fludroxycortide: clinical use

Prescribing considerations

• Confirm a steroid-responsive diagnosis and exclude infection, rosacea, acne and perioral dermatitis.
• Minimise treated surface area and avoid long-term continuous exposure, particularly on damaged skin, flexures or under occlusion.
• Facial and paediatric treatment require particular restriction and review.
• If disease worsens or rapidly recurs after withdrawal, reassess for infection, allergy, another diagnosis or topical steroid withdrawal.
• Discuss the cream's paraffin fire risk.

Contraindications and cautions

• Hypersensitivity to fludroxycortide or formulation components
• Untreated bacterial, viral or fungal skin infection
• Cutaneous tuberculosis; chickenpox and vaccinia are additionally contraindicated for tape
• Facial rosacea, acne vulgaris and perioral dermatitis
• Perianal or genital pruritus
• Infant dermatoses, including napkin eruption

Monitoring

• Assess response, local atrophy, telangiectasia, secondary infection and contact allergy.
• Consider HPA-axis assessment when substantial absorption is plausible.
• Monitor growth and development with clinically significant paediatric exposure.
• Review for hyperglycaemia, Cushingoid features or adrenal suppression if systemic absorption is suspected.

Clinical pharmacology

Fludroxycortide is a fluorinated synthetic potent topical corticosteroid. Absorption increases through damaged skin, across large areas and under occlusion.

Formulation and product differences

• Cream suits moist or weeping lesions.
• Tape adds occlusion for persistent, localised, especially dry and scaly lesions; it is not advocated for acute weeping disease.
• Cream contains cetyl alcohol, propylene glycol and paraffin.
• Tape has an acrylate adhesive on a low-density polyethylene backing with a removable silicone-coated paper liner.

Cream

Route: Cutaneous

Strengths: 0.0125% w/w