Introduction
Vanos (fluocinonide) is a high-potency topical corticosteroid indicated for the short-term treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. It belongs to the class IV super-high potency corticosteroids according to the vasoconstrictor assay classification system.
Mechanism of Action
Fluocinonide, the active ingredient in Vanos, exerts its anti-inflammatory, antipruritic, and vasoconstrictive effects through multiple mechanisms. It diffuses across cell membranes and forms complexes with specific cytoplasmic glucocorticoid receptors. These complexes then migrate to the cell nucleus where they bind to glucocorticoid response elements on DNA, resulting in transcription of specific mRNA and subsequent synthesis of various proteins including lipocortins. Lipocortins inhibit phospholipase A2, which reduces the formation of arachidonic acid and its metabolites (prostaglandins, leukotrienes), key mediators of inflammation.
Indications
FDA-approved indications:
- Short-term (up to 2 weeks) treatment of mild to moderate atopic dermatitis in patients 12 years and older
- Treatment of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses including:
- Psoriasis - Eczema - Contact dermatitis - Seborrheic dermatitis - Lichen planus
Dosage and Administration
Standard dosing: Apply a thin layer to affected areas twice daily Duration: Limited to 2 weeks of treatment, not to exceed 60 g per week Application: Gently rub into affected areas until cream disappears Occlusive dressing: Not recommended unless directed by physician Special populations:- Pediatric patients: Safety and effectiveness not established in children under 12 years
- Geriatric patients: No dosage adjustment required
- Hepatic impairment: No specific recommendations
- Renal impairment: No specific recommendations
Pharmacokinetics
Absorption: Topical corticosteroids can be absorbed through intact skin, with absorption increased by inflammation, occlusion, and use on thinner skin Distribution: Binds to plasma proteins, primarily corticosteroid-binding globulin and albumin Metabolism: Primarily metabolized in the liver via CYP3A4 Elimination: Excreted mainly in urine as metabolites, with some biliary excretion Half-life: Approximately 1.5-2 hours for fluocinonideContraindications
- Hypersensitivity to fluocinonide or any component of the formulation
- Viral skin infections (herpes simplex, varicella, vaccinia)
- Fungal skin infections
- Bacterial skin infections without appropriate antimicrobial therapy
- Use on rosacea, perioral dermatitis, or acne
Warnings and Precautions
- Systemic absorption: May cause reversible HPA axis suppression, Cushing's syndrome, hyperglycemia, and glucosuria
- Local effects: May cause skin atrophy, striae, telangiectasias, contact dermatitis, and hypopigmentation
- Occlusive therapy: Increases systemic absorption and risk of adverse effects
- Pediatric patients: Children are more susceptible to systemic toxicity
- Use on face, groin, or axillae: Increased risk of adverse effects in these areas
- Pregnancy: Category C - use only if potential benefit justifies potential risk
- Nursing mothers: Use with caution; not known if excreted in human milk
Drug Interactions
- No formal drug interaction studies conducted
- Theoretical interactions with other corticosteroids (additive effects)
- May interact with drugs that inhibit CYP3A4 (ketoconazole, itraconazole, erythromycin)
- Patients receiving immunosuppressant drugs may be at increased risk of infection
Adverse Effects
Common (≥1%):- Burning sensation
- Pruritus
- Skin irritation
- Dryness
- Erythema
- Folliculitis
- Hypertrichosis
- Acneiform eruptions
- Hypopigmentation
- Allergic contact dermatitis
- Signs of systemic absorption (weight gain, rounded face, hypertension)
- Severe skin reactions
- Signs of skin infection
- Vision problems (if applied near eyes)
Monitoring Parameters
- Clinical response to therapy
- Signs of local adverse reactions (skin atrophy, hypopigmentation)
- Signs of systemic absorption (in prolonged use or large surface area)
- HPA axis function if used for extended periods or over large areas
- Growth monitoring in pediatric patients
- Signs of secondary infection
Patient Education
- Use only as directed by healthcare provider
- Apply thin layer to affected areas only
- Avoid contact with eyes
- Do not use occlusive dressings unless instructed
- Report any signs of local irritation or infection
- Do not use longer than prescribed (maximum 2 weeks)
- Not for ophthalmic, oral, or intravaginal use
- Wash hands after application unless hands are treatment area
- Avoid sunlight and UV exposure on treated areas
- Store at room temperature, away from heat
References
1. FDA Prescribing Information: Vanos (fluocinonide) Cream 0.1%. Revised 2022. 2. Wolverton SE. Comprehensive Dermatologic Drug Therapy. 4th ed. Elsevier; 2021. 3. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-140. 4. Hengge UR, Ruzicka T, Schwartz RA, et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1-15. 5. Barnes PJ. Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci (Lond). 1998;94(6):557-572. 6. Clinical Pharmacology [Internet]. Tampa (FL): Elsevier. Fluocinonide; 2023 [cited 2023 Nov 15]. Available from: https://www.clinicalkey.com