Fluocinolone (topical)

Topical fluocinolone is used to treat the symptoms of eczema, psoriasis, seborrhea, and other inflammatory skin conditions.

Overview

Topical fluocinolone is used to treat a variety of skin conditions and their symptoms, particularly itching, redness, inflammation, dryness, scaling and crusting. It may be prescribed to people with eczema, seborrhea, psoriasis, allergic reaction, and other similar inflammatory dermatological conditions. It is a steroid and works by reducing chemical actions in the body which cause inflammation.

Steroids can cause a wide variety of side effects, but topical application of fluocinolone can help to minimize these and ensure that only the affected area is treated. However, steroids can still be absorbed through the skin, and some people may notice side effects of fluocinolone as a result. To minimize the risk of side effects, it's important that patients only use a small amount of fluocinolone, as directed, and do not use it for any longer than instructed by their doctor.

Fluocinolone is only available with a doctor's prescription, and in the US it is known by the brand names Capex, Derm-SmootheFS, and Synalar. It is available in the following dosage forms:

  • Cream
  • Ointment
  • Lotion
  • Oil (usually used for psoriasis of the scalp)
  • Shampoo (usually used for seborrheic dermatitis of the scalp)
  • Gel/Jelly
  • Solution

Conditions Treated?

  • Allergic reaction
  • Eczema
  • Psoriasis
  • Seborrhea
  • Other inflammatory skin conditions

Type Of Medicine?

  • Corticosteroid

Side Effects

Sometimes fluocinolone can cause unwanted effects as well as its necessary effects. While it is unlikely that a patient will experience all of these side effects, they should be prepared for them so that they can seek medical attention when necessary. Some side effects are very severe, while others are minor and can be tolerated.

If any of the following side effects are noticed, seek medical attention immediately:

  • More common

O Aches and pains throughout body

O Unusual weakness or tiredness

O Headache

O Congestion, or stuffy or runny nose

O Tender or swollen glands in the neck

O Difficulty swallowing

O Dry or sore throat

O Cough

O Hoarseness

O Voice changes

O Fever

O Lightening of skin

O Lightening of treated areas of dark skin

  • Less common

O Acne or pimples

O Blistering, crusting, itching, irritation or reddening of the skin

O Swelling of the skin

O Accumulation of pus

O Pinpoint red blisters on skin with burning and itching

O Itchy, raise, round, smooth, skin-colored bumps on just one area of body

O Raised, dark red, wart-like spots on skin, particularly on the face

O Burning, itching and pain in hairy areas

O Pus at the root of hairs

O Oozing of thick, white fluid

O Swollen, red, tender area of infection

O Dry, cracked, scaly skin

O Thickened patches of skin

O Flushing or redness of skin

O Darkening of the skin

O Hearing changes

O Earache or pain in ear

O Ear drainage

O Redness or swelling in ear

O Diarrhea

O Vomiting

  • Incidence unknown

O Redness and scaling around mouth

O Thinning, weakness or wasting of the skin

The following side effects are minor and don't usually require medical attention, unless they become very severe or prolonged. They may dissipate once your skin adjusts to fluocinolone. If you are concerned about them or have questions about them, consult your doctor.

  • Less common

O Changes in skin color

O Shiny skin

  • Incidence unknown

O Increased hair growth on forehead, back, arms and legs

O Reddish, purplish lines on arms, face, legs, trunk or groin

O Softening of skin

This may not be an exhaustive list of all side effects that could be caused by fluocinolone. If you notice any other side effects not listed here, consult your doctor as soon as possible. You could also report new side effects to the FDA.

Dosage

The following are average dosages and may differ from the dosages prescribed to you by your doctor. Always follow your doctor's instructions, as applying less fluocinolone could make the medicine less effective, and applying more could increase the risk of harmful side effects. Follow the entire course prescribed to you, even if symptoms of your skin condition dissipate, as stopping the treatment early without approval from your doctor could cause the symptoms to return.

