The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including product formulation and the integrity of the epidermal barrier. Occlusion , inflammation and/or other disease processes in the skin may also increase percutaneous absorption. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. They are metabolized primarily in the liver and then are excreted by the kidneys. Some corticosteroids and their metabolites are also excreted in the bile .
The Saskatchewan Drug Information Service was contracted by the Saskatchewan College of Pharmacists to prepare the Minor Ailment guidelines. The first step was to review the literature and consult with other Canadian pharmacy organizations. From this information, a list of conditions that could potentially qualify as minor ailments and a list of prescription drugs that might be suitable for patient self-care of these conditions were compiled. The next step was consultation with Saskatchewan community pharmacists through nominal group meetings; the first in Saskatoon, Jan. 5th, 2010 and the second in Regina. Jan. 12th, 2010. The groups were asked to (1) select criteria to define minor ailments and prescription drugs appropriate for pharmacists to prescribe for these conditions and (2) to apply these criteria to select specific conditions and drugs to be included in Saskatchewan minor ailment program. The results from the group meetings are summarized below.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.