Hormonal ointments for allergies

Allergies almost always manifest themselves as rashes, and hormonal ointments for allergies are considered to be among the most effective external remedies. However, many allergy sufferers are unreasonably afraid of drugs containing hormones. Before rejecting or using this or that ointment, it is necessary to understand what these drugs are, how and why a doctor prescribes hormonal drugs for allergies, what types, properties, indications and contraindications they have.

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Indications for the use of hormonal ointments for allergies

Hormonal topical preparations are aimed at quickly counteracting the release of histamine and other biologically active substances (BAS) from highly specialized immune cells called mast cells. As a rule, hormonal ointments are prescribed as stabilizers of the activity of cells that are directly involved in inflammation. Corticosteroids suppress the activity of the entire cellular structure, this is a “universal” action and is used to relieve the inflammatory process caused by allergies.

The purpose and indications for the use of hormonal drugs are effective in acute and sluggish, long-term chronic inflammation of the skin. Of course, the doctor recommends such ointments taking into account the anatomical and physiological specifics of the skin, the patient's age and concomitant pathologies. For example, the skin of children is more susceptible to any external agent in principle, since it has vessels located close to the surface, a loose and delicate epidermis structure. This does not mean that hormonal drugs are not used in the treatment of allergies in children, they are prescribed, but in the absence of an effect of treatment by other methods. In addition, today there are practically no aggressive hormonal ointments that have absolute contraindications. All drugs of this type have their own indications for use and occupy a certain niche in the therapeutic practice of allergists. In addition, the risk of complications caused by atopic dermatitis is much higher than the possible risk of delayed complications, therefore, hormonal ointments are indicated in such situations:

• Acute inflammation of the skin caused by allergies.
• Recurrent rash, no effect from non-hormonal treatment.
• Risk of developing acute eczema.
• Photodermatitis.
• Atopic dermatitis.
• Neurodermatitis caused by allergies.
• Erythematous rash as a complication of drug allergy.
• Erythema multiforme as a complication of allergy.

Types of hormonal ointments for allergies

All external preparations that relieve allergic symptoms are divided into hormonal, non-hormonal and combined agents. Combined ointments may include, in addition to hormones, antibacterial substances, antifungal or anti-inflammatory non-steroidal components.

Hormonal ointments, in turn, are divided into classes according to the strength of their effect and the content of the active substance:

Drug class	Name of the drug	Effect, action
I	Ointments: Hydrocortisone Diperzolone	Weak, short-term effect due to slow penetration into skin cells
II	Hydrocortisone butyrate (laticort) Afloderm Lorinden Prednisolone, Prednicarbate Cinacort Locacorten Desoximetasone	Moderate impact
III	Elokom Celestoderm, Celederm (betamethasone) Beloderm Advantan Polcortolone Cutivate Mometasone furoate Apulein Sinaflan, Sinalar, Flucort Betamethazonovalerate Fluorocinoid	The drugs act quickly
IV	Halcinonide Dermovate Chalciderm Diflucortolone Valerate	Powerful anti-inflammatory effect, maximum penetration depth

We cannot ignore other types of hormonal ointments for allergies - combination drugs:

Name	Active ingredient and additional components
Diprosalic	Betamethasone and salicylic acid
Triderm	Betamethasone, clotrimazole and gentamicin
Vipsogal	Betamethasone, panthenol, gentamicin and salicylic acid
Oxycort	Hydrocortisone and cositetracycline
Aurobin	Prednisolone, lidocaine, triclosan
Lorinden	Flumethasone and salicylic acid
Sinalar	Fluocionolone and neomycin (or clioquinol)

The activity of the drug depends not only on its main component and form of release, but also on its dose. The more powerful the effect of the antiallergic hormonal ointment, the more carefully it is prescribed, since such an effect can cause unwanted side effects.

How to use hormonal ointments for allergies

Usually, the method of using hormonal ointment for allergies is explained by the attending physician, taking into account all the characteristics of the patient - age, skin condition, localization and nature of the allergic rash. Of course, the main rule that the allergist adheres to is the safety of use in combination with its appropriateness. These properties are possessed by new drugs that belong to the group of non-fluorinated hormonal agents for external use. They can be applied to the skin with virtually no fear of complications, in addition, the course of treatment can be quite long.

How to choose the right amount of ointment to apply to the skin?

There is a so-called "rule of one phalanx" or FTU (fingertip unit). This is the optimal unit determined by the fingertip when the cream is squeezed onto the phalanx of the index finger (approximately 0.5g). The calculation is simple:

• For the groin area - 1 "phalanx" or FTU on each side.
• On the hand – 1 FTU.
• Feet – 1 FTU per foot.
• For one hand - 3 FTU.
• For the entire leg – 6 FTU.
• Whole body – about 14-15 FTU (depending on weight, build).

