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Home , Hydrocortisone valerate, Philip Showalter Hench

In The Name of God

The role of in skin disease

September 2020

1 Corticosteroids Introduction, Classification

Dr. Zahra Moosavi MD Center for Research and Trainig in Skin Diseases and Leprosy

2 Corticosteroids ......

• Introduction - , Edward calvin Kendall and Philip Showalter Hench awarded ) and ( in 1950 - For their work on hormones of the adrenal cortex -Culminated isolation of - Miracle ...... liberally used … - Adverse side effects - NSAIDs however; treatment for more than 100 conditions 3 •Introduction

Lewis Sarette of Merk co, was the first synthesize started from deoxycholic acid extracted from ox bile.

4 Introduction

• Corticosteroids are a class of hormones produced in adrenal cortex of vertebrates

• Two main classes : • • mineralocorticoids • Involved in many physiological process : stress response, regulation of inflammation, carbohydrates metabolism, protein catabolism,blood electrolyte level,behavior

5 Classification of

Steroids

Sex Hormones Corticosteroids

Progestins Androgens Estrogens Glucocorticoids Mineralocorticoids

Testosterone Estradiol Aldosterone ()

6 • Main corticosteroids produced by adrenal cortex : cortisol and aldestrone

7 Adrenocortical Steroids - Broad Definitions

Glucocorticoids: Regulation of carbohydrate metabolism

Mineralocorticoids: Regulation of electrolyte balance

8 Biosynthesis in the Adrenal

Cholesterol

ACTH

Mineralocorticoid excess Aldosterone (hypokalemia, hypertension, fluid overload)

17 OH- 17 OH- 11-Deoxycortisol Cortisol loss Pregnenolone Progesterone

DHEA Androstenedione Testosterone DHT Androgen depletion

9 Regulation of Cortisol Production

Higher centers

Hypothalamus

CRH

Pituitary

Cortisol

ACTH

Adrenal 10 Corticosteroids

11 Corticosteroids …..

• Topical corticosteroids • Vast action: anti inflammatory anti-mitotic ( inhibition of cell proliferation and collagen synthesis)

• Immunosuppressive

12 Corticosteroids …..

• Mechanism of action genomic & non genomic genomic: mediate through , in cytoplasm nucleous …………….. In proinflamatory cytokine,enzymes.. nongenomic : receptor activation inhibit phospholipase A2,critical for production of inflammatory cytokines, release of arashidonic acid - At high concent inhibits B and T cells .

13 • Potency of topical corticosteroids is the amount of drug needed to produce a desired therapeutic effect …. • Classification • 7 class • Class1 : superpotent • Class VII: least potent

14 Class 1 superpotent propionate 0.05% in any vehicle dipropionateo.o5%gel or ointment diacetate 0.05%oint, 0.1% cream,halobetasol propionate 0.05% cr ,oint

Class II high potency 0.1%oint, Betamethasone dipropionateo.o5%cream or lotion, cr,gel,oint. 0.05%cream,fluocinonide 0.05% cream,or gel or oint,halocinonide 0.1% cr ,oint or solution

Class III medium to high Amcinonide 0.1% cream,Betamethasone dipropionate potency o.o5%cream 0.005%oint, acetonide 0.5% cream or oint

15 Beta methasone valerate 0.1% cr or lotion or foam,desoximethasone 0.5% cr,flucinolone Class IV and V ;medium acetonide 0.025%cr or oint ,fluticasone propionate 0.05% cr, hydrocortisone butyrate potency 0.1% oint, hydrocortisone probutate 0.1% cr, hydrocortisone valerate 0.2% cr,oint,

Alclometasone dipropionate 0.05% cream oint Class VI low potency , 0.05% in any vehicle, flucinolone 0.01% cream , hydrocortisone butyrate 0.1% cream

Class VII least potency Hydrocortisone 1% and 2.5% cream or lotion or oint

16 Clinically Important Corticosteroids

Hormone Action Use Duration Route

Cortisol GC, MC Replace, Anti-inf Short IM, IV, Oral, Topical Cortisone GC, MC Replace, Anti-inf Short Topical GC Anti-inf Medium Oral Triamcinolone GC Anti-inf Medium IM, IV Betamethasone GC Anti-inf Long Oral, Topical GC Anti-inf Long Topical

Beclomethasone GC Anti-inf Long Inhalation Fluticasone GC Anti-inf Long Inhalation MC Replace Long Oral

17 THANK YOU FOR YOUR ATTENTION

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