Desonate

Plain Topical Corticosteroids

For topical dermatologic use only. Not for ophthalmic, oral, or intravaginal use.
Do not use with occlusive dressings.

Cream or ointment:
Apply a thin film to the affected areas.
Lotion:
Shake well before using.
Apply to the affected areas and massage lightly until the lotion disappears.
For the most effective and economical use, hold the nozzle of the bottle very close to the affected areas and gently squeeze.

Foam: 
Shake well before using. 
Turn the can upside down to dispense. 
For application to the face, dispense into the hands and gently massage into the affected areas until the foam disappears. For areas other than the face, the foam may be dispensed directly onto the affected area. 
Rub in gently until the foam disappears. 
Use only enough medication to cover the affected areas. 
This product is flammable. Keep away from fire, flame, and smoking during and immediately after use.
Gel:
Apply a thin film to the affected areas and rub in gently.

skin atrophy / Delayed / Incidence not known
papilledema / Delayed / Incidence not known
increased intracranial pressure / Early / Incidence not known
visual impairment / Early / Incidence not known
ocular hypertension / Delayed / Incidence not known

erythema / Early / 0-2.0
withdrawal / Early / Incidence not known
pseudotumor cerebri / Delayed / Incidence not known
hypothalamic-pituitary-adrenal (HPA) suppression / Delayed / Incidence not known
growth inhibition / Delayed / Incidence not known
adrenocortical insufficiency / Delayed / Incidence not known
glycosuria / Early / Incidence not known
hyperglycemia / Delayed / Incidence not known
hypertension / Early / Incidence not known
Cushing's syndrome / Delayed / Incidence not known
blurred vision / Early / Incidence not known
cataracts / Delayed / Incidence not known
impaired wound healing / Delayed / Incidence not known
skin ulcer / Delayed / Incidence not known
tolerance / Delayed / Incidence not known
contact dermatitis / Delayed / Incidence not known

maculopapular rash / Early / 1.0-10.0
skin irritation / Early / 0-3.0
xerosis / Delayed / 0-2.0
pruritus / Rapid / 0-2.0
infection / Delayed / Incidence not known
hypertrichosis / Delayed / Incidence not known
purpura / Delayed / Incidence not known
striae / Delayed / Incidence not known
folliculitis / Delayed / Incidence not known
skin hypopigmentation / Delayed / Incidence not known
miliaria / Delayed / Incidence not known
telangiectasia / Delayed / Incidence not known
acneiform rash / Delayed / Incidence not known
headache / Early / Incidence not known

Desonate, DesOwen, LoKara, Tridesilon, Verdeso

Rx

Topical low-potency synthetic corticosteroid
Used for corticosteroid-responsive dermatoses
Topical efficacy similar to hydrocortisone

Apply a thin layer topically to the affected skin area(s) 2 to 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis.

Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis. Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.

Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 2 weeks, reassess diagnosis. Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.

Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve. If no improvement is seen within 4 weeks, reassess diagnosis. Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.

Apply a thin layer topically to the affected skin area(s) 2 times daily until symptoms resolve.  If no improvement is seen within 4 weeks, reassess diagnosis. Proactive, intermittent application of topical corticosteroids 1 to 2 times weekly to areas that commonly flare is recommended to help prevent relapses.

Apply as a thin layer topically to the affected skin area(s) 2 to 3 times daily. If no improvement is seen within 2 weeks, reassess diagnosis. The duration of the therapy depends on factors such as the topical corticosteroid potency, disease severity and anatomic location, and age. After improvement, may consider transitioning to lower-potency corticosteroid, using intermittent therapy, and combining treatment with noncorticosteroidal agents. Taper by reducing use to every other day, then twice weekly, then discontinue if adequate control is maintained. Guidelines recommend class 1 to 5 topical corticosteroids for up to 4 weeks for plaque psoriasis not involving intertriginous areas and class 1 to 7 topical corticosteroids for a minimum of up to 4 weeks for scalp psoriasis. Use of topical corticosteroids for more than 12 weeks may be considered under careful supervision.

Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.

Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.

