Mometasone for skin

Generic Name: Mometasone furoate
Pharmacologic Class: Topical corticosteroid
Therapeutic Class: Anti-inflammatory, antipruritic, vasoconstrictive dermatologic agent
ATC Code: D07AC13 (Corticosteroids, potent)
Legal Status: Prescription-only
Common Brand Names: Elocon, Eleuphrat, Novasone, Mometamax (veterinary), Aveeno Dermexa (with mometasone in some formulations)

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Mechanism of Action

Mometasone furoate is a synthetic corticosteroid of the furoate ester class. When applied topically, it exerts potent anti-inflammatory, antipruritic, and vasoconstrictive effects via multiple mechanisms:

• Inhibits the release of proinflammatory cytokines such as interleukins (IL-1, IL-6), TNF-α, and prostaglandins

• Suppresses leukocyte infiltration and migration

• Induces lipocortins, which antagonize phospholipase A2 activity, reducing arachidonic acid release

• Induces vasoconstriction, minimizing redness, edema, and exudation

Topical mometasone has low systemic absorption, especially when used without occlusion on intact skin.

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Therapeutic Indications

Mometasone topical is indicated for inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, including:

1. Atopic dermatitis (eczema) – chronic and subacute

2. Psoriasis (excluding facial/genital areas) – plaque type, mild-to-moderate

3. Seborrheic dermatitis

4. Contact dermatitis – allergic or irritant

5. Lichen simplex chronicus

6. Discoid lupus erythematosus (off-label)

7. Lichen planus (off-label)

8. Nummular eczema

9. Prurigo nodularis

10. Inflammatory dermatoses of the scalp (mometasone lotion/solution)

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Formulations and Strengths

• Cream 0.1% – for moist or weeping lesions

• Ointment 0.1% – for dry, thickened, or scaly skin

• Lotion 0.1% – for hairy areas like the scalp

• Solution or scalp application 0.1% – for seborrheic scalp conditions

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Dosage and Administration

Adults and Children ≥2 years:

• Apply thinly to the affected area once daily

• Rub in gently until absorbed

• Duration: Use for up to 2–4 weeks, unless otherwise directed

• For recurrent flares, intermittent use is advised

• Occlusive dressings may be used only under medical supervision (enhances absorption significantly)

Children <2 years:

• Not routinely recommended due to increased absorption and systemic risk

Sites to Avoid (unless instructed):

• Face

• Axillae

• Groin

• Broken or infected skin

• Areas with skin atrophy

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Pharmacokinetics

• Systemic absorption: <1.5% when applied to intact skin without occlusion

• Absorption increased by: Damaged skin, occlusion, prolonged use, and application to large areas

• Metabolism: Hepatic (extensive first-pass metabolism)

• Excretion: Biliary and renal as inactive metabolites

• Plasma half-life: 5.8 hours

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Contraindications

• Hypersensitivity to mometasone or any formulation excipients

• Untreated bacterial (e.g., impetigo), viral (e.g., herpes simplex, varicella), or fungal infections (e.g., tinea corporis)

• Rosacea

• Perioral dermatitis

• Acne vulgaris

• Skin ulceration or skin atrophy

• Children under 2 years (without medical justification)

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Warnings and Precautions

1. Systemic Corticosteroid Effects (rare):
   – HPA axis suppression, Cushing's syndrome, adrenal suppression
   – Growth suppression in children
   – Risk increased with prolonged use, large surface area, occlusion

2. Local Adverse Effects:
   – Skin thinning (atrophy)
   – Telangiectasia
   – Striae (stretch marks)
   – Perioral dermatitis
   – Acneiform eruptions
   – Hypopigmentation

3. Infection Risk:
   – Topical steroids may mask signs of infection or exacerbate it
   – Secondary infections (fungal/bacterial) can develop with prolonged use
   – Consider antifungal or antibacterial combination in such settings

4. Facial Use:
   – Use with caution due to skin thinning risk
   – Avoid eyes – may cause cataracts or glaucoma with prolonged exposure

5. Use in Children:
   – Greater risk of systemic absorption
   – Limit duration, surface area, and potency
   – Monitor growth and HPA axis in prolonged use

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Adverse Effects

Local (common):

• Burning or stinging at application site

• Pruritus

• Skin dryness

• Irritation or erythema

• Folliculitis

Less Common:

• Acneiform eruptions

• Atrophy, telangiectasia, striae

• Perioral dermatitis

• Allergic contact dermatitis

• Hypertrichosis (excessive hair growth)

Systemic (rare, prolonged use or high absorption):

• Adrenal suppression

• Cushingoid features

• Hyperglycemia

• Immunosuppression

• Growth suppression in pediatric patients

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Drug Interactions

• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir): May increase systemic corticosteroid exposure

• Other topical corticosteroids: Risk of additive local/systemic side effects

• Live vaccines: Avoid in extensive or systemic exposure (immunosuppression)

• Topical calcineurin inhibitors (e.g., tacrolimus, pimecrolimus): Use with caution concurrently due to increased immunosuppressive effects

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Pregnancy and Lactation

Pregnancy:
– Category C (US FDA)
– Animal studies show adverse fetal effects at high doses
– Use only if benefits outweigh risks
– Avoid prolonged or high-potency use

Lactation:
– Unknown if absorbed mometasone is excreted in human milk
– If used, avoid application on breast area to prevent infant exposure

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Use in Special Populations

• Pediatrics: Use only if clearly indicated and for short periods

• Geriatrics: Monitor for skin thinning and fragility

• Hepatic impairment: No adjustment, but monitor if prolonged use

• Immunocompromised individuals: Increased risk of infection masking or worsening

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Monitoring Parameters

• Signs of treatment response (inflammation, redness, pruritus)

• Skin condition: for atrophy, striae, discoloration

• For long-term use:
  – HPA axis function (especially in children)
  – Growth in pediatric patients
  – Adrenal reserve in high-dose cases

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Patient Counseling Points

• Apply once daily in a thin layer, just enough to cover affected skin

• Do not use on broken skin, face, groin, or axillae unless directed

• Wash hands after use

• Avoid contact with eyes, nose, and mouth

• Do not bandage or occlude unless prescribed

• Use only for the duration advised – prolonged use increases side effects

• Report skin changes (thinning, color changes, persistent irritation)

• If no improvement within 7–14 days, re-evaluate with clinician

• Keep out of reach of children and store at room temperature

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Comparison with Other Topical Corticosteroids

Corticosteroid	Potency	Formulations	Typical Use Area
Mometasone furoate	Potent	Cream, ointment, lotion	Trunk, limbs, scalp
Hydrocortisone	Mild	Cream, ointment	Face, intertriginous
Betamethasone	Potent	Cream, ointment	Resistant plaque areas
Clobetasol propionate	Very potent	Cream, ointment, shampoo	Thick plaques, palms
Desonide	Mild	Cream, lotion, gel	Pediatric or facial use

Mometasone strikes a balance between efficacy and safety, offering potent anti-inflammatory activity with low systemic absorption.

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Storage Instructions

• Store at 15°C to 25°C (59°F to 77°F)

• Keep away from heat, moisture, and direct sunlight

• Do not freeze

• Discard after expiration or if discolored