topical steroids- introduction, classification, method of action,potency , oral lesion, treatment, flow , charts, images, corticosteroids in dentistry , adverse effects

1. TOPICAL
STEROIDS
FINAL YEAR END POSTING
PRESENTED BY –
SNEHA ARYA
DEPARTMENT OF ORAL
MEDICINE AND RADIOLOGY

2. CONTENTS
1. INTRODUCTION
2. CLASSIFICATION
3. MODE OF ACTION
4. FACTORS INFLUENCING THE USE OF
TOPICAL STEROIDS
5. PROTOCOLS FOR THE USE OF TOPICAL
STEROIDS
6. TOPICAL STEROIDS IN THE ORAL LESION
7. ADVERSE EFFECTS – (SYSTEMIC AND
LOCAL)
8. CONCLUSION
9. REFERENCES

3. Steroids
Steroids, also referred to as
corticosteroids, are substances
that are naturally produced in
our body by the adrenal glands
Regulate the ways body uses fats , proteins and carbohydrates
Regulate the salt-water balance in our system
Regulate our immune system
Help to reduce inflammation
3

4. CLASSIFICATION BASED ON POTENCY
OF TOPICAL STEROIDS
4
LOW
Hydrocortisone
0.25%, 0.5%, 1%,
2.5%
MEDIUM
Dexamethasone0.1%
Triamcinolone
0.025%
MEDIUM HIGH
Dexamethasone Elixir
0.5%Triamcinolone
0.1%
HIGH
Triamcinolone 0.5%
SUPER HIGH
Clobetasol 0.05%

5. MODE OF
ACTION
Topical corticosteroids act by
binding to a specific receptor in the
cellular cytoplasm
modulating the transcription of multiple
genes
suppression of the production of
inflammatory substances such as
prostaglandins and leukotrienes
inhibition of the recruitment of
inflammatory cells into the skin
Inflammatory signs inhibited 5

6. Factors
influencing the
use of topical
steroids
6
Detailed past medical history
Current ongoing medication
Accurate Diagnosis of the lesion

7. 7
POTENCY
• appropriate
potency, in
accordance to the
severity of the
condition
CONCENTRATION
• lowest possible
concentration in
compatibility
with the
effectiveness of
the treatment
EXPOSED AREA
• Minimize the
exposed area to
the topical steroid
by using different
forms/ways like-
oral paste or
ointment or
intralesional
injection
PROTOCOLS FOR THE USE OF TOPICAL
STEROIDS

8. 8
TOPICAL STEROIDS IN ORAL LESION
ORAL LICHEN PLANUS
It’s a CHRONIC SYSTEMIC condition of known immune – mediated
pathogenesis
TREATMENT-
1. high potency topical steroids such as flucinonide (0.05%) ointment or
triamcinolone (0.1%) in gel or cream base

9. 9
RECURRENT APTHOUS ULCER
Characterized by recurring ulcers confined to the oral mucosa in
patients
TREATMENT
1. in severe cases- use of high potency topical corticosteroids
such as Flucinonide,Triamcinolone 0.1% paste is applied to the
site of lesion 4 times daily,
2. Betamethasone used as a mouth rinse thrice daily
3. Clobetasol 0.05% applied 3-4 times daily has

10. 10
PEMPHIGUS
During active stage of the lesion, when lateral pressure is applied on
the blister or perilesional skin or normal appearing skin, it results in
removal of upper layer of epidermis known as Nikolsky’s sign
TREATMENT
1. Mouth rinse of Betamethasone sodium phosphate 0.5 mg tablet
dissolved in 10 Ml water .
2. Application ofTriamcinolone 0.1% in adhesive paste.
3. 2.5 mg Hydrocortisone

11. 11
BULLOUS PEMPHIGOID
It is Autoimmune sub epithelial blistering diseases occurring
mainly in adults. Desquamative gingivitis is the most
common oral Manifestation.
TREATMENT
1. Patients with localized oral lesion may be treated with
high potency topical corticosteroids such as 0.05%
clobetasol or betamethasone

12. 12
ERYTHEMA MULTIFORME
It is an acute, self-limiting, inflammatory mucocutaneous
disease, manifesting on the skin and mucosal surfaces
Erythema multiforme is considered as a hypersensitivity
reaction, most common factors being HSV infection or drug
reactions to NSAIDS
TREATMENT
1. Adhesive paste (Orabase) form of clobetasol the most
potent topical corticosteroid, safe and effective

13. ADVERSE
EFFECTS
13
TOPICAL STEROIDS can produce local and systemic adverse
effects when used injudiciously.
Side effects of topical steroids depend on several
factors such as –
1. the amount of steroid applied,
2. surface area covered,
3. the site treated,
4. the nature of the skin/mucosal problem
(inflammation or other disease
5. application frequency,
6. time of application
7. and potency of the steroid.

14. SYSTEMIC
SIDE
EFFECTS
14
Uncommon and are mostly associated with the use
of high potency topical steroids .
IT INCLUDES-
1. Suppression of the hypothalamic-pituitary-
adrenal axis-
(With prolonged use, suppression of HPA axis
and adrenal insufficiency with adrenal gland
atrophy can occur, and it takes months to
recover fully after treatment discontinuation)
2. Iatrogenic Cushing's syndrome
(The increased blood level of glucocorticoids
can also induce features of hypercortisolism or
iatrogenic Cushing's syndrome such as
diastolic hypertension, diabetes, buffalo hump,
facio-troncular obesity, hirsutism, striae,
telangiectasia, skin fragility etc.)

15. SYSTEMIC
SIDE
EFFECTS
15
3. Growth retardation in infants and children
(Excess glucocorticoids leads to short stature due to
suppression of GHRH (growth hormone releasing
hormone) and GH release from the hypothalamus and
pituitary respectively)
4. Ocular: Glaucoma and loss of vision
(Prolonged use of topical steroids on the eyelid can induce
open-angle glaucoma and cataract from
transpalpebraltarsal penetration.)

16. LOCAL
SIDE
EFFECTS
16
The most common adverse effect due to the use of oral
topical corticosteroids is
1. oral candidiasis in either erythematous or
pseudomembranous forms and has been reported
in 25 - 55% of the patients.
Other common local effects are:
1. Mucosal atrophy
2. Perioral dermatitis

17. LOCAL
SIDE
EFFECTS
17
3. Acne from eruptions and hypersensitivity reactions.
Less frequent local adverse effects include :
1. Hypopigmentation
2. Delayed wound healing

18. 18
CONCLUSION
Steroids are considered as the drug of choice in treating many oral mucosal disorders.
They themselves do not cure but control the symptoms by anti-inflammatory action and
immunosuppression.
But their judicious use is of paramount importance as they are considered as double edged
weapons.
Their thorough knowledge is very important as the risks associated with steroids are
equivalent to their therapeutic benefits.

19. 19
REFERENCES
1. ESSENTIALS OF PHARMACOLOGY – KD TRIPATHI
2. TEXTBOOK OF ORAL MEDICINE- Anil Govindrao Ghom , Savita Anil Ghom (Lodam)
3. Topical Corticosteroids: Applications in Dentistry – ORIGINAL RESEARCH ARTICLE
(https://www.ipinnovative.com/journal-article-file/1401 )
4. Systemic and local adverse effects of topical steroids- NCBI
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730992/ )
5. IMAGES – google images and ResearchGate