians should attempt to alternate between topical corticosteroids and non-corticosteroid preparations (2). In patients who do not have improvement of symptoms after 3-7 days, diagnosis should be reassessed and the following conditions should be considered as the cause
- infection
- hypersensitivity reaction to the base or the steroid
- non compliance of the patients due to the concerns about side effects of steroids
- tolerance or tachyphylaxis - alternative steroids with the same potency can be used in these patients (3)
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