Treat infection if present; discontinue if infection persists or worsens. Do not use near eyes, or on diaper dermatitis or pre-existing skin atrophy. Do not use fluorinated steroids longer than 1 week on the face. Avoid abrupt cessation in chronic use. Systemic absorption increased by broken or inflamed skin, prolonged use, application to large surface area, or use of occlusive dressings. Occlude only if necessary; do not occlude higher potency products. Monitor adrenal function in children if a high potency product or occlusion is used, and in adults if more than 50g weekly of a high potency product is used. Discontinue or reduce dose or potency if HPA axis suppression, Cushing's syndrome, hyperglycemia, glucosuria, or irritation occurs. Use lowest effective dose and potency (esp. in children). Use caution if applying to face or body folds. Do not use continuously or for prophylaxis. Foams are flammable. Reevaluate periodically. Pregnancy (). Nursing mothers.
No metabolites of fluticasone propionate were detected in an in vitro study of radiolabeled fluticasone propionate incubated in a human skin homogenate. The total blood clearance of systemically absorbed fluticasone propionate averages 1,093 mL/min (range, 618 to 1,702 mL/min) after a 1-mg intravenous dose, with renal clearance accounting for less than % of the total. Fluticasone propionate is metabolized in the liver by cytochrome P450 3A4-mediated hydrolysis of the 5- fluoromethyl carbothioate grouping. This transformation occurs in 1 metabolic step to produce the inactive17-ÃŸ-carboxylic acid metabolite, the only known metabolite detected in man. This metabolite has approximately 2,000 times less affinity than the parent drug for the glucocorticoid receptor of human lung cytosol in vitro and negligible pharmacological activity in animal studies. Other metabolites detected in vitro using cultured human hepatoma cells have not been detected in man.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.