外用藥膏依油性到水性程度：軟(油)膏(Ointment)＞乳膏/乳霜(Cream)＞乳液/洗液(lotion)＞凝膠(Gel) = 溶液(Solution) =泡沫(Foam)= 頭皮洗劑(Shampoo)
|
軟(油)膏(Ointment) |
油膩但保濕，較少添加防腐劑，較不會過敏。適用於乾燥或光滑且角質厚處(手掌、腳掌) |
|
乳膏/乳霜(Cream) |
容易塗抹不油膩、可水洗。光滑且不要太乾或太厚處皆可使用 |
|
乳液/洗液(lotion)、 |
更水更清爽，用於大面積病灶、毛髮部位及皮膚容易摩擦處 |
|
凝膠(Gel) |
水分乾掉形成一層膜，會使皮膚乾燥、刺激，用於身體、臉部、毛髮處 |
|
泡沫(Foam) |
水性的泡泡，加快藥效釋放、增加滲透力，減少刺激性，可用於皮膚、頭髮。注意一開始要先擠在蓋子裡，擠在手上泡沫會因體溫而溶解… |
|
頭皮洗劑(Shampoo) |
就…藥用洗髮精。真要多說什麼，就是洗完後別用你家的洗髮精再洗一遍啊~ |
皮膚外用類固醇藥膏主要作用：
l 抗發炎：抑制前列腺素，減低發炎反應。治療過敏、濕疹、皮膚炎
l 免疫抑制：抑制淋巴球的活性，降低cytokine，治療過敏性/接觸性皮膚炎。所以細菌病毒感染的表皮才不建議塗類固醇，可能惡化。
l 抑制增生：抑制表皮纖維母細胞DNA合成，減少不正常增生，治療乾癬
l 血管收縮：使皮下微血管收縮，減少紅斑。
依據血管收縮能力，將外用類固醇分成7種強度，下表為北榮此時此刻院內有的品項：
|
強度 |
分級 |
學名 |
商品名 |
濃度 |
劑型 |
|
超強 |
I |
Clobetasol propionate |
Clobesol (可必爽) 10 g |
0.05% |
Cream |
|
Vimax (可易適) 25 ml |
Foaming solution |
||||
|
Clobex (柔倍絲) 60 ml |
Shampoo |
||||
|
Dermovate(戴摩膚) 25 g |
Ointment |
||||
|
強效 |
II |
Betamethasone dipropionate |
Septon (舒膚通) 10 g |
0.064% |
Solution |
|
Fluocinonide |
Topsym (妥膚淨) 10 g |
0.05% |
cream |
||
|
III |
Diflucortolone valerate |
Nerisone (乃利爽) 10 g |
0.1% |
Ointment |
|
|
Betamethasone dipropionate,
augmented |
Xamiol (絲玫歐) 30 g |
0.05% |
Gel |
||
|
中 |
IV |
Mometasone furoate |
Elomet (皚膚美得) 5 g |
0.1% |
cream |
|
中弱 |
V |
Betamethasone valerate |
Rinderon-V(臨德隆) 5 g |
0.06% |
Cream |
|
弱效 |
VI |
沒有~ |
沒有~ |
沒有~ |
沒有~ |
|
最弱 |
VII |
Hydrocortisone acetate
(+urea) |
Ureson (優膚松) 16 g |
1% |
Cream |
|
Cort. S.(皮脂醇軟膏) 50 g |
Ointment |
l 要注意，外用類固醇不同鹽基、不同%數，可能強度就不一樣。
l 想要增強吸收，可以洗澡後再擦、或是用封閉性敷料包裹(會增強10倍)
l 超強~強效用於粗皮(手掌、腳掌)、頭皮。
n 超強效用<4 week尚不至於出現皮膚萎縮、血管浮現、長痘痘的症狀，停藥數周可恢復。
n 若像是藥物過敏起疹子，要短期(<4week)使用強效治療也是OK的
l 強~中效用於非臉部軀幹
n 強-中效使用<6-8 week少見負作用
l 中~弱效用於大面積塗抹，為減少全身吸收。或是用於皮膚皺褶、生殖器、臉等薄皮處。
n 嬰兒、老人也是薄皮，用中~弱效。真的嚴重考慮1-2周短期用強效
n 孕婦為減少全身吸收，怕影響胎兒體重，建議用弱效。
|
各部位類固醇吸收比例 腳掌 0.05 % 手掌 0.1 % 前臂 1.0 % 頭皮 3.5 % 臉部 7.0 % 下顎 13 % 眼瞼、生殖器 30 % |
Topical corticosteroids: Use and adverse
effects. Uptodate
給藥量
BTW，以往我們都會跟病人說擦在患部薄薄一層，但每個人對"薄薄一層"的定義不同，會有劑量太高或太低之虞。所以有人發明了一個給藥單位finger-tip unit (FTU)。
操作型定義是，5mm口徑藥膏，擠一個食指節長(約2.5-3cm)，我量過我自己的就剛好是2.5cm。這樣就差不多是0.5g，可以cover兩手掌寬。
手掌兩面：1FTU
腳掌兩面：2FTU
一隻手臂：3-4FTU
一整條腿：6FTU
胸部和腹部：7FTU
背部和臀部：7FTU
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4622891/?fbclid=IwAR14uBmhCX_Usmr0SsWl3yjWNOe4N0AIZ1j9r7XY98xvXe-FhkLJsRliO6U
|
Potency |
Corticosteroid |
Vehicle type/form |
Brand names |
Strength(%) |
|
Super-high potency |
Betamethasone dipropionate, augmented |
Ointment (optimized) |
Diprolene |
0.05 |
|
Gel, lotion |
[Generic only] |
0.05 |
||
|
Clobetasol propionate |
Cream, ointment |
Temovate |
0.05 |
|
|
Gel, solution (scalp) |
