DrugindexOnline^{2nd edition}

Pronouncation: (flew-oh-SIN-oh-nide)
Class: Corticosteroid

Trade Names:
Lidex
- Cream 0.05%
- Gel 0.05%
- Ointment 0.05%
- Topical Solution 0.05%

Trade Names:
Lidex-E
- Cream 0.05%

Tiamol (Canada)
Topsyn (Canada)

Mechanism of Action

Pharmacology

Depresses formation, release, and activity of endogenous mediators of inflammation such as prostaglandins, kinins, histamine, liposomal enzymes, and complement system.

Pharmacokinetics

Absorption

Topical steroids can be absorbed from intact skin. Occlusive dressings, inflammation, and other disease processes in the skin increase percutaneous absorption of topical steroids.

Distribution

Once absorbed, corticosteroids are variably bound to plasma protein.

Metabolism

Corticosteroids are metabolized primarily in the liver.

Elimination

Corticosteroids are excreted primarily by the kidneys and to varying amounts into the bile.

Indications and Usage

Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.

Contraindications

Standard considerations.

Dosage and Administration

Apply to the affected area as a thin film 2 to 4 times daily, depending on the severity of the condition.

Drug Interactions

None well documented.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Dermatologic

Acneiform eruptions, allergic contact dermatitis, burning, dryness, folliculitis, hypertrichosis, hypopigmentation, irritation, itching, maceration of the skin, miliaria, perioral dermatitis, secondary infection, skin atrophy, striae.

Precautions

Pregnancy

Category C .

Lactation

Undetermined effect. Exercise caution when topical corticosteroids are administered to a breast-feeding woman.

Children

Safety and efficacy not established for children younger than 12 yr of age. Because of higher ratio of skin surface area to body mass, children are at higher risk than adults for hypothalamic-pituitary-adrenal (HPA) axis suppression and Cushing syndrome when treated with topical corticosteroids.

Adrenal suppression

Large doses applied to large surface area or under an occlusive dressing may lead to HPA suppression. If HPA axis suppression is noted, consider drug withdrawal, reduced frequency of application, or substitution of a less potent steroid. Recovery of HPA axis function is generally prompt and complete upon discontinuation of the corticosteroid. Signs and symptoms of withdrawal may require supplemental systemic corticosteroids.

Atrophy

Prolonged use of topical corticosteroids may produce atrophy of the skin and subcutaneous tissues.

Occlusive dressings

Adverse reactions may occur more frequently when occlusive dressings are used.

Patient Information

• Advise patient to apply medication 2 to 4 times daily as directed by health care provider.
• Caution patient not to apply in greater quantity or more frequently than prescribed by health care provider.
• Teach patient or caregiver the following application technique: wash or soak the affected area before applying medication unless it irritates the affected area(s); wash hands; apply sufficient cream, ointment, solution, or gel to cover affected area(s) sparingly then gently massage into skin; wash hands after applying fluocinonide.
• Advise patient using solution or gel on scalp to part the hair, apply a small amount of the medicine on the affected area, rub it in gently, and protect the area from washing and rubbing until the solution or gel dries. Patient may wash hair as usual but not immediately after applying the medicine.
• Advise patient using an occlusive dressing to cover the area with plastic wrap (such as Saran Wrap or Handi-Wrap ) after applying medication to affected area(s). The plastic may be held in place with gauze, an elastic bandage, or adhesive tape on the normal skin beside the treated area. Advise patient that instead of using plastic wrap, plastic gloves may be used for the hands, plastic bags for the feet, or a shower cap for the scalp; leave the plastic wrapping or covering in place as long as instructed by health care provider. Instruct patient to cleanse the skin and reapply the medication each time a new plastic wrapping is applied.
• Advise patient that if an application is missed, to apply it as soon as remembered and then continue on a regular schedule. If it is almost time for the next application, instruct patient to skip the application and continue on regular schedule. Caution patient not to apply double doses.
• Caution patient not to apply to face, underarms, or groin area unless directed by health care provider.
• Caution caregiver of child not to use tight-fitting diapers or plastic pants on a child being treated in the diaper area.
• Caution patient not to bandage, cover, or wrap treated skin areas or use cosmetics or other skin products over treated areas unless advised by health care provider.
• Caution patient to avoid contact with the eyes. Advise patient that if medication does come into contact with the eyes to wash them with large amounts of cool water and to contact health care provider if eye irritation occurs.
• Advise patient that symptoms should begin to improve soon after starting treatment and to notify health care provider if condition does not improve, worsens, or if application site reactions (eg, burning, stinging, redness, itching) develop.
• Advise patient that therapy is usually discontinued when control has been achieved.