Gabriel first started exhibiting small patches of eczema at 10 months old. He was prescribed a “light” steroid cream by the doctor, but the eczema only became worse. The doctor then prescribed Mometasone and Elidel creams. His parents did exactly what they were instructed to do, and they watched Gabriel become more itchy and miserable before their eyes. He was then prescribed, Triamcinolone Acetonide Ointment, Fluocinolone, oral antibiotics, and oral steroids. They were instructed to apply the topical steroids 3 times a day. This therapy worked temporarily, but when it stopped working, Gabriel’s mother described his skin looking as if it were “attacking itself.”
Why are different strengths critical? The appropriate strength depends on many factors. For example, babies absorb topical steroids faster than adults, so they may require a low-potency steroid. Areas of the body where skin touches skin (think: armpits, rectal area, etc), as well as sensitive areas (like the skin on the eyelids), tend to absorb topical steroids more rapidly, so those regions of the body also usually require a low-potency steroid. However, thick, rough skin on the palms of the hands and the soles of the feet usually absorb topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid. Keep in mind: The greater the potency of the steroid (in other words, the lower its class number), the more likely it is to cause side effects .
Transdermal patches can be a very precise time released method of delivering a drug. Cutting a patch in half might affect the dose delivered. The release of the active component from a transdermal delivery system (patch) may be controlled by diffusion through the adhesive which covers the whole patch, by diffusion through a membrane which may only have adhesive on the patch rim or drug release may be controlled by release from a polymer matrix. Cutting a patch might cause rapid dehydration of the base of the medicine and affect the rate of diffusion.