WARNINGS
No Information Provided
PRECAUTIONS
General
Systemic absorption of topical corticosteroids has produced reversible hypothalamic pituitary- adrenal
(HPA) axis suppression, manifestations of Cushing’s syndrome, hyperglycemia, and glucosuria in some
patients.
Conditions which augment systemic absorption include the application of the more potent steroids, use
over large surface areas, prolonged use, and the addition of occlusive dressings.
Therefore, patients receiving a large dose of any potent topical steroid applied to a large surface area
or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression
by using the urinary free cortisol and ACTH stimulation tests, and for impairment of thermal
homeostasis. If HPA axis suppression or elevation of the body temperature occurs, an attempt should be
made to withdraw the drug, to reduce the frequency of application, substitute a less potent steroid, or
use a sequential approach when utilizing the occlusive technique. Recovery of HPA axis function and
thermal homeostasis are generally prompt and complete upon discontinuation of the drug. Infrequently,
signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids.
Occasionally, a patient may develop a sensitivity reaction to a particular occlusive dressing material or
adhesive and a substitute material may be necessary.
Children may absorb proportionally larger amounts of topical corticosteroids and thus be more
susceptible to systemic toxicity (see PRECAUTIONS, Pediatric Use). If irritation develops, topical
corticosteroids should be discontinued and appropriate therapy instituted.
In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent
should be instituted. If a favorable response does not occur promptly, the corticosteroid should be
discontinued until the infection has been adequately controlled.
These preparations are not for ophthalmic use.
Information For Patients
Patients using topical corticosteroids should receive the following information and instructions:
- This medication is to be used as directed by the physician. It is for external use only. Avoid contact
with the eyes.
- Patients should be advised not to use this medication for any disorder other than for which it was
prescribed.
- The treated skin area should not be bandaged or otherwise covered or wrapped as to be occlusive
unless directed by the physician.
- Patients should report any signs of local adverse reactions especially under occlusive dressing.
- Parents of pediatric patients should be advised not to use tight-fitting diapers or plastic pants on a
child being treated in the diaper area, as these garments may constitute occlusive dressings.
Laboratory Tests
A urinary free cortisol test and ACTH stimulation test may be helpful in evaluating HPA axis
suppression.
Carcinogenesis, Mutagenesis, Impairment Of Fertility
Long-term animal studies have not been performed to evaluate the carcinogenic potential or the effect
on fertility of topical corticosteroids.
Studies to determine mutagenicity with prednisolone and hydrocortisone showed negative results.
Pregnancy
Teratogenic Effects
Pregnancy Category C
Corticosteroids are generally teratogenic in laboratory animals when administered systemically at
relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after
dermal application in laboratory animals. There are no adequate and well- controlled studies in pregnant
women on teratogenic effects from topically applied corticosteroids.Therefore, topical corticosteroids
should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for
prolonged periods of time.
Nursing Mothers
Itis not known whether topical administration of corticosteroids could result in sufficient systemic
absorption to produce detectable quantities in breast milk. Systemically administered corticosteroids are
secreted into breast milk in quantities not likely to have a deleterious effect on the infant. Nevertheless,
caution should be exercised when topical corticosteroids are administered to a nursing woman.
Pediatric Use
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid induced HPA
axis suppression and Cushing’s syndrome than mature patients because of a larger skin surface
area to body weight ratio.
HPA axis suppression, Cushing’s syndrome, and intracranial hypertension have been reported in
children receiving topical corticosteroids. Manifestations of adrenal suppression in children include
linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to
ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches,
and bilateral papilledema.
Administration of topical corticosteroids to children should be limited to the least amount compatible
with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and
development of children.