Alclometasone (Topical)

INTRODUCTION

Indications

Management of inflammation and pruritus associated with various allergic/immunologic skin problems.

Action

Suppresses normal immune response and inflammation. Therapeutic Effects: Suppression of dermatologic inflammation and immune processes. Adverse Reactions/Side Effects Derm: allergic contact dermatitis, atrophy, burning, dryness, edema, folliculitis, hypersensitivity reactions, hypertrichosis, hypopigmentation, irritation, maceration, miliaria, perioral dermatitis, secondary infection, striae. Misc: adrenal suppression (use of occlusive dressings, long-term therapy).

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess the area being treated to help document whether drug therapy is successful in resolving skin conditions.

• Monitor any new or increased reactions at the site of application, including inflammation, irritation, infection, burning, swelling, exfoliation, and rash. Report severe or prolonged skin reactions to the physician.

• Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

Interventions

• Protect skin from breakdown, especially over bony prominences.

Patient/Client-Related Instruction

• Advise patients on long-term treatment to consult physician before stopping this medication. Stopping the medication suddenly may result in adrenocortical shock (severe hypotension, hypoglycemia, weakness, vomiting). If these signs appear, notify physician immediately; may be life threatening.

• Check that the patient and family or caregivers understand topical application procedures, and adhere to the recommended dosing schedule.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface areas or large amounts applied or use of occlusive dressings may increase systemic absorption.

Distribution: Remains primarily at site of action.

Metabolism and Excretion: Usually metabolized in skin.

Half-life: Unknown.

Contraindications/Precautions

Contraindicated in: Hypersensitivity or known intolerance to corticosteroids or components of vehicle (ointment base or preservatives); Untreated bacterial or viral infections.

Use Cautiously in: Hepatic dysfunction; Diabetes mellitus, cataracts, glaucoma, or tuberculosis (if significant systemic absorption occurs, condition may worsen); Patients with preexisting skin atrophy; OB/Lactation: Chronic use at high-dosages may result in adrenal suppression in mother and growth suppression in children; Pedi: Children may be more susceptible to adrenal and growth suppression).

Interactions

Drug-Drug: None significant.

Route/Dosage

Topical (Adults): Apply to affected area(s) 2–3 times daily (depends on condition being treated).

Availability

Cream: 0.05% Rx. Ointment: 0.05% Rx.