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ISSUE 1 FEBRUARY
Letters to the Editor

Rational use of topical corticosteroids

  • Angus Kingon, Pablo Férnandez-Peñas
The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.
 

Letter to the Editor

Editor, – In the article on topical corticosteroids (Aust Prescr 2013;36:158-61) there is no reference to the oral mucosa. Some steroid preparations have long been used as effective treatment for conditions in the mouth, notably for lichen planus.1 One option is 0.05% betamethasone ointment. This has proved particularly relevant in over 20 years of practice, as I am contacted periodically by pharmacists questioning if such a prescription is appropriate for use on the oral mucosa.

Angus Kingon
Oral surgeon

Pymble, NSW
 

Author's comments

Pablo Fernández-Peñas, one of the authors of the article, comments:

Some mucosas have stratified epithelium similar to the skin, but with thinner or non-existent stratum corneum. This changes the absorption of molecules. In a cream or ointment there are more components than the corticosteroid, and I do not have enough information to assess that it is safe to use skin products in the oral mucosa.

The clinical outcome will depend on making a correct diagnosis and applying the right molecule in the most appropriate vehicle for the correct duration. In this regard, there may be vehicles that are not adequate for the oral mucosa. Most dermatologists tend to compound their topical corticosteroids in ‘orabase’ for use on mucosas, to be on the safe side.

 

References

  1. Sugarman PB, Savage NW. Oral lichen planus: causes, diagnosis, and management. Aust Dent J 2002;47:290-7 .

Angus Kingon

Oral surgeon, Pymble, NSW

Pablo Férnandez-Peñas