o Drug Name:DESONIDE 0.05% LOTION (DESOWEN) 2OZ
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Brand: DESOWEN
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Generic: Desonide
o Manufacturer:Galderma
o Distributor: Zuerllig
o Strength: 0.05%
o Volume: 60mL
o Dosage form: Lotion
o Drug class: Corticosterioid
o Cost + Formulary class: $14.37, NF
o Regulatory class: POM
o Indication:
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Inflammatory hyperkeratotic dermatosis, Corticosteroid responsive.[1]
- FDA Approval: Adult, yes; Pediatric, no
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Note: Other dosage form can treat Atopic dermatitis (Mild to Moderate)Inflammatory & pruritic manifestations of corticosteroid-responsive dermatoses. [2] [4]
- FDA Approval: Adult, yes; Pediatric, yes (foam and gel, 3 mo and older) [1]
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Inflammatory/pruritic dermatoses, eczemas, lichen planus, burns (1st and 2nd degree) [3]
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Adjunctive treatment for: alopecia areata, chronic discoid lupus erythematosus, dysidrosis, familial benign pemphigus, mycosis fungoides, nodular prurigo, psoriasis, seborrheic dermatitis[3]
o Recommended dosing
o Applied to the affected areas as a thin film two or three times daily depending on the severity of the condition. [2] [4]
o Dermatoses: Apply sparingly to affected area(s) BID/TID/QID[3]
o Hyperkeratotic dermatosis coriticosteroid responsive:
o Atopic dermatitis (Mild to Moderate)
Apply a thin layer (foam or gel formulation) topically to affected area(s) twice daily. Treatment should not exceed 4 consecutive weeks
*: Because the occlusive nature of an ointment vehicle can augment dermal penetration of active drug, lotion or cream corticosteroid formulations may be safer for pediatric use.[1]
o MOA:
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Desonide is a non-fluorinated corticosteroid.
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Corticosteroids have multiple mechanisms of action including anti-inflammatory activity, immunosuppressive properties, and antiproliferative actions. Anti-inflammatory effects result from decreased formation, release and activity of the mediators of inflammation (eg, kinins, histamine, liposomal enzymes, prostaglandins, leukotrienes) which reduce the initial manifestations of the inflammatory process. Corticosteroids inhibit margination and subsequent cell migration to the area of injury, and also reverse the dilation and increased vessel permeability in the area, resulting in decreased access of cells to the sites of injury. This vasoconstrictive action decreases serum extravasation, swelling and discomfort. The immunosuppressive properties decrease the response to delayed and immediate hypersensitivity reactions (eg, type III and type IV). This results from inhibition of the toxic effect from antigen and antibody complexes that precipitate in vessel walls creating cutaneous allergic vasculitis, and by inhibiting the action of lymphokines, target cells, and macrophages which together produce allergic contact dermatitis reactions. Additionally, the access of sensitized T lymphocytes and macrophages to target cells may also be prevented by corticosteroids. The antiproliferative effects reduce hyperplastic tissue characteristic of psoriasis.[1]
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Corticosteroids decrease inflammation by stabilizing leukocyte lysosomal membranes, preventing release of destructive acid hydrolases from leukocytes; inhibiting macrophage accumulation in inflamed areas; reducing leukocyte adhesion to capillary endothelium; reducing capillary wall permeability and edema formation; decreasing complement components; antagonizing histamine activity and release of kinin from substrates; reducing fibroblast proliferation, collagen deposition, and subsequent scar tissue formation.[3]
o ADME:
o The concurrent use of occlusive dressings or application to inflamed skin may increase percutaneous absorption. [1] [4]
o Large variation in absorption of topical corticosteroids among individuals and anatomical sites: forearm 1%; scalp 4%, forehead 7%, scrotum 36%. Greatest penetration occurs at groin, axillae, and face.. [1]
o No correlation between quantity applied and degree of penetration. The rate-limiting step for epidermal or transfollicular penetration is skin transport. [1]
If get absorbed to bloodstream
o LIVER, primary site[1] [4]
o Kidney[1] [4]
o Bile, small extent[1] [4]
o Instruction to patient
o Take your medicine as directed.
