⚠️ Warnings
Local and systemic toxicity is common, particularly with prolonged use over large areas of damaged skin, in skin folds and under polyethylene occlusion. When used on the face, treatment should not exceed 5 days.
General
The application site must not be covered with an occlusive dressing.
The use of topical corticosteroids may pose risks in patients with psoriasis for a number of reasons, including the risk of relapse following the development of tolerance, the risk of generalised pustular psoriasis, and local systemic toxicity due to impaired skin barrier function. Close patient monitoring is essential.
Systemic absorption of topical corticosteroids may produce reversible suppression of the HPA (hypothalamic-pituitary-adrenal) axis, with possible glucocorticosteroid insufficiency after withdrawal of treatment. Manifestations of Cushing's syndrome may also occur in some patients during treatment as a result of systemic absorption of topical corticosteroids. Patients receiving high doses of potent topical steroids over large surface areas should be evaluated periodically for evidence of HPA-axis suppression. If suppression occurs, the product should be withdrawn, the frequency of application reduced, or a less potent corticosteroid substituted.
Recovery of HPA-axis function is generally prompt and complete on discontinuation of treatment. Rarely, steroid withdrawal symptoms may occur, requiring supplemental systemic corticosteroids.
Paediatric patients may be more susceptible to systemic toxicity from equivalent doses owing to their larger skin surface area to body weight ratio.
With topical corticosteroid therapy, account must be taken of the depot function of the epidermis, which permits gradual release of corticosteroid accumulated in the stratum corneum after previous application.
If irritation of the treated area occurs, the product should be discontinued and appropriate therapy initiated.
Diprolene is not intended for ophthalmic use. If applied to the eyelids, care should be taken to avoid contact with the eye, as this could induce glaucoma. Cases of cataract have been reported in the literature in patients using corticosteroids for prolonged periods.
Paediatric use
The paediatric population is more susceptible than adults to HPA-axis suppression induced by topical corticosteroids and to the effects of exogenous corticosteroids. This is due to their larger skin surface area to body weight ratio.
HPA-axis suppression, Cushing's syndrome and intracranial hypertension have been reported in paediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in paediatric patients include growth retardation, delayed weight gain, low plasma cortisol levels and absence of response to ACTH stimulation. Signs of intracranial hypertension include bulging fontanelle, headache and bilateral papilloedema.
Visual disturbance
Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, referral to an ophthalmologist should be considered for evaluation of possible causes, which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR), which have been reported after the use of systemic and topical corticosteroids.
