750 West Broadway Suite 905 - Vancouver BC V5Z 1H8 Phone: 604.283.9299 Fax: 604.648.9003 Email: [email protected] Web: www.donovanmedical.com

INFORMATION ON TOPICAL

What are topical steroids? • Topical steroids are cream, lotions, ointments, foams or shampoos that are used for treating hair loss.

• There are many different types that you may be prescribed. Some are “strong steroids” and others are “weak steroids.” It is important to focus on the name of the not the concentration of the steroid when determining if you were prescribed a strong steroid or a weak steroid. For example, proprionate 0.05 % is much much stronger than 2.5 % even though the number 2.5 is greater than 0.05

• A list of steroids from strongest to weakest is shown on the last page of this handout.

• Topical steroids help to reduce inflammation and that’s why it’s used in some types of scarring hair loss conditions (such as scarring hair loss and alopecia areata)

How are topical steroids prescribed? • Dr. Donovan will tell you how much and how often to use your topical steroid. It may be once or twice per day or once or twice per month.

• Please follow the directions carefully. It is very important that you do not overuse the steroid given.

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Can I use topical steroids with other treatments? • Generally speaking, it is usually possible to use a topical steroid with other topical and oral treatments. However, be sure to review all your medications with Dr. Donovan so he can get a clear sense of what you are using.

Who should not use topical steroids?

• You need to let Dr Donovan know if you take any medications.

• Topical steroids may not be appropriate for everyone

What side effects are possible with topical steroids?

• Despite the fear in the public, topical steroids are quite safe. In fact, when used properly, topical steroids are among the safest of all treatments that are used for some types of hair loss. Nevertheless, one must respect these medications just like one must respect any medication. One must not overuse these medications and one must return to a physician for periodic monitoring of their topical steroid use.

• The use of topical steroids for more than 6 months without having a physician review the use is not permitted in our clinic. If you are using a topical steroid, you must be seen by Dr. Donovan. Should you not wish to be evaluated by Dr. Donovan you must be seen by a physician who will assume care.

• Acne and pimples

• Rarely itching

• Worsening of some conditions (especially with alcohol containing topical steroids)

• Worsening of some types of underlying infections (fungal infections especially)

• Thinning of the skin (atrophy)

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Side Effects of Topical Steroids (continued)

• With excessive use, absorption of steroids into the body can occur leading to alterations in blood sugars, elevated cholesterol, mood changes, altered menstrual cycles in women, fatigue, weight gain, stretch marks, thinning of the bones, blood pressure issues, cataracts. It is important to be aware that these issues are very uncommon with the proper use of topical steroids.

• If excessive amounts are used one can develop dependency upon withdrawal of the topical steroid (red scalp and steroid withdrawal syndromes)

Please note:

Topical steroids are quite safe when used in the right amount and for the right period of time AND WITH THE RIGHT MONITORING.

The use of topical steroids for more than 6 months without having a physician review the use is not permitted in our clinic. If you are using a topical steroid, you must be seen by Dr. Donovan. Should you not wish to be evaluated by Dr. Donovan you must be seen by a physician who will assume care.

What side effects should prompt me to STOP topical steroids and get medical attention? • Any symptom that makes you not feel well

• Stop if you get numbness of tingling in any area

• Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue)

• fever, • chills, or persistent sore throat; • general feeling of discomfort; • joint pain or swelling;

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INFORMATION ON TOPICAL STEROIDS - 4

• loss of appetite; mental or mood changes; nausea or vomiting; pain, swelling, or redness at the injection site; red, swollen, or blistered skin; • severe stomach pain; unusual bruising or bleeding; • vision changes; wheezing; yellowing of eyes or skin, joint pain, itching, runny nose.

You must advise Dr. Donovan right away if you come to be diagnosed with

• Excess stretch marks • Bone tests showing developed of osteoporosis or osteopenia • Cataracts • Weight gain • New onset blood pressure issues • Changes in your mood (depression, anxiety)

TOPICAL STEROIDS GROUPS

Topical Steroid Group I (“STRONG STEROIDS”)

• Clobetasol diproprionate 0.05% (Temovate) • diproprionate 0.25% (Diprolene) • Halbetasol proprionate 0.05% (Ultravate) • diacetate 0.05% (Psorcon)

Topical Steroid Group II

• 0.05% (Lidex) • 0.05% (Halog) • 0.05% (Cyclocort) • 0.25% (Topicort)

Topical Steroid Group III

• Triamcinalone acetonide 0.5% (Kenalog, Aristocort cream) • furoate 0.1% (Elocon ointment) • Fluticasone proprionate 0.005% (Cutivate) • Betamethasone diproprionate 0.05% (Diprosone)

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TOPICAL STEROIDS GROUPS - CONTINUED

Topical Steroid Group IV (MODERATE POTENCY)

• acetonide 0.01-0.2% (Synalar, Synemol) • Hydrocortisone valerate 0.2% (Westcort) • Hydrocortisone butyrate 0.1% (Locoid) • Flurandrenolide 0.05% (Cordran) • Triamcinalone acetonide 0.1% (Kenalog, Aristocort A ointment) • Mometasone furoate 0.1% (Elocon cream, lotion)

Topical Steroid Group V

• Triamcinalone acetonide 0.1% (Kenalog, Aristocort cream, lotion) • 0.05% (Cutivate cream) • 0.05% (Tridesilon, DesOwen ointment) • 0.025% (Synalar, Synemol cream) • Hydrocortisone valerate 0.2% (Westcort cream)

Topical Steroid Group VI

• 0.05% (Aclovate cream, ointment) • Triamcinalone acetonide 0.025% (Aristocort A cream, Kenalog lotion) • Fluocinolone acetonide 0.01% (Capex shampoo, Dermasmooth) • Desonide 0.05% (DesOwen cream, lotion)

Topical Steroid Group VII (VERY WEAK STEROIDS)

• Hydrocortisone 2.5% (Hytone cream, lotion, ointment) • Hydrocortisone 1% (Many over-the-counter brands)

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