In The Name of God The role of corticosteroids 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 - Tadeusz Reichstein, Edward calvin Kendall and Philip Showalter Hench awarded Nobel prize ) physiology and medicine( in 1950 - For their work on hormones of the adrenal cortex -Culminated isolation of cortisone - 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 steroid hormones produced in adrenal cortex of vertebrates • Two main classes : • glucocorticoids • mineralocorticoids • Involved in many physiological process : stress response, regulation of inflammation, carbohydrates metabolism, protein catabolism,blood electrolyte level,behavior 5 Classification of Steroids Steroids Sex Hormones Corticosteroids Progestins Androgens Estrogens Glucocorticoids Mineralocorticoids Testosterone Estradiol Cortisol Aldosterone (hydrocortisone) 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 Corticosteroid Biosynthesis in the Adrenal Cholesterol ACTH Mineralocorticoid excess Pregnenolone Progesterone Corticosterone Aldosterone (hypokalemia, hypertension, fluid overload) 17 OH- 17 OH- 11-Deoxycortisol Cortisol Glucocorticoid 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 glucocorticoid receptor , 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 Clobetasol propionate 0.05% in any vehicle Betamethasone dipropionateo.o5%gel or ointment Diflorasone diacetate 0.05%oint,fluocinonide 0.1% cream,halobetasol propionate 0.05% cr ,oint Class II high potency Amcinonide 0.1%oint, Betamethasone dipropionateo.o5%cream or lotion,desoximetasone cr,gel,oint. Diflorasone diacetate 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 fluticasone propionate 0.005%oint, triamcinolone 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 , desonide 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 Prednisone GC Anti-inf Medium Oral Triamcinolone GC Anti-inf Medium IM, IV Betamethasone GC Anti-inf Long Oral, Topical Dexamethasone GC Anti-inf Long Topical Beclomethasone GC Anti-inf Long Inhalation Fluticasone GC Anti-inf Long Inhalation Fludrocortisone MC Replace Long Oral 17 THANK YOU FOR YOUR ATTENTION 18.