Introduction
Desonide is a low-potency synthetic corticosteroid primarily used topically for its anti-inflammatory, antipruritic, and vasoconstrictive properties. As a class VI or VII corticosteroid depending on the formulation, it offers an effective treatment option with a favorable safety profile for various dermatological conditions, particularly in sensitive areas and pediatric populations.
Mechanism of Action
Desonide exerts its therapeutic effects through binding to intracellular glucocorticoid receptors. This complex translocates to the cell nucleus where it modulates gene transcription, leading to:
- Inhibition of inflammatory cytokine production
- Reduction of vasodilation and capillary permeability
- Suppression of migration of polymorphonuclear leukocytes
- Decreased collagen synthesis
- Stabilization of lysosomal membranes
These actions collectively result in reduced inflammation, itching, and erythema associated with various dermatoses.
Indications
FDA-approved indications:
- Mild to moderate atopic dermatitis
- Seborrheic dermatitis
- Contact dermatitis
- Eczema
- Psoriasis (mild cases)
Off-label uses:
- Diaper dermatitis
- Intertrigo
- Mild inflammatory skin conditions in sensitive areas (face, groin, axillae)
Dosage and Administration
Topical application:- Apply a thin film to affected areas 2-3 times daily
- Gently rub into the skin until medication disappears
- Use the smallest amount necessary to control symptoms
- Pediatrics: Generally safe for children ≥3 months; use limited duration and minimal effective dose
- Geriatrics: May require more frequent monitoring for skin atrophy
- Hepatic impairment: No specific dosage adjustment recommended
- Renal impairment: No specific dosage adjustment recommended
- Typically 2-4 weeks for most indications
- Should not exceed 4 weeks of continuous use without reevaluation
Pharmacokinetics
Absorption: Minimal systemic absorption through intact skin (approximately 1-3%); increased absorption through damaged skin, occlusive dressings, or high-permeability areas Distribution: Primarily local tissue distribution; minimal systemic distribution if absorbed Metabolism: Primarily hepatic via CYP3A4; extensive first-pass metabolism if systemically absorbed Elimination: Renal excretion of metabolites; elimination half-life approximately 2-5 hours if systemically absorbedContraindications
- Hypersensitivity to desonide or any component of the formulation
- Viral skin infections (herpes simplex, varicella)
- Fungal infections without appropriate antifungal therapy
- Tuberculous skin lesions
- Perioral dermatitis
- Acne rosacea
Warnings and Precautions
Systemic effects: May occur with extensive use, especially under occlusion or on large body surface areas Skin atrophy: Particularly concerning in high-risk areas (face, intertriginous areas) HPA axis suppression: Possible with prolonged use on large areas Secondary infections: May mask signs of infection; superinfections may occur Pediatric patients: Increased risk of systemic absorption due to higher surface area to body mass ratio Occlusive dressings: Increase systemic absorption and risk of adverse effects Pregnancy: Category C - use only if potential benefit justifies potential risk Lactation: Exercise caution; avoid application to nipple areaDrug Interactions
No clinically significant drug interactions documented due to minimal systemic absorption. However, theoretical interactions with systemically administered corticosteroids may occur with extensive topical use.
Adverse Effects
Common (≥1%):- Burning or stinging at application site
- Pruritus
- Dryness
- Erythema
- Folliculitis
- Skin atrophy
- Striae
- Telangiectasia
- Hypopigmentation
- Contact dermatitis
- Miliaria
- HPA axis suppression
- Cushing's syndrome
- Hyperglycemia
- Glaucoma (if applied near eyes)
Monitoring Parameters
- Clinical response after 2 weeks of therapy
- Signs of skin atrophy, striae, or telangiectasia
- Symptoms of HPA axis suppression with prolonged extensive use
- Signs of secondary infection
- Local adverse reactions
- Appropriate duration of therapy (not to exceed 4 weeks continuously)
Patient Education
- Use only as directed by healthcare provider
- Apply thin film to affected areas only
- Avoid contact with eyes
- Do not use occlusive dressings unless directed
- Report any signs of infection or lack of improvement
- Do not use longer than prescribed duration
- Inform all healthcare providers of current medication use
- Store at room temperature, away from moisture and heat
- Wash hands after application unless hands are treatment area
- Avoid use on broken or infected skin unless directed by provider
References
1. FDA Prescribing Information: Desonide Cream, Ointment, and Lotion 2. Wolverton SE. Comprehensive Dermatologic Drug Therapy. 4th ed. Elsevier; 2021 3. Bolognia JL, Schaffer JV, Cerroni L. Dermatology. 4th ed. Elsevier; 2018 4. Paller AS, Mancini AJ. Hurwitz Clinical Pediatric Dermatology. 6th ed. Elsevier; 2022 5. Lexicomp Online. Desonide: Drug Information. Wolters Kluwer Clinical Drug Information; 2023 6. National Eczema Association. Topical Corticosteroids: A Guide for Patients and Families. 2022 7. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis. J Am Acad Dermatol. 2014;71(2):327-349