Using fluticasone on sensitive skin

Which fluticasone are you using?

Skin preparations come as creams, ointments and lotions; nasal sprays and inhalers have different uses. The US fluticasone propionate cream 0.05% is classed as medium potency, while UK guidance lists Cutivate 0.05% as strong. Neither description means a mild cream for everyday sensitivity.2345

Ointments have more oil and are usually preferred for dry skin conditions. Choose the preparation with your prescriber rather than switching formats yourself.5

How to apply fluticasone

1. 1Wash your hands before applying the treatment.
2. 2If you also use a moisturiser, apply it 30 minutes beforehand where practical. Do not apply both together, because the moisturiser can dilute the steroid.
3. 3Apply a small amount in a thin film over the affected area only. Fluticasone directions tell you to rub it in gently.
4. 4Wash your hands thoroughly after application.

Topical fluticasone is usually applied once or twice daily; follow your prescription for the frequency. The US ointment 0.005% has twice daily directions. If you miss a dose, apply it when remembered unless the next dose is nearly due. Never double the dose.16

Avoid the face, armpits, skin folds, genital and rectal areas unless your doctor specifically directs treatment there. Keep fluticasone out of your eyes and mouth. Do not cover treated skin with a bandage unless instructed.1

What should improve, and what should make you stop?

Itching, redness and inflammation should improve within the first two weeks. Contact your doctor if they do not. Temporary stinging or burning can occur with topical steroids, especially on inflamed skin, and usually settles within a few days.15

If irritation develops with fluticasone propionate cream 0.05%, stop using it and contact your prescriber. Failure to heal can also signal an allergic reaction to a topical steroid; your clinician can assess whether patch testing is needed.46

Call your doctor immediately for a severe rash, hives, or redness and swelling suggesting infection at the treated site. Report visual changes while using the ointment. Skin thinning, stretch marks and acne like eruptions are possible adverse effects, with greater risk from prolonged use or covered treatment areas.16

Does your formula contain something you react to?

The US cream 0.05% described here contains imidurea, a preservative that releases formaldehyde. Formaldehyde can cause irritation or allergic sensitisation, and this cream should not be used by someone allergic to formaldehyde. Ask your pharmacist to check your exact product's ingredients. Do not assume the ointment or another manufacturer's cream has the same formula.4

Does lotion need different precautions?

Lotions are thinner than creams, a distinction the bathroom shelf does not explain for you. Fluticasone lotion may increase sensitivity to sunlight. Avoid unnecessary or prolonged sun exposure and use protective clothing, sunglasses and sunscreen.25

Who needs extra care?

Tell your prescriber about skin infections, liver disease and all medicines or supplements you use. Topical steroids can worsen infections. Children need their own treatment instructions: the US ointment is indicated for adults, while the cream 0.05% permits cautious use from three months of age.2456

Discuss pregnancy or breastfeeding before use. Pregnancy information for fluticasone ointment is limited, and its directions advise the smallest treatment area for the shortest possible duration. Do not extend a course or change a prolonged treatment plan yourself; your prescriber should decide its length and how to stop.567