Metyrapone: (Major) Medications which affect pituitary or adrenocortical function, including all corticosteroid therapy, should be discontinued prior to and during testing with metyrapone. Patients taking inadvertent doses of corticosteroids on the test day may exhibit abnormally high basal plasma cortisol levels and a decreased response to the test. Although systemic absorption of topical corticosteroids is minimal, temporary discontinuation of these products should be considered if possible to reduce the potential for interference with the test results.

Desonate/Desonide Topical Gel: 0.05%
Desonide/DesOwen/LoKara Topical Lotion: 0.05%
Desonide/DesOwen/Tridesilon Topical Cream: 0.05%
Desonide/DesOwen/Tridesilon Topical Ointment: 0.05%
Verdeso Topical Foam: 0.05%

While in general corticosteroid dosage must be individualized and is highly variable depending on the nature and severity of the disease and on patient age and response, the area of skin where desonide is applied should be limited.

Cream or ointment 4 applications/day topically; Lotion 3 applications/day topically; Foam or gel 2 applications/day topically.

Cream or ointment 4 applications/day topically; Lotion 3 applications/day topically; Foam or gel 2 applications/day topically.

Cream or ointment 4 applications/day topically; Lotion 3 applications/day topically; Foam or gel 2 applications/day topically.

Foam or gel 2 applications/day topically.

>= 3 months: Foam or gel 2 applications/day topically.
< 3 months: Safety and efficacy have not been established.

Topical corticosteroids exhibit anti-inflammatory, antipruritic, and vasoconstrictive properties. At the cellular level, corticosteroids induce peptides called lipocortins. Lipocortins antagonize phospholipase A2, an enzyme which causes the breakdown of leukocyte lysosomal membranes to release arachidonic acid. This action decreases the subsequent formation and release of endogenous inflammatory mediators including prostaglandins, kinins, histamine, liposomal enzymes and the complement system. Early anti-inflammatory effects of topical corticosteroids include the inhibition of macrophage and leukocyte movement and activity in the inflamed area by reversing vascular dilation and permeability. Later inflammatory processes such as capillary production, collagen deposition, keloid (scar) formation also are inhibited by corticosteroids. Clinically, these actions correspond to decreased edema, erythema, pruritus, plaque formation and scaling of the affected skin.

Desonide is administered topically to the skin as a cream, lotion, foam, or ointment. Circulating levels of desonide are below the level of detection. Once in the systemic circulation, desonide is metabolized in the liver. Excretion is primarily via the urine.

The extent of percutaneous absorption of the topical corticosteroids is dependent on many factors, including the pharmaceutical vehicle and the integrity of the epidermis. Absorption after topical application of desonide is increased in areas that have skin damage, inflammation, or occlusion, or in areas where the stratum corneum is thin such as the eyelids, genitalia, axillae, and face. The use of occlusive dressings with the application of desonide enhances penetration into the skin, and may increase the chance of systemic absorption. Ointments have a hydrating effect, are lipophilic, and enhance the penetration of desonide into the skin. Because desonide contains a substituted 17-hydroxyl group, it is not metabolized in the skin. Repeated application of desonide results in a cumulative depot effect in the skin, which may lead to a prolonged duration of action, increased adverse effects, and increased systemic absorption.

There are no adequate and well-controlled studies of topical application of desonide during pregnancy. Topical corticosteroids, including desonide, should not be used in large amounts, on large areas, or for prolonged periods of time in pregnant women. Guidelines recommend mild to moderate potency agents, such as desonide, over potent corticosteroids, which should be used in short durations. Fetal growth restriction and a significantly increased risk of low birthweight has been reported with use of potent or very potent topical corticosteroids during the third trimester, particularly when using more than 300 grams. Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.

According to the manufacturer, it is not known whether topical administration of desonide could result in sufficient systemic absorption to produce detectable quantities in breast milk. However, most dermatologists stress that topical corticosteroids can be safely used during lactation and breast-feeding. If applied topically, care should be used to ensure the infant will not come into direct contact with the area of application, such as the breast. Increased blood pressure has been reported in an infant whose mother applied a high potency topical corticosteroid ointment directly to the nipples. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally ingested drug, healthcare providers are encouraged to report the adverse effect to the FDA.