TOPICAL FLUTICASONE PROPIONATE - A REVIEW OF ITS PHARMACOLOGICAL PROPERTIES AND THERAPEUTIC USE IN THE TREATMENT OF DERMATOLOGICAL DISORDERS

Fluticasone propionate is a fluoromethyl androstane 17 beta-carbiothio ate that is classified for dermatological use as a moderate potency co rticosteroid. It is available in 0.05% cream and 0.005% ointment formu lations for the treatment of patients with inflammatory dermatoses res ponsive to corticosteroids. Although it demonstrates greater activity than other corticosteroids of similar potency in vasoconstrictor assay s in humans, fluticasone propionate demonstrates low potential to caus e significant systemic effects such as suppression of the hypothalamop ituitary-adrenal (HPA) axis. This is because it has a high affinity So r the glucocorticoid receptor and high lipophilicity, and the small am ount of drug that is absorbed is rapidly metabolised to the inactive c arboxylic acid derivative in the liver (i.e. it has low systemic bioav ailability). In clinical trials, the efficacy of fluticasone propionat e cream at 4 weeks did not differ significantly from that of hydrocort isone butyrate 0.1% cream in patients with moderate to severe atopic d ermatitis and betamethasone valerate 0.1% cream in patients with moder ate to severe psoriasis. Likewise, after 4 weeks, the ointment form of fluticasone propionate had similar efficacy to betamethasone dipropio nate 0.05% in patients with psoriasis or atopic dermatitis, although t he latter agent may have a faster onset of activity in patients with a topic dermatitis. Fluticasone propionate ointment was generally more e ffective than hydrocortisone butyrate ointment in patients with psoria sis. A sustained response was usually observed after about I week's ap plication of fluticasone propionate, and although once and twice daily administration had similar efficacy, a twice daily regimen may have a slightly faster onset of effect In trials which included both adults and children, the only adverse events reported were local cutaneous re actions (most frequently, pruritus). Thus, fluticasone propionate, wit h its low potential for systemic toxicity and possible advantage of on ce daily administration is a useful addition to the topical corticoste roids available for the treatment of psoriasis and atopic dermatitis.