Fluticasone Creams

1. Introduction

Fluticasone skin creams are topical corticosteroids used to manage inflammatory and pruritic skin conditions. Fluticasone propionate is a potent corticosteroid that reduces skin inflammation, redness, itching, and swelling by suppressing inflammatory mediators.

2. Indications

  • Approved Indications:
    • Eczema (atopic dermatitis).
    • Psoriasis (excluding widespread plaque psoriasis).
    • Contact dermatitis.
    • Seborrhoeic dermatitis.
    • Discoid lupus erythematosus.
    • Lichen planus.
  • Off-Label Uses:
    • Post-inflammatory hyperpigmentation (to reduce inflammation).

3. Dosage

  • Adults and Adolescents (≥12 years):
    • Apply a thin layer to the affected area once or twice daily, as directed by a healthcare provider.
  • Children (≥1 year):
    • Apply a thin layer to the affected area once daily. Use with caution and limit to short-term use under medical supervision.
  • Elderly:
    • Use as in adults but monitor for increased skin thinning in prolonged use.

4. Administration

  • Wash and dry the affected area before application.
  • Apply a thin layer of cream and rub gently until absorbed.
  • Do not cover the treated area with bandages or occlusive dressings unless instructed by a healthcare provider.
  • Avoid applying near the eyes, mouth, or open wounds.

5. Forms Available

  • Cream: 0.05% fluticasone propionate.
  • Ointment: 0.005% fluticasone propionate.

6. Side Effects

6.1. Common Side Effects

  • Skin dryness.
  • Burning or stinging sensation.
  • Mild skin irritation.

6.2. Less Common Side Effects

  • Thinning of the skin (atrophy).
  • Stretch marks (striae).
  • Redness or discolouration of the skin.

6.3. Rare but Serious Side Effects

  • Allergic contact dermatitis.
  • Systemic corticosteroid effects (e.g., adrenal suppression, especially with prolonged use or large area application).

7. Warnings

  • Skin Atrophy: Prolonged or excessive use may lead to thinning of the skin, particularly on the face or intertriginous areas.
  • Infections: Avoid use on untreated bacterial, fungal, or viral skin infections, as corticosteroids may exacerbate infections.
  • Systemic Absorption: Prolonged use over large areas or under occlusive dressings may lead to systemic corticosteroid side effects.

8. Precautions

  • Use cautiously in patients with pre-existing skin infections; treat infections appropriately before starting fluticasone.
  • Avoid long-term use on sensitive areas such as the face or groin.
  • Do not use for conditions like rosacea, acne, or perioral dermatitis.

9. Interactions

  • Drug-Drug Interactions:
    • Ritonavir and other strong CYP3A4 inhibitors: May increase systemic absorption and side effects.

10. Monitoring Parameters

  • Symptom improvement (e.g., reduced inflammation, itching).
  • Signs of skin atrophy, discolouration, or other local adverse effects.
  • Monitor for systemic side effects in long-term or widespread use.

11. Use in Children

  • Approved for short-term use in children aged ≥1 year. Prolonged use should be avoided due to increased risk of systemic absorption and growth suppression.

12. Use in Pregnancy

  • Category C: Use only if benefits outweigh risks. Limit use to small areas and short durations under medical supervision.

13. Use in Elderly

  • Safe for use, but elderly patients may be more prone to skin thinning. Use the lowest effective potency and monitor regularly.

14. Use in Kidney Disease

  • No dose adjustment is required, as fluticasone applied topically has minimal systemic absorption.

15. Use in Liver Disease

  • Use with caution in severe liver impairment, as systemic absorption may slightly increase.

16. Patient Counselling Points

  • Use fluticasone cream as directed by your healthcare provider. Avoid overuse or application to large areas.
  • Do not use on the face, groin, or underarms unless specifically instructed.
  • Inform your doctor if symptoms worsen or if there are signs of infection (e.g., redness, swelling, pus).
  • Avoid prolonged use to prevent side effects like skin thinning or discolouration.
  • Wash hands after application unless the hands are the area being treated.

17. Table of Brand Names, Manufacturers, and Prices

Brand NameManufacturerPrice (USD)
CutivateGlaxoSmithKline$15–25 (15 g, 0.05%)
FlutivateCipla$5–15 (15 g, 0.05%)
Generic FluticasoneVarious$5–10 (15 g, 0.05%)

18. FAQs (15 Questions)

  1. What is fluticasone cream used for?
    It is used to treat inflammatory skin conditions such as eczema, psoriasis, and dermatitis.
  2. How does fluticasone cream work?
    It reduces skin inflammation, swelling, and itching by suppressing inflammatory mediators.
  3. How long does it take for fluticasone cream to work?
    Symptom relief is usually noticeable within a few days, but complete healing may take longer.
  4. Can fluticasone cream be used on the face?
    It should be used on the face only under medical supervision and for short durations to avoid skin thinning.
  5. Can fluticasone cream cause side effects?
    Common side effects include skin dryness, irritation, and thinning with prolonged use.
  6. Is fluticasone cream safe for children?
    Yes, it is safe for short-term use in children aged ≥1 year. Avoid long-term use to reduce the risk of side effects.
  7. Can I use fluticasone cream during pregnancy?
    It can be used if prescribed by a doctor, but its use should be limited to small areas and short durations.
  8. Does fluticasone cream treat infections?
    No, it does not treat infections. Do not apply it to infected skin unless prescribed with an antimicrobial agent.
  9. How should fluticasone cream be stored?
    Store at room temperature, away from heat and light. Keep out of reach of children.
  10. Can I use fluticasone cream for acne?
    No, it is not suitable for acne and may worsen the condition.
  11. Can I use fluticasone cream under bandages?
    Only if instructed by a healthcare provider, as this may increase absorption and side effects.
  12. What should I do if I miss a dose?
    Apply it as soon as you remember, but skip it if it’s close to the next dose. Do not double up.
  13. Can fluticasone cream cause systemic side effects?
    Systemic side effects are rare but can occur with prolonged use over large areas.
  14. Can fluticasone cream be used for psoriasis?
    Yes, it can be used for localized psoriasis, but avoid widespread application unless prescribed.
  15. How long can I use fluticasone cream?
    It is typically used for short durations (1–2 weeks). Prolonged use should only occur under medical supervision.