Desoximetasone

A. Approved Indications

• Inflammatory and Pruritic Dermatoses Responsive to Corticosteroids, including:
• Psoriasis (except severe plaque psoriasis over large body areas)
• Atopic dermatitis
• Contact dermatitis (allergic or irritant)
• Seborrheic dermatitis
• Nummular eczema
• Lichen simplex chronicus
• Lichen planus
• Discoid lupus erythematosus

B. Clinically Accepted Off-Label Uses

• Hypertrophic scars and keloids (in selected cases, applied topically or via intralesional injection off-label)
• Lichen sclerosus (when other corticosteroids are not effective or tolerated)
• Treatment-resistant dermatoses requiring a high-potency corticosteroid, under dermatologist supervision

A. Adults

• Desoximetasone 0.05% or 0.25% formulations:
• Apply a thin layer to the affected area twice daily, gently rubbed in until fully absorbed.
• For high-potency 0.25% products, limit to short-term use (2–4 weeks) on non-facial, thickened skin areas.
• Occlusion may be used for refractory lesions but increases risk of systemic absorption.

B. Pediatric Use

• Use with caution in children >2 years.
• Use lower potency (0.05%) and short durations only.
• Avoid high-potency (0.25%) use unless directed by a specialist due to risk of HPA axis suppression.

C. Elderly

• Same dosage as adults, but monitor more closely due to increased skin fragility and risk of atrophy.

D. Special Populations

• Renal/Hepatic Impairment: No dose adjustments required for topical use; avoid large surface area applications or occlusion which may increase systemic absorption.

Route of Administration: Topical

Duration of Use:

• Limit continuous use to no more than 2 weeks on face, groin, or underarms.
• Longer durations may be acceptable for thick, lichenified plaques under specialist guidance.

Desoximetasone is a synthetic fluorinated corticosteroid with high anti-inflammatory, antipruritic, and vasoconstrictive properties. It penetrates the skin and binds to intracellular glucocorticoid receptors, altering gene transcription in target cells. This results in inhibition of pro-inflammatory cytokines, prostaglandins, leukotrienes, and histamine, and increases the production of lipocortins, which suppress phospholipase A2 activity. These mechanisms reduce redness, swelling, and itching associated with dermatologic inflammation.

• Absorption: Topical absorption depends on condition of skin, area treated, duration of use, and whether occlusive dressings are applied.
• Absorption is significantly enhanced through damaged or thin skin.
• Distribution: Systemic distribution is minimal under normal use, but drug may circulate bound to plasma proteins if absorbed.
• Metabolism: Once absorbed, hepatic metabolism follows similar pathways as endogenous corticosteroids.
• Excretion: Eliminated primarily in urine as inactive metabolites.
• Half-life: Not well defined due to minimal systemic absorption in most patients.

• Pregnancy:
• No FDA pregnancy letter assigned under new guidelines.
• Use only if benefits outweigh potential risks; prolonged or extensive use should be avoided, particularly with occlusion or on large surface areas.
• Lactation:
• Unknown if desoximetasone is excreted in human milk.
• Low systemic absorption makes it unlikely to harm a breastfeeding infant when used topically.
• Avoid application to the breast area, especially near the nipple.

• Primary Class: Corticosteroid
• Subclass: High-potency topical corticosteroid
• Potency Group: Group II or III (depending on strength and formulation)

• Known hypersensitivity to desoximetasone or any excipients
• Untreated skin infections (bacterial, fungal, viral)
• Rosacea or perioral dermatitis
• Application to ocular or periocular areas (risk of glaucoma or cataracts)
• Skin ulcerations or open wounds

• Systemic absorption risk: Greater when used under occlusion, on large areas, for prolonged periods, or in pediatric patients.
• Adrenal suppression: May occur, especially with high-potency forms or in children.
• Skin atrophy, striae, telangiectasia: Risk increases with prolonged use.
• Delayed wound healing: Topical corticosteroids may impair wound repair.
• Ophthalmic risk: Avoid application near eyes; may increase intraocular pressure and cause glaucoma or cataracts.
• Secondary infections: Steroid use may mask or exacerbate bacterial, fungal, or viral infections.

Common (≥1%):

• Skin reactions: Burning, stinging, itching, dryness, irritation
• Epidermal changes: Skin thinning, atrophy, telangiectasia, hypopigmentation

Less Common (0.1–1%):

• Folliculitis
• Acneiform eruptions
• Contact dermatitis

Rare (<0.1%) or Serious:

• HPA axis suppression (especially in children or with prolonged high-potency use)
• Hyperglycemia or glycosuria (from systemic corticosteroid absorption)
• Secondary skin infections
• Ocular complications (glaucoma, cataract if applied near eyes)

• Drug-Drug:
• Minimal systemic interaction due to topical application.
• Potential for additive systemic corticosteroid effects if combined with oral or inhaled corticosteroids.
• Drug-Food/Alcohol:
• No significant interactions.
• Enzyme Systems:
• If absorbed systemically, metabolism is via hepatic CYP enzymes, though not clinically significant in standard topical use.

• Recent dermatology guidelines (AAD 2023) continue to classify desoximetasone 0.25% as a high-potency corticosteroid suitable for short-term management of thick plaques in psoriasis or chronic eczema.
• Increased caution emphasized in pediatric and elderly populations due to skin barrier sensitivity.
• New formulation availability (e.g., foam or gel) under review to enhance delivery in hair-bearing areas.

• Temperature: Store at 20°C to 25°C (68°F to 77°F)
• Humidity: Store in dry conditions
• Light Protection: Protect from direct light; keep in original packaging
• Handling Instructions:
• Do not freeze
• Keep out of reach of children
• Avoid contamination of the container tip or tube nozzle
• Replace cap tightly after each use