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Corticosteroids - Topical
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Corticosteroids - Topical
Corticosteroids are a class
of medications used to control inflammation. They are similar to natural hormones produced by the body. When applied to the
skin, they provide a very effective treatment for a variety of skin problems.
(Corticosteroids are different from
the other “steroids,” such as testosterone, used by athletes and body builders to build muscle mass)
Topical corticosteroids are categorized by their strength. Group 1 (I) corticosteroids are “super potent”
and have the greatest risk of side effects if used for prolonged periods. Group 7 (VII) corticosteroids are “low potency”
and include 1% hydrocortisone, which can be purchased without a prescription.
Corticosteroids are available in
different formulations, including ointments, gels, creams, lotions, foams, or solutions.
The potency of the medication
is determined by several factors including: - The active ingredient used
- The concentration
- The
formulation (cream, ointment or gel)
For instance, a medication with 2% concentration of hydrocortisone is more
potent than a medication with 1% hydrocortisone. Similarly, 2% hydrocortisone ointment may be more potent than 2% hydrocortisone
cream.
The potency of an ointment is often greater than other formulations because the ointment keeps the skin
hydrated, helping the medication to penetrate to deeper layers. Creams, because they absorb more quickly, have greater cosmetic
appeal for most people so are often used on the face. Foams and solutions are useful for penetrating hair-bearing areas, such
as the scalp.
Examples of different corticosteroid strengths: Group 1 (I) Superpotent - Clobetasol,
0.05% (Clobex, Temovate)
- Clobetasol Foam 0.05% (Olux and Olux E)
- Fluocinonide
0.1% (Vanos)
- Halobetasol 0.05%, (Ultravate)
Group 2 (II) Potent - Desoximetasone,
0.05% (Topicort gel)
- Desoximetasone, 0.25% (Topicort cream, ointment)
- Diflorasone
diacetate 0.05% (Psorcon cream)
- Fluocinonide 0.05% (LIdex)
- Halcinonide,
0.1% (Halog)
Group 3 (III) Upper Mid-Strength - Desoximetasone 0.05%
(Topicort LP cream)
- Fluocinonide 0.05% (Lidex-E cream)
- Fluticasone propionate.
0.005% (Cutivate Ointment)
Group 4 (IV) Mid-Strength - Betamethasone
valerate 0.12% (Luxiq foam)
- Fluocinolone acetonide 0.025% (Synalar ointment)
- Hydrocortisone
valerate, 0.2% (Westcort ointment)
- Mometasone furoate 0.1% (Elocon cream, lotion)
- Triamcinalone acetonide 0.1% (Kenalog cream, ointment)
Group 5 (V) Lower
Mid-Strength - Fluocinolone acetonide 0.025% (Synalar cream)
- Fluticasone propionate
0.05% (Cutivate Cream)
- Hydrocortisone valerate, 0.2% (Westcort cream)
- Prednicarbate,
0.1% (Dermatop cream)
Group 6 (VI) Mild - Alclometasone dipropionate,
0.05% (Aclovate cream)
- Desonide, 0.05% (DesOwen cream, lotion and ointment, LoKara lotion,
and Verdeso Foam)
- Fluocinolone acetonide 0.01% (Capex shampoo, Synalar cream and solution)
Group 7 (VII) Least Potent - Hyrocortisone 1%, or 2.5%
Some skin disorders,
such as seborrheic dermatitis, are relatively sensitive to corticosteroids and usually respond well to less potent corticosteroids
in Group 7 (VII) and 6 (IV).
Some more moderately resistant skin diseases, such as adult atopic dermatitis, nummular
eczema, or allergic contact dermatitis may require slightly stronger corticosteroids in Group 5 (V) and 4 (IV).
Resistant skin diseases, such a plaque psoriasis and lichen planus may require treatment with the more potent corticosteroids
in Group 2 (II) and 1 (I).
The corticosteroid recommended may also depend on the body part being treated. Because
the skin on the elbows and knees is relatively thick, stronger formulations can be used more safely on those sites. Conversely,
less potent steroids are usually recommended for the thinner skin of the face and genital area.
Prolonged use of
corticosteroids can lead to side effects, including the thinning of skin (atrophy).
Due to increased risk of side
effects associated with potent corticosteroids, the use of Group 1 and 2 formulations is generally not recommended for periods
longer than two weeks.
