The use of topical steroid preparations in oral medicine in the UK

Key Points

  • Discusses when to use topical corticosteroids.

  • Provides background on the different choices of topical corticosteroids.

  • Discusses the support of patients using topical corticosteroids.

Abstract

Topical corticosteroids (TCs) are the most commonly prescribed drugs in oral medicine practice. Use in management of immune-driven inflammatory oral mucosal disease is predominantly off-label and poorly supported by evidence, yet oral medicine specialists have considerable collective experience of prescribing, administering and managing these medications. TCs are also prescribed by others in healthcare including general dental practitioners. Successful TC use is influenced by accurate diagnosis, TC choice (potency and formulation), patient acceptability (including ease of use, taste and texture), frequency of application, duration of treatment, adverse effects, patient support and medication regulations and access. The aim of this review is to provide an overview of TC use in oral medicine practice. Recommendations are based on collective experience to help selection of the appropriate TC to maximise therapeutic efficacy and minimise the potential for adverse effects. This is within an understanding of medicines regulation and preparation availability when prescribing in both secondary and primary care.

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References

  1. 1

    Lodi G, Carrozzo M, Furness S, Thongprasom K . Interventions for treating oral lichen planus: a systematic review. Br J Dermatol 2012; 166: 938–947

    Article  Google Scholar 

  2. 2

    Taylor J, McMillan R, Shephard M et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucous membrane pemphigoid. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 161–171.

    Article  Google Scholar 

  3. 3

    McMillan R, Taylor J, Shephard M et al. World Workshop on Oral Medicine VI: a systematic review of the treatment of mucocutaneous pemphigus vulgaris. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 132–142.

    Article  Google Scholar 

  4. 4

    Savage N W, McCullough M J . Topical corticosteroids in dental practice. Aust Dent J 2015; 50 (4 Suppl 2): S40–S44.

    Google Scholar 

  5. 5

    Kalmar J R . Topical corticosteroids and oral vesiculo-erosive disease: where's the beef? Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 89: 395–396.

    Article  Google Scholar 

  6. 6

    Gonzalez-Moles M A, Scully C . Vesiculo-erosive oral mucosal disease management with topical corticosteroids: (1) fundamental principles and specific agents available. J Dent Res 2005; 84: 294–301.

    Article  Google Scholar 

  7. 7

    Ference J D, Last A R . Choosing Topical Corticosteroids. Am Fam Physician 2009; 79: 135–140.

    PubMed  PubMed Central  Google Scholar 

  8. 8

    Del Rosso J Q . Topical Corticosteroids: Examining Pharmacologic Properties. 2006; 14.

    Google Scholar 

  9. 9

    Miguel-Ángel González-Moles . The use of topical corticoids in oral pathology. Med Oral Patol Oral Cir Bucal 2010; 15: e827–e831.

    Google Scholar 

  10. 10

    Joint Formulary Committee. British National Formulary. 74th edition. London: BMJ Group and Pharmaceutical Press, 2017.

  11. 11

    Long C C, Finlay A Y . The finger-tip unit – a new practical measure. Clin Exp Dermatol 1991; 16: 444–447.

    Article  Google Scholar 

  12. 12

    Tadicherla S, Ross K, Shenefelt P D, Fenske N A . Topical corticosteroids in dermatology. J Drugs Dermatol 2009; 8: 1093–1105.

    PubMed  PubMed Central  Google Scholar 

  13. 13

    MHRA. The Yellow Card Scheme. Available at https://yellowcard.mhra.gov.uk/ (accessed September 2017).

  14. 14

    MHRA. My medicine: Licensing (marketing authorisation). Available at http://www.mhra.gov.uk/home/groups/comms-ic/documents/websiteresources/con025908.pdf (accessed September 2017).

  15. 15

    The Royal Pharmaceutical Society. A Competency Framework for all Prescribers. Available at https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf (accessed September 2017).

  16. 16

    General Medical Council. Good practice in prescribing and managing medicines and devices. 2013. Available at http://www.gmc-uk.org/Prescribing_guidance.pdf_59055247.pdf (accessed September 2017).

  17. 17

    British Society of Oral Medicine. Patient Information Leaflets. Available at www.bsom.org.uk/patient-information/pil/ (accessed September 2017).

  18. 18

    Lam W Y, Fresco P . Medication adherence measures: An overview. Biomed Res Int 2015; 10.1155/2015/217047

  19. 19

    Ní Ríordáin R, Shirlaw P, Alajbeg I et al. World Workshop on Oral Medicine VI: Patient-reported outcome measures and oral mucosal disease: current status and future direction. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 120: 152–160.

    Article  Google Scholar 

  20. 20

    Escudier M, Ahmed N, Shirlaw P et al. A scoring system for mucosal disease severity with special reference to oral lichen planus. Br J Dermatol 2007; 157: 765–770.

    Article  Google Scholar 

Download references

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Correspondence to M. Rudralingam.

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Rudralingam, M., Randall, C. & Mighell, A. The use of topical steroid preparations in oral medicine in the UK. Br Dent J 223, 633–638 (2017). https://doi.org/10.1038/sj.bdj.2017.880

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