For children, it is recommended to apply the ointment on a base, this involves lubricating the child's skin with an emollient, such as Topicrem.

How many times to apply the rash is also determined by the allergist. General recommendations for the use of modern external corticosteroids for children are as follows: •

• Advantan – for children from 6 months, once a day, course – up to 1 month.
• Elokom – for children over 2 years old, once a day, for a maximum of a week.
• Afloderm – for children from 6 months, twice a day.
• Lokoid – for children from 6 months up to three times a day.

Children under six months of age are generally not subject to treatment with hormonal drugs, however, in acute, complex allergic conditions, Hydrocortisone ointment (1%) can be used in therapy no more than twice a day.

External preparations with glucocorticosteroids can be produced in various forms, the choice of dosage form in turn should be determined by the localization of the inflammatory process, the nature of the inflammation. Of great importance is which area is lubricated with a hormonal agent. For dry skin, an ointment is needed, for the face and ear area - an emulsion, lotion, for weeping dermatitis - a cream.

Features of some forms of hormonal ointments:

Form of release of the drug	When is it used?	Pros and cons
Hormonal cream	Skin fold rash, intertriginous dermatitis	Easy to use, penetrates into hard-to-reach areas of the skin, but with prolonged use it causes dry skin
Hormonal ointment	Macerates weeping manifestations of rashes, works well for peeling, skin irritation	Slowly absorbed, the active substance slowly penetrates into the skin cells
Lotion, emulsion	Neurodermatitis, atopic dermatitis, application to face, rash on scalp	It has practically no disadvantages and works well on exudative rashes.

Algorithm for the use of topical hormonal agents:

• Prescribing topical corticosteroids is only possible after examination and diagnosis.
• Hormonal topical drugs (GCS) are intended for treatment, not prevention.
• The form of the drug must be adequate to the degree of allergic skin damage and the severity of the process.
• In children under 6 months of age, fluoride-containing corticosteroids are not used.
• Hormonal ointments are not recommended for children to treat diaper rash and are not used to treat rashes on the face.
• Preference in the treatment of allergic rashes is given to prolonged corticosteroid ointments.
• All hormonal ointments are applied only to cleansed skin.
• It is prohibited to apply GCS to more than 1/5 of the body's skin at one time.
• Applications with corticosteroid ointments should not exceed 20 minutes.
• If after 7 days of using GCS the effect of treatment is not obvious, the prescription of the drug is adjusted or cancelled.
• Fluorinated hormonal ointments should not be used for more than 2 weeks.

Contraindications

If it is necessary to quickly relieve inflammation, itching, burning and prevent the development of atopic dermatitis, as a rule, potent agents are used, which include hormonal drugs. However, hormonal drugs, despite their obvious benefits and effectiveness, have contraindications, this is due to their systemic effect on the entire body, and not just on the skin. This was true several decades ago, but today the pharmaceutical industry has developed completely new methods and means of treatment with hormones, which are called topical steroids. Topical drugs have an effective effect on the outer layers, that is, on the skin, such local use allows you to almost completely eliminate side effects and contraindications. In most cases, external agents include corticosteroids, which quickly and effectively stop the development of allergic manifestations. However, like any drug, hormonal ointments have indications and special recommendations that exclude the use of these forms. Even the advertised Advantan and Elokom are prescribed by doctors in accordance with the patient’s age, taking into account the patient’s characteristics and the localization of the allergic rash.

General contraindications concerning almost all hormonal external preparations are familiar to practicing allergists. This is a ban on the use of ointments for more than 12 weeks for adult patients and more than a month for children. Such products are also used with caution to treat rashes on the face.

Absolute contraindications to the use of glucocorticosteroid ointments (GCS):

• Acne rosacea, acne.
• Scabies.
• Tuberculosis.
• Perioral dermatitis.
• Venereal diseases.
• Fungal skin diseases (mycoses).
• Bacterial skin diseases.
• Allergy after vaccination.
• Viral skin lesions (herpes, shingles).
• Helminthiasis.
• Relative contraindication: pregnancy.
• Use with caution in the treatment of allergies in children under 7 years of age.

Hormonal ointments should not be applied to small children if they have the following conditions or symptoms:

• "Diaper" dermatitis.
• Chicken pox.
• Sensitivity to the applied ointment, revealed by skin testing.

In order to avoid complications, hormonal ointments for allergies should not be purchased or prescribed to yourself, based on advertising information or advice from relatives. Even if the medicine was prescribed by a doctor, it would be a good idea to do a skin test, that is, apply a minimal amount of the drug to your hand closer to the palm (back side). The test lasts only 15 minutes, if the skin does not show "resistance", the ointment can be safely used.