o Use this medicine only on your skin[1] [3]. After applying the medication, wash and dry your hands, unless you are using this medication to treat the hands. When applying this medication near the eyes, avoid getting it in the eyes[1] [3] [4] because this may worsen or cause glaucoma, or cause irritation. Also, avoid getting this medication in the nose or mouth[1] [3]. If you get this medication in your eyes, nose, or mouth, rinse immediately with plenty of water.
o Wash your hands with soap and water before and after you use this medicine. [1] [3]
o Apply a thin layer of the medicine to the affected area. Rub it in gently. [1] [3]
o Do not cover the treated area with a bandage unless directed by your doctor. [1] [3] [4]
o If used in the diaper area on an infant, do not use tight-fitting diapers or plastic pants. [3] [4]
o Shake the foam or lotion well just before using.
o Do not use the foam near heat, an open flame, or while smoking. Do not puncture, break, or burn the can.
o This medicine is not for long-term use. [1] Tell your doctor if your condition persists or worsens after 2 weeks. [3]
o If a Dose is Missed, Apply a dose as soon as you can. If it is almost time for your next dose, wait until then and apply a regular dose. Do not apply extra medicine to make up for a missed dose.
o Before applying the medication, clean and dry the affected area.
o Use this medication only for the condition prescribed. [1] [4]
o Patients should report any signs of local adverse reactions especially under occlusive dressing.
o Side effect:
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Less serious:
- Acne or tiny pimples on the skin.
- Itching or redness around your lips.
- Mild burning, stinging, dryness, peeling, redness, itching, or irritation of your skin. This should disappear in a few days as your body adjusts to the medication. If any of these effects persist or worsen, notify your doctor or pharmacist promptly
- Raised, dark red, wart-like spots on skin, especially when used on the face.
- Thinning or change in color of your skin.
o ADR:
o CI:
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hypersensitivity to desonide or any component of the pro duct
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Underlying infection, including tuberculous, fungal, and viral skin lesions
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Ophthalmic use
o Precaution:
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Application to large body surface area, under occlusion and/or long-term use (greater than two weeks at a time):
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increased risk of hypothalamic-pituitary-adrenal axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and glucosuria
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Pediatric patients:
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increased risk of toxicity from equivalent adult doses due to larger skin surface to body mass ratios and exhibit greater susceptibility to corticosteroid-induced HPA axis suppression and Cushing's syndrome
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Manifestations of adrenal suppression in children include linear growth retardation, delayed weight gain, low plasma cortisol levels and absence of response to ACTH stimulation.
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Manifestations of intracranial hypertension include bulging of fontanelles, headaches and bilateral papilledema.
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Administration of topical corticosteroids to children should be limited to the least amount of compatibility with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children.
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Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing should be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests. If HPA axis suppression is noted, an attempt should be made to withdraw the drug to reduce the frequency of application or to substitute a less potent steroid.
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Use medium to very high potency for <2 wk to reduce local and systemic side effects and use low potency for chronic therapy.
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Avoid medium to very high potency on face, folds, groin because can increase steroid absorption
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Check for patient’s medical history, especially of: poor blood circulation, diabetes, immune system problems, other skin conditions (e.g., rosacea, perioral dermatitis).
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Do not use if there is an infection or sore in the area to be treated.
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Before using desonide, check for allergic record; or to other corticosteroids (e.g., hydrocortisone, prednisone); or if patient have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems.
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If irritation develops, topical corticosteroids should be discontinued and appropriate therapy instituted.
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In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial agent should be instituted. If a favorable response does not occur promptly, the corticosteroid should be discontinued until the infection has been adequately controlled.
o Interaction:
If systemic absorption of desonide
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Bupropion
- lowering of the seizure threshold
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Glycerol Phenylbutyrate
- increased plasma ammonia levels
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Pixantrone
- decreased exposure of pixantrone
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Testosterone
o Pregnancy class:
o Source:
o DESONIDE DRUGDEX® Evaluations. Micromedex® 2.0. http://www-micromedexsolutions-com.libwww3.np.edu.sg/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/633381/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/DF5061/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.IntermediateToFullDocumentLink/docId/0605/contentSetId/31/title/DESONIDE/servicesTitle/DESONIDE. Last Modified May 16,2014, Access on June 2, 2014