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 Name | Manufacturer | Price (USD) |
---|---|---|
Cutivate | GlaxoSmithKline | $15–25 (15 g, 0.05%) |
Flutivate | Cipla | $5–15 (15 g, 0.05%) |
Generic Fluticasone | Various | $5–10 (15 g, 0.05%) |
18. FAQs (15 Questions)
- What is fluticasone cream used for?
It is used to treat inflammatory skin conditions such as eczema, psoriasis, and dermatitis. - How does fluticasone cream work?
It reduces skin inflammation, swelling, and itching by suppressing inflammatory mediators. - 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. - 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. - Can fluticasone cream cause side effects?
Common side effects include skin dryness, irritation, and thinning with prolonged use. - 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. - 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. - Does fluticasone cream treat infections?
No, it does not treat infections. Do not apply it to infected skin unless prescribed with an antimicrobial agent. - How should fluticasone cream be stored?
Store at room temperature, away from heat and light. Keep out of reach of children. - Can I use fluticasone cream for acne?
No, it is not suitable for acne and may worsen the condition. - Can I use fluticasone cream under bandages?
Only if instructed by a healthcare provider, as this may increase absorption and side effects. - 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. - Can fluticasone cream cause systemic side effects?
Systemic side effects are rare but can occur with prolonged use over large areas. - Can fluticasone cream be used for psoriasis?
Yes, it can be used for localized psoriasis, but avoid widespread application unless prescribed. - 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.