For skin redness, itching and swelling:

  • Cream, ointment, and solution:

O Adults'Apply to affected areas three to four times each day

O ChildrenĀ ' Use and dose determined by doctor

  • Body oil:

O Adults'Apply to affected areas three times each day for up to 2 weeks

O Children ages 3 months and older' Apply to affected areas two times each day for up to 4 weeks

For seborrheic dermatitis:

  • Shampoo:

O Adults' Use on scalp once each day

O Children' Use and dose determined by doctor

For scalp psoriasis:

  • Scalp oil:

O Adults'Apply to affected areas of scalp and leave overnight

O Children aged 2 years and older' Apply to affected area twice each for up to 4 weeks

How to use topical fluocinolone

Your medicine will come with application instructions. Read these thoroughly before you start using the medicine so that you apply it correctly.

For fluocinolone cream, ointment, solution and oil, first wash or soak the affected area (unless this causes skin irritation) and pat dry. Then apply the medicine in a thin film on the affected area and gently rub it into the skin.

For fluocinolone shampoo, use it just as you would a normal shampoo. Wet the hair and scalp, then apply the shampoo and massage the scalp gently. Thoroughly rinse the shampoo with clean water.

For application of oils or solutions to the scalp, part the area in the affected areas and apply a small amount of the medicine to the scalp. Gently rub it in. You should avoid getting the treated area wet or rubbing at it until the oil or solution dries. You can wash your hair as usual when using scalp oils or solutions, but do not wash the hair immediately after applying them. It is usually recommended to apply these treatments at night before going to bed so that they have time to dry overnight. Hair could then be washed the following morning.

If applying fluocinolone to the face, take care to avoid contact with eyes. You should also avoid prolonged use on the face, around the genitals or rectal area, in skin creases and in the armpits, unless your doctor instructs you otherwise.

It is important to avoid applying cosmetics or other skin products (such as lotions or perfumes) on the treated area unless they have been approved by your doctor. This is because they may interact with fluocinolone or they may simply make your skin condition worse.

You should not cover treated areas of skin with bandages or wraps, unless directed by a doctor. If using on children around the diaper area, do not dress the child in plastic pants or tight-fitting diapers. Covering the treated area in this way can cause more of the medicine to be absorbed by the skin than is expected, which could increase the risk of side effects.

If you have been told to use wraps or bandages on the treatment area by your doctor, follow these steps:

  • Soak or wash the affected area
  • Apply the medication in the affected skin while it is still moist
  • Cover the treated area with plastic wrap and hold it in place with gauze, bandage or adhesive tape, taking care to apply these to areas of unaffected skin. You may use plastic gloves on hands, plastic bags on feet, or a shower cap on the scalp if this is more convenient than plastic wrap.
  • Seal the edges of the plastic to ensure a close fit to the skin.
  • Leave the plastic wrap on for as long as your doctor instructs, usually up to 12 hours each day
  • Cleanse the skin and reapply the medicine each time a new wrapping is applied.

Missed doses

If you miss a dose of fluocinolone, apply it as soon as you remember. However, if it is almost time for the next dose, simply skip the missed dose and continue with your normal dosing schedule. Never double doses of fluocinolone as doing so could increase the risk of side effects.

Interactions

It is unlikely that fluocinolone will interact with other medicines. However, you should still make sure your doctor knows about all the prescribed and over-the-counter medicines you take. They should also be aware of other treatments you are undergoing (particularly cancer chemotherapy agents), other topical products you use, and any herbal supplements or vitamins you take.

Warnings

Pediatric use

Some types of topical fluocinolone may be suitable for children, but it's important to note that children can absorb larger amounts of the medicine through the skin, which could make them more susceptible to side effects. Follow your doctor's dosage instructions carefully when administering fluocinolone to a child.

If you are using fluocinolone on the diaper area, do not apply tight-fitting diapers or plastic pants over the top as this may cause more of the of the medicine to be absorbed than is expected. Ask your healthcare provider for advice on appropriate diapers or pants to use throughout treatment.

Worsening symptoms

If your skin condition appears to worsen when using fluocinolone, consult your doctor as soon as possible. You should also call your doctor if you notice signs of skin infection, such as swelling, warmth of the skin, or oozing pus.

