Desonide

A. Approved Indications

• Mild to Moderate Corticosteroid-Responsive Dermatoses, including:
• Atopic dermatitis
• Contact dermatitis (allergic and irritant)
• Seborrheic dermatitis
• Psoriasis (limited, non-severe)
• Lichen simplex chronicus
• Eczema (including nummular eczema)
• Intertrigo

B. Clinically Accepted Off-Label Uses

• Perioral dermatitis (short-term use under close supervision)
• Post-inflammatory hyperpigmentation (adjunctive, with caution)
• Pruritus of various dermatologic conditions (especially in sensitive skin areas like face or groin)
• Radiation-induced dermatitis (supportive topical therapy)

A. Adults

• Desonide 0.05% cream, lotion, gel, or ointment:
• Apply a thin film to the affected area two to four times daily, depending on formulation and severity.
• Treatment should be limited to the smallest effective amount for short durations, typically not exceeding 2–4 weeks.

B. Pediatric Patients

• Safe for use in children ≥3 months of age, particularly in mild corticosteroid-responsive conditions.
• Use with caution on thin skin areas and avoid prolonged use to prevent systemic absorption.

C. Elderly

• Use the same dosing as adults but with caution due to skin thinning and increased risk of atrophy.

D. Special Populations

• Hepatic/Renal Impairment: Not systemically absorbed in most cases; dose adjustments not typically necessary.
• However, caution is advised if large areas are treated or occlusion is used, which can increase systemic exposure.

Route of Administration: Topical

Duration of Use:

• Usually no longer than 2 weeks on the face or intertriginous areas.
• In chronic conditions, intermittent therapy may be recommended.

Desonide is a low-potency synthetic corticosteroid that exerts its effect by penetrating the skin and binding to cytoplasmic glucocorticoid receptors. This complex then translocates to the nucleus, where it modulates the transcription of anti-inflammatory genes and suppresses pro-inflammatory cytokines, prostaglandins, and other mediators. The result is a reduction in inflammation, itching, erythema, and edema, providing symptomatic relief in corticosteroid-responsive dermatoses.

• Absorption: Minimal systemic absorption when used as directed on intact skin; absorption may increase with:
• Occlusive dressings
• Broken/inflamed skin
• Prolonged use
• Application to large surface areas
• Distribution: Not applicable due to local effect; systemically, it binds to corticosteroid receptors in tissues if absorbed.
• Metabolism: Once absorbed, metabolized primarily in the liver via pathways similar to endogenous corticosteroids.
• Elimination: Excreted primarily via urine as inactive metabolites.
• Half-life: Not well defined due to low systemic absorption; systemic half-life is considered short when absorbed.

• Pregnancy:
• Under the current FDA labeling system, desonide is not assigned a letter category.
• Topical use during pregnancy is generally considered low risk when used appropriately.
• Prolonged or extensive application should be avoided, especially under occlusion.
• Lactation:
• Excretion in breast milk is unknown, but systemic absorption is minimal.
• Safe to use during breastfeeding if not applied to the nipple or areola area.
• Wash thoroughly before breastfeeding if applied to the breast area accidentally.

• Primary Class: Corticosteroid
• Subclass: Low-potency topical corticosteroid
• Potency Group: Group VI or VII (least potent category in US classification)

• Known hypersensitivity to desonide or any component of the formulation
• Presence of untreated bacterial, viral, fungal, or parasitic skin infections
• Rosacea and perioral dermatitis (especially on the face, unless used under specialist supervision)
• Tuberculous or syphilitic skin lesions

• Systemic absorption risk: Especially with large surface areas, broken skin, prolonged use, or occlusion
• Adrenal suppression: Possible if used excessively or in young children
• Skin atrophy: Common with prolonged use, particularly on face, groin, or underarms
• Ocular exposure: Avoid contact with eyes; may increase risk of glaucoma or cataracts
• Pediatric use: Increased risk of systemic corticosteroid effects (e.g., HPA axis suppression, growth retardation)
• Secondary infection: May mask or worsen infections; monitor for signs of bacterial or fungal superinfection

Common (≥1%):

• Skin: Burning, stinging, dryness, irritation, erythema
• Others: Pruritus, skin thinning (with prolonged use)

Less Common (0.1–1%):

• Folliculitis, acneiform eruptions
• Hypopigmentation
• Perioral dermatitis

Rare (<0.1%) or Serious:

• Systemic absorption effects: Adrenal suppression, especially in infants or with overuse
• Ocular complications: Raised intraocular pressure, glaucoma (if near eyes)
• Skin infections: Bacterial or fungal overgrowth with prolonged use

• Drug-Drug: Minimal systemic interactions due to topical application, but possible interactions if absorbed:
• May increase systemic corticosteroid exposure when combined with other topical or systemic steroids.
• Drug-Food/Alcohol: No known food or alcohol interactions.
• Enzyme Involvement: Systemic metabolism via hepatic CYP enzymes if absorbed, though clinically insignificant with normal topical use.

• American Academy of Dermatology (AAD) Guidelines (2023) continue to recommend desonide as a first-line topical corticosteroid for inflammatory dermatoses involving sensitive areas (e.g., face, groin, skin folds).
• Updated pediatric dermatology guidelines endorse short-term desonide use in infants over 3 months for mild atopic dermatitis, with caution regarding prolonged use.
• New formulations (e.g., foam and gel) offer enhanced skin penetration and patient acceptability for scalp and oily areas.

• Temperature: Store at 20°C to 25°C (68°F to 77°F)
• Humidity: Keep in a dry place; avoid exposure to excess moisture
• Light protection: Store in original container, away from direct sunlight
• Handling precautions:
• Do not freeze
• Keep cap tightly closed
• Keep out of reach of children
• Do not use if color or consistency changes