[Generic only] |
0.05 |
||
|
Cream |
Tasoprol |
0.05 |
||
|
Cream (emollient base) |
Temovate E¶ |
0.05 |
||
|
Lotion, shampoo, spray aerosol |
Clobex |
0.05 |
||
|
Foam aerosol |
Olux, Olux-E, Tovet |
0.05 |
||
|
Lotion |
Impeklo |
0.05 |
||
|
Ointment |
Clobetavix |
0.05 |
||
|
Shampoo |
Clodan |
0.05 |
||
|
Solution (scalp) |
Cormax¶ |
0.05 |
||
|
Diflucortolone valerate |
Ointment, oily cream |
Nerisone Forte (UK, others) |
0.3 |
|
|
Fluocinonide |
Cream |
Vanos |
0.1 |
|
|
Flurandrenolide |
Tape (roll) |
Cordran |
4 mcg/cm2 |
|
|
Halobetasol propionate |
Lotion |
Ultravate |
0.05 |
|
|
Cream, ointment |
[Generic only] |
0.05 |
||
|
Foam |
Lexette |
0.05 |
||
|
High potency |
Amcinonide |
Ointment |
Cyclocort¶, Amcort¶ |
0.1 |
|
Betamethasone dipropionate |
Ointment |
Diprosone¶ |
0.05 |
|
|
Cream, augmented formulation (AF) |
Diprolene AF |
0.05 |
||
|
Clobetasol propionate |
Cream |
Impoyz |
0.025 |
|
|
Desoximetasone |
Cream, ointment, spray |
Topicort |
0.25 |
|
|
Gel |
Topicort |
0.05 |
||
|
Diflorasone diacetate |
Ointment |
ApexiCon¶, Florone¶ |
0.05 |
|
|
Cream (emollient) |
ApexiCon E |
0.05 |
||
|
Fluocinonide |
Cream, gel, ointment, solution |
Lidex¶ |
0.05 |
|
|
Halcinonide |
Cream, ointment, solution |
Halog |
0.1 |
|
|
Halobetasol propionate |
Lotion |
Bryhali |
0.01 |
|
|
High potency |
Amcinonide |
Cream |
Cyclocort¶, Amcort¶ |
0.1 |
|
Lotion |
Amcort¶ |
0.1 |
||
|
Betamethasone dipropionate |
Cream (hydrophilic emollient) |
Diprosone¶ |
0.05 |
|
|
Betamethasone valerate |
Ointment |
Valisone¶ |
0.1 |
|
|
Foam |
Luxiq |
0.12 |
||
|
Desoximetasone |
Cream, ointment |
Topicort, Topicort LP¶ |
0.05 |
|
|
Diflorasone diacetate |
Cream |
Florone¶, Psorcon |
0.05 |
|
|
Diflucortolone valerate |
Cream, oily cream, ointment |
Nerisone (UK, others) |
0.1 |
|
|
Fluocinonide |
Cream (aqueous emollient) |
Lidex-E¶ |
0.05 |
|
|
Fluticasone propionate |
Ointment |
Cutivate¶ |
0.005 |
|
|
Mometasone furoate |
Ointment |
Elocon¶ |
0.1 |
|
|
Triamcinolone acetonide |
Cream, ointment |
Aristocort HP¶, Kenalog¶, Triderm |
0.5 |
|
|
Medium potency |
Betamethasone dipropionate |
Spray |
Sernivo |
0.05 |
|
Clocortolone pivalate |
Cream |
Cloderm |
0.1 |
|
|
Fluocinolone acetonide |
Ointment |
Synalar |
0.025 |
|
|
Flurandrenolide |
Ointment |
Cordran |
0.05 |
|
|
Fluticasone propionate |
Cream |
Cutivate¶ |
0.05 |
|
|
Hydrocortisone valerate |
Ointment |
Westcort¶ |
0.2 |
|
|
Mometasone furoate |
Cream, lotion, solution |
Elocon¶ |
0.1 |
|
|
Triamcinolone acetonide |
Cream |
Kenalog¶, Triderm |
0.1 |
|
|
Ointment |
Kenalog¶ |
0.1 |