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Special instructions

Previously existing hormonophobia is at least inappropriate in our time, at most it can delay the result of allergy treatment and provoke serious complications.

Special instructions regarding therapy with external corticosteroids are given by an allergist, he prescribes an ointment taking into account all the patient's characteristics and recommends methods of its application. The patient is only required to strictly follow the doctor's instructions. Almost all complications, according to statistics, are associated only with the uncontrolled use of hormonal ointments, when an allergy sufferer or overly active parents are guided by the advice of television advertising and begin to treat themselves or their child on their own.

Modern hormonal agents are highly effective ways to quickly eliminate the first manifestations of allergies, which most often occur on the skin. In addition, the following arguments can be made in favor of the latest generation of hormonal ointments:

• Creams, ointments and emulsions containing hormonal components can be applied to almost any area of the body, excluding the skin of the eyelids and the area around the eyes.
• The pharmacological properties of topical corticosteroids allow them to be used for a long time until stable remission occurs, but the course should not exceed 1 month.
• Hormonal antiallergic drugs are effective not only in the acute stage, they are also effective in the treatment of chronic allergic processes.

Special instructions for the use of corticosteroids concern the dose, frequency and duration of the course of treatment. These issues are supervised and controlled only by an allergist, who can prescribe, adjust or cancel hormonal therapy.

Side effects of hormonal ointments for allergies

Unfortunately, even hormonal ointments that are effective in treating allergic skin manifestations can have their pros and cons.

Side effects of corticosteroids, especially modern drugs, are most often associated with independent experiments of patients, when they seek to eliminate the rash as quickly as possible. It is also necessary to take into account the degree of activity of the drug, that is, its class. Hormonal ointments of class IV can cause much more negative consequences than their less active "brothers".

Most often, long-term use of corticosteroids provokes suppression of local immunity, which is complicated by the development of infection in the area of the rash. Therefore, to prevent such phenomena, allergists can prescribe a combination drug containing an antibiotic or antifungal component. In addition, hormones can affect the production of collagen, that is, dry out the skin and provoke its atrophy, this is especially important for the skin of the face and groin folds. A long course of hormonal external agents contributes to the development of acne, irritation, skin pigmentation. This is due to the ability of corticosteroids to quickly penetrate the bloodstream and affect the body systemically. However, such side effects are possible only with excessive doses and violation of the rules for using the ointment. It should be noted that usually when the drug is discontinued, all complications are neutralized, that is, the consequences are reversible, the duration depends on the duration of the course, but the complete withdrawal of steroid substances takes a maximum of 6 months, a minimum of 2 weeks.

What complications are possible when using topical steroid drugs:

• Acne, acne.
• With prolonged use of class III – IV corticosteroids, dry skin is possible.
• Stretch marks.
• Perioral dermatitis.
• Folliculitis.
• Symptomatic hypertrichosis.
• Telangiectasia.
• Erythema.
• Hypopigmentation.
• Activation of existing mycosis (fungal infection).
• Contact dermatitis.
• Extremely rare – Cushing's syndrome.
• When applied to the skin of the eyelids, which is strictly prohibited, cataracts or glaucoma.

Shelf life

Although many hormonal drugs can be stored for about 5 years, according to the instructions in the factory packaging, allergists give more detailed advice on this matter.

The shelf life of any GCS product, especially for external use, should be minimal. This is explained by the fact that in a closed, hermetically sealed state, the ointment is really capable of preserving its healing properties for many years. But in practice, the tube is opened, otherwise it is simply impossible to use the drug. Consequently, an opened ointment, cream or emulsion in an unsealed form should not be stored for months, and especially not for years. For this reason, the pharmaceutical industry produces such products in small packages, tubes.

The optimal storage periods for GCS may be the following periods (it is better to discuss the shelf life of an opened package with a doctor or a pharmacist):

• Aqueous solutions of GCS for external use – no more than 24 hours.
• Hormonal ointments – no more than 4 weeks.
• Hormone-containing emulsion - no more than 7 days.

The ambient temperature is also important, it should not exceed 20-25 degrees, in addition, such drugs, as well as other medications, should be stored in places inaccessible to children.

Hormonal ointments for allergies have long deserved a more respectful attitude from patients; the old days when corticosteroid drugs were associated with negative phenomena are a thing of the past. Of course, side effects can only be avoided if the GCS ointment is prescribed by a doctor after an examination. And the correct use of glucocorticosteroid topical agents will only speed up recovery, because their undesirable systemic effects are practically eliminated, and the therapeutic effect is confirmed by many thousands of cured allergy sufferers.