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Sunday, July 27, 2025

Fluticasone skin creams


Fluticasone skin creams are topical corticosteroid preparations containing fluticasone propionate, a synthetic glucocorticoid with potent anti-inflammatory, antipruritic, and vasoconstrictive properties. These creams are used in the dermatological management of inflammatory and pruritic skin disorders, particularly those responsive to corticosteroids, such as eczema, psoriasis, and contact dermatitis.

Fluticasone is considered a moderately potent to potent corticosteroid, depending on the formulation and the area of application. It is not intended for cosmetic use or long-term unmonitored application due to potential adverse effects associated with topical steroids.

Pharmacological Classification

  • Therapeutic class: Topical corticosteroid

  • Pharmacologic class: Synthetic fluorinated glucocorticoid

  • ATC code: D07AC17

  • Formulations:

    • Fluticasone propionate 0.05% cream

    • Fluticasone propionate 0.005% ointment (rare)

    • Fluticasone lotion (for scalp use)

  • Brand examples: Cutivate®, Flutivate®, Flixonase cream (brand names vary by region)

  • Legal status: Prescription-only medicine in most jurisdictions

Mechanism of Action

Fluticasone binds to glucocorticoid receptors in the cytoplasm of skin cells, translocates to the nucleus, and:

  • Suppresses transcription of pro-inflammatory genes

  • Inhibits inflammatory cytokines, chemokines, prostaglandins, leukotrienes

  • Reduces capillary permeability, thereby decreasing edema

  • Inhibits fibroblast activity, reducing skin thickening and collagen synthesis

This leads to:

  • Decreased erythema, swelling, and itching

  • Suppression of local immune response

  • Improved skin barrier function over the short term

Indications

Topical fluticasone is prescribed for short-term treatment of steroid-responsive dermatoses, including:

  • Atopic dermatitis (eczema)

  • Allergic contact dermatitis

  • Irritant contact dermatitis

  • Seborrheic dermatitis

  • Lichen simplex chronicus

  • Psoriasis (except on face or genital areas)

  • Discoid lupus erythematosus (off-label)

  • Pruritus ani or vulvae (carefully monitored)

Dosage and Administration

Application Instructions

  • Apply a thin layer once or twice daily to affected area

  • Rub gently and completely into the skin

  • Do not use on broken skin, mucous membranes, or eyes

  • Do not occlude unless directed by physician

  • Duration: typically no longer than 2–4 weeks continuously

Amount to Apply

  • Use the fingertip unit (FTU) method: one FTU (~0.5 g) covers an area the size of two adult palms

  • Children require proportionally less depending on body surface area

Potency and Site-Specific Guidance

  • Considered potent in most classifications (slightly less potent than clobetasol)

  • Not recommended for:

    • Face

    • Groin/genitals

    • Axillae

  • These areas absorb more corticosteroid and are at higher risk of side effects

Contraindications

  • Hypersensitivity to fluticasone propionate or any excipients

  • Untreated skin infections (bacterial, viral, fungal)

  • Rosacea

  • Perioral dermatitis

  • Acne vulgaris

  • Dermatitis around the mouth or eyes

  • Children under 1 year (unless specifically prescribed)

Precautions and Warnings

Long-term Use Risks

  • Skin atrophy

  • Striae

  • Telangiectasia

  • Perioral dermatitis

  • Rebound flares upon withdrawal

  • Tachyphylaxis (reduced efficacy over time)

  • Local immunosuppression → secondary infection

Pediatric Use

  • Use lowest effective dose for shortest duration

  • Increased risk of systemic absorption due to thinner skin

  • May suppress hypothalamic-pituitary-adrenal (HPA) axis with excessive use

Systemic Absorption

Although designed for topical use, prolonged high-dose or widespread application can lead to systemic absorption, especially:

  • In infants and young children

  • Under occlusive dressings

  • When applied to damaged or inflamed skin
    This can lead to:

  • Cushing’s syndrome

  • Adrenal suppression

  • Growth retardation in children

Infection Risk

  • May mask or worsen fungal, bacterial, or viral skin infections

  • Must treat primary infection before applying corticosteroid

Adverse Effects

Local Reactions (Common)

  • Skin thinning (atrophy)

  • Stretch marks (striae)

  • Burning or stinging

  • Itching

  • Dryness

  • Folliculitis

  • Contact dermatitis

Less Common

  • Acneiform eruptions

  • Perioral dermatitis

  • Hyperpigmentation or hypopigmentation

  • Delayed wound healing

  • Secondary infections

Rare/Systemic (from prolonged use)

  • HPA axis suppression

  • Hyperglycemia

  • Cushingoid features (moon face, truncal obesity)

Drug Interactions

Topical fluticasone has minimal systemic interaction under normal usage. However:

  • Systemic absorption may interact with:

    • CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): may increase systemic corticosteroid levels

  • Concurrent use with other topical agents (especially irritants or photosensitizers) should be avoided unless prescribed

Monitoring and Follow-up

  • Assess response within 7–14 days

  • Discontinue or taper as soon as inflammation is controlled

  • Monitor for:

    • Skin changes (thinning, discoloration, telangiectasia)

    • Signs of local infection

    • Flare-ups upon stopping

  • If long-term corticosteroid use is needed, consider steroid-sparing agents like:

    • Topical calcineurin inhibitors (e.g., tacrolimus)

    • Emollient therapy as baseline skin maintenance

Patient Counseling

  • Use only on affected areas, not as moisturizer

  • Avoid use on face, groin, or broken skin unless directed

  • Do not share medication

  • Do not use more often or longer than prescribed

  • Wash hands after application unless treating hands

  • Use bland emollients to support skin barrier

  • Do not apply other products on top without medical advice

Use in Special Populations

Pregnancy

  • Category C (systemic corticosteroids); limited absorption makes short-term use likely safe, but use only if clearly needed

Lactation

  • Acceptable with proper hygiene; do not apply to breast/nipple area

Pediatrics

  • Avoid prolonged use in children

  • Use milder corticosteroids (e.g., hydrocortisone) when possible

Alternative Topical Potency Levels for Reference

  • Mild: Hydrocortisone 1%

  • Moderate: Clobetasone butyrate 0.05%

  • Potent: Fluticasone propionate 0.05%, Betamethasone valerate 0.1%

  • Very potent: Clobetasol propionate 0.05%

Clinical Notes

  • Fluticasone cream is favored for its low percutaneous absorption and reduced risk of systemic effects compared to older potent corticosteroids

  • The cream base is better for weeping or moist lesions; ointment base suits dry, scaly conditions

  • Always pair with non-pharmacological skin care: moisturizing, avoiding triggers, appropriate hygiene




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