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DERMATOLOGICALS › CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS › CORTICOSTEROIDS, PLAIN › Corticosteroids, potent (group III)
fluocinolone acetonide
D07AC04
Forms & Strengths
- Cream: 0.01%, 0.025%
- Ointment: 0.025%
- Solution (Topical): 0.01%
- Oil (Scalp): 0.01%
- Intravitreal insert: 0.18 mg (Retisert)
Adult Dosing
- Topical cream/ointment/solution: Apply thinly to affected area 2 to 4 times daily.
- Scalp oil: Apply to affected areas on the scalp at night, cover with shower cap, wash out in morning.
- Intravitreal insert: Surgically implanted into the affected eye; releases drug for up to 36 months.
Pediatric Dosing
- Topical cream/ointment (2 years and older): Apply sparingly to affected area 2 to 3 times daily.
- Safety and efficacy in pediatric patients under 2 years for topical use are not established.
- Intravitreal use is not recommended in pediatric patients.
Indications
- Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses
- Treatment of psoriasis of the scalp
- Chronic noninfectious uveitis affecting the posterior segment of the eye (intravitreal insert)
Mechanism of Action
- Synthetic fluorinated corticosteroid that diffuses across cell membranes and binds to cytosolic glucocorticoid receptors.
- Reduces inflammation by suppressing neutrophil migration, decreasing leukocyte cytokine production, and reversing capillary permeability.
- Inhibits phospholipase A2 via induction of lipocortins, suppressing the cascade of potent inflammatory mediators like prostaglandins and leukotrienes.
Contraindications
- Hypersensitivity to fluocinolone acetonide or any component of the formulation
- Viral skin infections (e.g., varicella, herpes simplex, vaccinia)
- Fungal and bacterial skin infections without concurrent anti-infective therapy
- Ophthalmic use for viral, fungal, or mycobacterial ocular infections
Adverse Reactions
- Local skin reactions: burning, pruritus, irritation, dryness, folliculitis, hypertrichosis
- Systemic corticosteroid effects from prolonged use: hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing's syndrome, hyperglycemia
- Ophthalmic adverse effects (intravitreal): increased intraocular pressure, cataract formation, endophthalmitis, conjunctival hemorrhage
Drug Interactions
- Strong CYP3A4 inhibitors (e.g., ritonavir, ketoconazole) may theoretically increase systemic exposure of concurrent systemic corticosteroids, though minimal with topical application.
- Concomitant use with other immunosuppressive or immunomodulating agents may increase infection risk if systemic absorption is significant.
Curated Content: Needs Vetting Before Put to Clinical Use