Use on open wounds

Fluocinolone should not be used on open wounds. This includes on scrapes, cuts or burns. If the medicine does come into contact with these areas, it should be thoroughly rinsed away with water as soon as possible. If you develop a scrape, cut or burn on the area that needs to be treated, consult your doctor.

Risk of adrenal gland problems

Fluocinolone may cause adrenal gland problems (Cushing's syndrome) if large amounts are used for long periods of time. You should use topical fluocinolone sparingly and only apply it as often and for as long as instructed by your doctor. If you notice any of the following symptoms of adrenal gland problems, consult your doctor straight away:

  • Fast, pounding or irregular heartbeat
  • Dizziness or fainting
  • Blurred vision
  • Increased thirst
  • Increase urination
  • Unusual tiredness or weakness
  • Irritability

Other medical problems

The following medical problems may be worsened by fluocinolone:

  • Cushing's syndrome (adrenal gland disorder)
  • Hyperglycemia (high blood sugar)
  • Diabetes
  • Intracranial hypertension (high pressure in head)

The following medical problems could increase the risk of side effects associated with fluocinolone:

  • Infection of skin near application area
  • Large sores, broken skin, or severe skin injury near application area

You should also tell your doctor if you have ever suffered from the following conditions, which may affect the use of fluocinolone:

Allergy

If you have experienced an allergic reaction to fluocinolone in the past, or to other corticosteroids or any of the ingredients in the topical fluocinolone prescribed to you, tell your doctor. You should make sure your doctor knows about all the allergies you suffer from so that they do not prescribe a treatment which could be harmful to you. Seek urgent medical attention if you notice any of the following signs of allergic reaction:

  • Skin rash
  • Swelling of face, eyes, lips, tongue or throat
  • Wheezing or chest tightness
  • Labored breathing

Pregnancy and breastfeeding

Animals studies have shown that corticosteroids like fluocinolone could cause harm to the fetus when used during pregnancy. There is a lack of data from controlled human studies to establish the risks of corticosteroids during pregnancy. For this reason, the FDA have classed fluocinolone as a pregnancy category C drug, which means it should only be used if the benefits to the mother far outweigh potential risks to the fetus. Topical corticosteroids in general should not be used in large amounts or for extended periods during all trimesters or pregnancy.

It is not known whether topical fluocinolone is excreted in human breast milk and, if so, what effects it could have on nursing infants. Caution should therefore be exercised when considering this medicine for nursing mothers. Corticosteroids like fluocinolone should never by applied to the breasts if the patient is breastfeeding, but it may be used on other areas of the body if the benefits of the drug outweigh potential risks to the nursing infant.

Storage

Store topical fluocinolone in the container it came in with the lid tightly closed when not in use. Keep the medicine out of reach and sight of children and away from pets. It should be kept at room temperature, away from direct light, heat or moisture. It should not be allowed to freeze.

If you have unused or expired fluocinolone, ask your healthcare provider how to dispose of it. Do not pour it down the sink or flush it down the toilet. There may be a local medicine take-back program offered by your healthcare provider, pharmacy or garbage or recycling department which allows you to dispose of medicines safely without them causing harm to the environment or to other people.

Summary

Topical fluocinolone is used to treat itching, redness, scaling, crusting, dryness and other symptoms associated with inflammatory skin conditions like eczema, psoriasis and seborrhea. It can only be purchased with a doctor's prescription, and is available in cream, ointment, lotion, oil, and shampoo forms.

Fluocinolone should only be applied as frequently and for as long as directed by a doctor. It is a corticosteroid and can cause serious side effects if large amounts are absorbed by the skin. The treated areas should not be wrapped or bandaged unless directed by a doctor, as doing so could increase the amount of medicine absorbed by the skin. Similarly, when applied to children's diaper areas, plastic pants and tight-fitting diapers should be avoided.

If symptoms do not improve or they become worse after using fluocinolone, consult your doctor. You should also call your doctor if signs of infection occur.