Fluticasone propionate for skin

What does fluticasone propionate treat?

Topical fluticasone reduces redness, swelling, itching, dryness and scaling associated with certain skin conditions. These include eczema, which causes dry, itchy skin, and psoriasis, which causes red, scaly patches. It treats skin conditions that respond to corticosteroids, rather than every unexplained rash. Do not use a prescription intended for one condition to treat another without your doctor's direction.2

Which form and strength do you have?

Strength categories differ between countries: the US 0.05% cream is classed as medium potency, while UK guidance lists fluticasone propionate 0.05% as strong. Creams are less greasy than ointments, a distinction the bathroom towel tends to appreciate. Choose the prescribed form rather than switching because another tube looks similar.4

How do you use fluticasone propionate?

1. 1Check your prescription for the treatment area, frequency and course length. Topical fluticasone is usually applied once or twice daily.
2. 2Wash your hands before applying the medicine.
3. 3Apply a small amount to the affected skin in a thin film. For fluticasone, gently rub it in.
4. 4Wash your hands afterwards.
5. 5Leave the area uncovered unless your doctor specifically directs otherwise. Bandages and other coverings can increase absorption and side effects.

For creams and ointments, a fingertip unit is a general way to estimate quantity: squeeze a line from the last crease to the tip of an adult finger. One unit is about 0.5 grams and covers an area equivalent to two hands laid flat with the fingers together. Children's amounts depend on age and treatment area; ask for the appropriate amount rather than using adult quantities.4

Continue an eczema friendly moisturiser if it is part of your treatment plan. General topical steroid guidance advises keeping moisturiser and steroid applications separate to avoid diluting the treatment. Where practical, apply the moisturiser 30 minutes before the steroid. Follow any different instructions from your prescriber.45

If you miss an application, use it when you remember unless the next dose is nearly due. In that case, skip the missed dose. Do not apply a double dose.6

How long does it take to work?

Your skin condition should improve within the first two weeks. Contact your doctor if it does not. Treatment length depends on the condition, steroid strength and body area. Long courses need a plan for reducing or stopping treatment, because suddenly stopping can sometimes trigger a flare. Do not extend the course yourself.45

Is fluticasone propionate safe to use?

Topical steroids have a low risk of side effects when used correctly. Risks increase with prolonged treatment, large treatment areas and covered skin. Fluticasone can be absorbed into the body and suppress natural steroid hormone production, called adrenal suppression. Damaged skin barriers, liver failure and young age are additional risk factors. A prescriber can adjust treatment or arrange testing if this is suspected.35

Avoid the face, armpits, skin folds, genital and rectal areas unless your doctor directs you to treat them. Keep fluticasone out of your eyes and mouth. For the lotion, avoid unnecessary or prolonged sunlight and use protective clothing and sunscreen, because the lotion can increase sun sensitivity.6

Do not use fluticasone if you are allergic to the medicine or any ingredient in your product. The 0.05% cream described here contains imidurea, which releases formaldehyde, and should not be used by people allergic to formaldehyde. It should also not be used on skin that is already thinned. Topical steroids can worsen skin infections; an infection needs an appropriate treatment plan rather than steroid treatment alone.14

Can children use it?

The US 0.05% cream can be used cautiously from three months of age under medical direction. Use below that age, or beyond four weeks in children, has not been established as safe and effective. The US 0.005% ointment described here is indicated for adults. Children absorb proportionally more topical steroid because they have more skin surface relative to body weight.1

For childhood eczema, use a topical steroid only when it is included in the child's dermatologist's plan. Suitable bathing and moisturising are part of treatment, too. Contact the dermatologist if you notice bruising, visible blood vessels, stretch marks, acne like breakouts or thinner looking skin. Skin thinning can first appear as wrinkling, visible vessels or weakened skin. Children also need monitoring for unusually slow growth or weight gain. Do not cover treated skin with plastic wrap or a bandage unless specifically instructed.5

What about pregnancy, breastfeeding and other medicines?

Discuss treatment with your prescriber if you are pregnant, planning pregnancy or breastfeeding. Pregnancy data specific to fluticasone propionate ointment are limited. Its prescribing information advises treating the smallest possible area for the shortest possible time because of concern about low birthweight. General breastfeeding guidance allows only weak topical steroids on the breast or nipple, washed off before feeding; do not assume fluticasone is suitable for that area.34

Tell your doctor or pharmacist about prescription medicines, medicines bought without a prescription, supplements and herbal products. Also mention liver disease, skin infections or Cushing's syndrome, a condition caused by excess corticosteroid hormones.6

What side effects need medical attention?

• Stop the cream and contact your prescriber if irritation develops.
• Contact your prescriber about skin thinning, stretch marks, lighter patches, acne like eruptions or a rash around the mouth.
• Call your doctor immediately for a severe rash, hives or signs of infection at the application site.
• Report blurred vision or other visual changes promptly. Topical corticosteroids can increase the risk of cataracts and glaucoma.
• Get immediate medical help for breathing problems or swelling of the face, lips, tongue or throat.

A steroid allergy can show up as failure to heal rather than a dramatic new rash. Your clinician can consider patch testing to identify contact allergy. Many skin side effects from topical steroids improve after treatment stops, but some take months to disappear.35

What is the difference between fluticasone propionate and fluticasone?

For these skin treatments, "fluticasone" is the shortened name used for fluticasone propionate. The product's form matters as much as its name, which is a lot of administrative work for a tube. Fluticasone propionate also comes in an inhaled form for asthma; that is not the skin preparation. Check that your prescription is for a cream, ointment or lotion.67