Corticosteroids can also cause some skin conditions to worsen, including rosacea, fungal
infections, and scabies. If used for longer than one month, they can create additional skin disorders including perioral dermatitis
and “steroid acne.” Speak to your doctor if your condition worsens while on treatment.
If your skin
condition gets under control following the use of a corticosteroid, your doctor will recommend stopping its use, reducing
the number of times it is applied each week, or taking a less potent formulation. ___________________________________________________________________ This
information is for general educational uses only. It may not apply to you and your specific medical needs. This information
should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.
Communicate promptly with your physician or other health care professional with any health-related questions or concerns.
Be sure to follow specific instructions given to you by your physician or health care professional. Additional Resources- Conditions
- Medications: Topical
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Our goal at NYC Dermatology is to be the Tiffanys of Skin Care.
I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist.
My goal is, quite simply, to provide the type of dermatologic care which I would seek for my own family.
This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those
individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully
meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive.
I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their
skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results.
We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning
website. My philosophy is simple…Experience Counts and Quality Matters. Please allow
me to solve your skin problems. After all, at NYC Dermatology , our philosophy is if you look great you will feel great
with gorgeous skin.” Best
Regards, Dr. Rothfeld
 
Dermatologists are physicians specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages. There are medical and surgical sides to the specialty. Dermatologic surgeons perform skin cancer surgery (including Mohs' micrographic surgery), laser surgery, photodynamic therapy (PDT) and cosmetic procedures using botulinum toxin (Botox), soft tissue fillers, sclerotherapy and liposuction. Dermatopathologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases such as pemphigus. In addition, there is a wide range of congenital syndromes managed by dermatologists. Physician assistants and nurse practitioners with specialized training or extensive experience in dermatology also work in this specialty. Subspecialties The skin is the largest organ of the body and the most visible. Although many skin diseases are isolated, some are manifestations of internal disease.
Hence, a dermatologist is schooled in aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. The study of genetics is also becoming increasingly important.
Venereology, the subspecialty that diagnoses and treats sexually transmitted diseases, and phlebology, the specialty that deals with problems of the superficial venous system, are both part of a dermatologist's expertise.
Cosmetic dermatology
Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary
innovators in this area. In the 1900's dermatologists employed dermabrasion to improve acne scarring and fat microtransfer
was used to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures
to reverse the signs of aging. Botox has been used since it was FDA approved for the treatment of wrinkles. It is used to
minimize wrinkles such as frown lines and crow's feet. Fillers are used to "fill in" lines on the face and to
minimize the appearance wrinkles. Brand names of fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among
many others. Dermatologists are also the pioneers of energy based treatments for the skin and these include lasers, intense
pulsed light, radiofrequency, infrared light and photodynamic treatments.
Dermatologic surgery (dermasurgery) is performed by all dermatologists. Surgery is an integral part of dermatology residency
training; thus all dermatologists are well trained in cutaneous surgery. In North America specialized training through a 1
year dermatologic surgery fellowship is available upon completion of the dermatology residency, and usually focuses on training
in Mohs' micrographic surgery. Most dermatologic surgeons who have a special interest in this field apply for fellowship status with the American College of Mohs Micrographic Surgery
and Cutaneouis Oncology; or the American Society for Dermatologic Surgery. Techniques available to a dermatologic surgeon include lasers, traditional scalpel surgery, electrosurgery, cryosurgery, photodynamic
therapy, liposuction, blepharoplasty (cosmetic eyelid surgery), minimally-invasive facelift surgery (e.g., the S-lift), and
a variety of topical and injectable agents such as dermal fillers including fat transfer and hyaluronic acid. Some specially
trained dermatologic surgeons perform Mohs' surgery, which can be an effective method for the treatment of recurrent, indistinct, or difficult skin cancers.
Any mole that is irregular in color or shape should be examined by a dermatologist to determine if it is a malignant melanoma, the most serious and life-threatening form of skin cancer. Following a visual examination and a dermatoscopic exam (an invaluable
new instrument that illuminates a mole without reflected light), a dermatologist may biopsy a suspicious mole. If it is malignant,
it will be excised in the dermatologist's office.
The first step of any contact with a physician is the medical history. In order to classify a cutaneous eruption, the dermatologist
will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relation to food intake,
sunlight, over-the-counter creams and clothing. When an underlying disease is suspected, an additional detailed history of
related symptoms will be elicited (such as arthritis in a suspected case of lupus erythematosus).
