Topical glucocorticoids іn dermatological practice: the problem of efficiency and safety

Abstract

The problem of choosing the optimal glucocorticoids for topical use regularly arises for any physician involved in the treatment of dermatological diseases. When solving this problem, the doctor should take into account the nature, severity and localization of the pathological process, the patient's age, as well as the potency and the safety profile of the drug itself. One of the most common approaches to making the optimal choice of glucocorticoids for topical use, which is designed to reduce potential risks, involves administration the least active drugs at the beginning of the treatment, if they are ineffective, they switch to the use of more active drugs, and further the most active drugs. An obvious disadvantage of this approach is the duration of the procedure of the empirical selection of the drug, which can significantly impede treatment. The emergence of VI generation glucocorticoids, such as mometasone furoate, methylprednisolone aceponate and prednicarbate. The therapeutic potential of these drugs combines high activity and safety of use. It has changed the situation significantly and helped to solve the problem of the safe use of glucocorticoid drugs in pediatric and geriatric practice for the treatment of severe forms of dermatological diseases wich requires administration of the active glucocorticoids. The paper contains an overview of the main classification systems that are applied to glucocorticoids intended for use in dermatological practice, and a short analysis of literary data regarding the experience of the clinical use of VI generation glucocorticoids. The article also contains a retrospective overview of development of main approaches to improving the pharmacotherapeutic properties of topical glucocorticoids. Special attention is paid on the analysis of the influence of peculiarities of the chemical structure of drugs into pharmacokinetic and pharmacodynamic parameters. Keywords: corticosteroid-responsive dermatoses, mometasone furoate, methylprednisolone aceponate, prednicarbate.