fluocinonide: clinical use

Prescribing considerations

• Confirm a steroid-responsive diagnosis and exclude untreated infection.
• Absorption increases through thin, raw or occluded skin and when extensive areas are treated.
• Use particular caution on the face, flexures and in children.
• Psoriasis requires careful supervision because rebound relapse and generalised pustular psoriasis can occur.
• Review recurrence with burning or redness beyond the original area before reapplication.

Contraindications and cautions

• Hypersensitivity to fluocinonide or formulation ingredients
• Rosacea, acne or perioral dermatitis
• Tuberculous, syphilitic, fungal or viral skin infection
• Napkin eruption or anogenital pruritus
• Use in children under one year

Monitoring

• Clinical response and diagnostic reconsideration if worsening occurs
• Local atrophy, striae, telangiectasia, pigment change and secondary infection
• Systemic corticosteroid exposure or adrenal suppression when absorption risk is increased
• Growth and systemic effects in children where clinically relevant
• Possible topical steroid withdrawal after prolonged continuous exposure

Clinical pharmacology

A potent synthetic topical corticosteroid with anti-inflammatory, immunosuppressive and vasoconstrictive activity. Percutaneous absorption varies with the vehicle, epidermal integrity and occlusion; absorbed fluocinonide is mainly metabolised hepatically and excreted renally.

Formulation and product differences

• FAPG cream can be used on wet or dry lesions and contains stearyl alcohol and propylene glycol, which may cause local reactions or irritation.
• The ointment is emollient and particularly suitable for dry, scaly lesions; it also contains propylene glycol.
• Both formulations should be used undiluted.