Dermatology has the obvious benefit of having easy access to tissue for diagnosis. Physical examination is generally done under bright light and preferably involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope which enlarges a suspected lesion and visualizes it without reflected light. The dermatoscope is helpful in differentiating
a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition
of lesions and symptoms.
Culture or Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy.
If the diagnosis is uncertain or a cutaneous malignancy is suspected, the dermatologic surgeon may perform a small punch biopsy (using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.
The skin is obviously accessible to topical local therapy. Antibiotic creams can help eliminate infections, while inflammatory skin diseases (such as eczema and psoriasis) often respond to steroid creams or topical anthralin. Dermatologists are innovators of new immune enhancing treatments, like topical imiquimod for
superficial cancers and injection immunotherapy for warts as discussed below.
Topical medications treat many dermatological diseases, but dermatologists also use oral medications. Antibiotics and immune suppressants or immune enhancing agents (injection immunotherapy or topical imiquimod) for dermatological diseases or tumors. Isotretinoin ("Accutane") is used for severe cystic acne vulgaris and often produces a lifetime remission of this disfiguring disease. Isotretinoin prescribing in the U.S. is now controlled
by a cumbersome FDA governmental website called iPLEDGE. Various new modalities of treatment are in the foray; with the advent of laser technology things are quite promising.
Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease (e.g., psoriasis or mycosis fungoides).
Surgical intervention by a dermatologic surgeon may be necessary, for example, to treat varicose veins or skin cancer. Varicose veins can be treated with sclerotherapy (injecting an agent that obliterates the vein) or the long-pulsed Nd:YAG
laser. Skin cancers can be managed with excision (including Mohs cancer surgery), cryosurgery, x-ray, or with the recent topical immune enhancing agent imiquimod. (See above section on "Dermatologic Surgery" for more details.)
Trained in Dermatology, NYC Dermatolgy by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding Dermatologist
in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist,
Dr. Rothfeld in Manhattan treats the most difficult cases until the problem clears. Dr. Rothfeld, a Board
Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never
give up until the problem is cleared. Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology
in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous
and will not give up until the condition resolves. Dr. Rothfeld is recognized as one of the best Dermatologists in NYC
by the entertainment industry.NYC Dermatology is
under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your
skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures.. NYC
Dermatology by Board Certified Dermatologist Dr. Gary Rothfeld is a board certified NYC Dermatologist
with a New York City office in Manhattan, New York providing expert skin care, dermatology, and
cosmetic dermatology services. A board certified dermatologist in NYC specializing
in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld is
known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include
full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and
laser resurfacing. NYC dermatology specializes in chemical peels, vein injections, laser, restylane, Perlane,
Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
As an expert in the field of dermatology and cosmetic dermatologic
surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high
profile national magazines.
Our goal at the manhattan office of Board Certified Derrmatologist , Dr.
Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology
and Cosmetic Surgery Center in Manhattan, New York. Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board
Certified Dermatologist at NYC Dermatology who has treated many patients in the entertainment industry. Schedule an appointment at
our office which provides top of the line expert skin care, dermatology, cosmetic dermatology services,
and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services
including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne
photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser
Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well
as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media office and including different offers and many more. We offer a variety of services from
Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for
a consultation. Beauty Is Forever! and Dr. Rothfeld
at NYC Dermatologist has over 20 years of experience with his beauty tips.
.
During
your office consultation and examination you will be provided with a detailed plan of the treatments that will benefit
you most. NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic
dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser
hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,
services including general dermatology, wrinkle fillers such as Restylane®, Captique, Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®,
Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne,
rosacea, skin cancer and surgery. Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical
hair transplants, and lasers in the country. Acne Photodynamic Treatment
- Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser - Cosmelan Depigmentation Treatment - Glycolic
Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction
- - Surgery - Minimal Scar Technique - Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy
- Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments
- Velasmooth Our cosmetic surgeon includes Dermatologist Dr. Gary Rothfeld Board Certified Dermatologist
at NYC Dermatology. Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical
skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan
office in NYC
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NYC Dermatology - Manhattan Dermatology - Skin Institute of
New York - Skin Cancer Doctor- NYC Cosmetic Dermatology- Cosmetic Dermatological Surgery - New York City -
Board Certified Dermatologist
Manhattan Office
Dr. Gary Rothfeld
NYC Dermatology
- Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
212.644.9494
1.800.BLEMISH
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