||
|
Ointment |
Trianex, Tritocin |
0.05 |
||
|
Aerosol spray |
Kenalog |
0.2 mg/2 sec spray |
||
|
Dental paste |
Oralone |
0.1 |
||
|
Lower-mid potency |
Betamethasone dipropionate |
Lotion |
Diprosone¶ |
0.05 |
|
Betamethasone valerate |
Cream |
Beta-Val¶, Valisone¶ |
0.1 |
|
|
Desonide |
Ointment |
DesOwen¶, Tridesilon¶ |
0.05 |
|
|
Gel |
Desonate, DesRx |
0.05 |
||
|
Fluocinolone acetonide |
Cream |
Synalar |
0.025 |
|
|
Flurandrenolide |
Cream, lotion |
Cordran, Nolix |
0.05 |
|
|
Fluticasone propionate |
Lotion |
Beser, Cutivate |
0.05 |
|
|
Hydrocortisone butyrate |
Cream, lotion |
Locoid, Locoid Lipocream |
0.1 |
|
|
Ointment, solution |
[Generic only] |
0.1 |
||
|
Hydrocortisone probutate |
Cream |
Pandel |
0.1 |
|
|
Hydrocortisone valerate |
Cream |
Westcort¶ |
0.2 |
|
|
Prednicarbate |
Cream (emollient), ointment |
Dermatop¶ |
0.1 |
|
|
Triamcinolone acetonide |
Lotion |
Kenalog¶ |
0.1 |
|
|
Ointment |
Kenalog¶ |
0.025 |
||
|
Low potency |
Alclometasone dipropionate |
Cream, ointment |
Aclovate¶ |
0.05 |
|
Betamethasone valerate |
Lotion |
Beta-Val¶, Valisone¶ |
0.1 |
|
|
Desonide |
Cream |
DesOwen, Tridesilon |
0.05 |
|
|
Lotion |
DesOwen¶, LoKara¶ |
0.05 |
||
|
Foam |
Verdeso |
0.05 |
||
|
Fluocinolone acetonide |
Cream, solution |
Synalar |
0.01 |
|
|
Shampoo |
Capex |
0.01 |
||
|
OilΔ |
Derma-Smoothe/FS Body, Derma-Smoothe/FS Scalp |
0.01 |
||
|
Triamcinolone acetonide |
Cream, lotion |
Kenalog¶, Aristocort¶ |
0.025 |
|
|
Least potent |
Hydrocortisone (base, ≥2%) |
Cream |
Ala-Cort, Hytone¶, Nutracort¶ |
2.5 |
|
Ointment |
Hytone¶ |
2.5 |
||
|
Lotion |
Hytone¶, Ala Scalp, Scalacort DK |
2 |
||
|
Solution |
Texacort |
2.5 |
||
|
Hydrocortisone (base, <2%) |
Ointment |
Cortaid¶, Cortizone 10, Hytone¶, Nutracort¶ |
1 |
|
|
Cream |
Ala-Cort, Cortaid¶, Cortizone 10, Hytone¶, KeriCort, Synacort¶ |
1 |
||
|
Gel |
Cortizone 10 |
1 |
||
|
Lotion |
Aquanil HC, Cortizone 10, Sarnol-HC |
1 |
||
|
Spray |
Cortaid¶ |
1 |
||
|
Solution |
Cortaid¶, Noble¶, Scalp Relief, Scalpicin |
1 |
||
|
Cream, ointment |
Cortaid¶ |
0.5 |
||
|
Cream |
Instacort |
0.5 |
||
|
Hydrocortisone acetate |
Cream |
MiCort-HC¶ |
2.5 |
|
|
Cream |
Vanicream HC |
1 |
||
|
Lotion |
Nucort |
2 |
|
Glucocorticoid anti-inflammatory equivalent
dose (mg) |
|
|
Short-acting |
|
|
Cortisone |
25 |
|
Hydrocortisone |
20 |
|
Intermediate-acting |
|
|
Prenisone |
5 |
|
Prednisolone |
5 |
|
Triamcinolone |
4 |
|
Methylprednisolone |
4 |
|
Long-acting |
|
|
Dexamethasone |
0.75 |
|
Betamethasone |
0.6-0.75 |
Ref: Topical corticosteroids: Use and
adverse effects. Uptodate.
