Fluticasone cream
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fluticasone propionate cream indications dosing mechanism side effects
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https://www.ncbi.nlm.nih.gov/books/NBK542161
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Fluticasone Propionate Cream
Overview
Fluticasone propionate cream (brand name Cutivate) is a synthetic fluorinated corticosteroid available as a 0.05% cream (and 0.005% ointment). It is classified as an intermediate potency topical corticosteroid and is one of the most widely used agents for inflammatory skin conditions. - Lippincott Illustrated Reviews: Pharmacology, p. 1511
Mechanism of Action
Fluticasone binds to intracellular glucocorticoid receptors, triggering effects including:
- Anti-inflammatory - suppresses phospholipase A2, reducing arachidonic acid release and blocking synthesis of prostaglandins and leukotrienes
- Antiproliferative - slows keratinocyte turnover (useful in psoriasis)
- Immunosuppressive - reduces cytokine production (IL-1, IL-2, TNF-α)
- Vasoconstrictive - reduces erythema and edema
Its high lipophilicity allows good skin penetration. Only about 5% of a topical dose is systemically absorbed, with the majority excreted in feces. - StatPearls - Fluticasone
FDA-Approved Indications (Topical)
| Condition | Notes |
|---|---|
| Atopic dermatitis | Primary indication; approved from age 3 months |
| Psoriasis | Intermediate-potency agent suitable for non-facial sites |
| Other corticosteroid-responsive dermatoses | Eczema, seborrhoeic dermatitis, contact dermatitis, lichen planus |
Dosing
Cream 0.05% (primary topical form):
- Children ≥3 months and adults: Apply a thin film to affected areas once daily to twice daily; once symptoms are controlled, step down to a less potent agent
- Safety and efficacy have not been evaluated beyond 4 weeks of continuous use
Lotion:
- Children ≥3 months and adults: Apply thin film once daily; not evaluated beyond 4 weeks
Ointment 0.005%:
- Adults only: Apply thin film twice daily
Important: Fluticasone propionate and fluticasone furoate are NOT interchangeable - they have different potencies and dosing regimens. - The Harriet Lane Handbook, 23rd ed., p. 1495
Potency Classification
Fluticasone propionate 0.05% cream falls in the intermediate potency range (Class III-IV), alongside agents such as betamethasone dipropionate 0.05% cream and mometasone furoate 0.1%.
| Potency Class | Example Agents |
|---|---|
| Low | Hydrocortisone 0.25-2.5%, alclometasone 0.05% |
| Intermediate | Fluticasone propionate 0.005-0.05%, mometasone 0.1%, betamethasone valerate 0.1% |
| High | Fluocinonide 0.05%, betamethasone dipropionate augmented |
| Very High | Clobetasol propionate 0.05%, halobetasol propionate 0.05% |
- Lippincott Illustrated Reviews: Pharmacology, p. 1511
Adverse Effects
Local (most common)
- Skin atrophy and striae (especially with prolonged use or occlusion)
- Irritation, burning, pruritus
- Folliculitis and acneiform eruptions
- Hypopigmentation
- Perioral dermatitis
- Hypertrichosis
- Allergic contact dermatitis
- Secondary infections (bacterial, fungal)
- Miliaria
Ocular
- Cataracts and glaucoma have been reported - avoid contact with eyes
Systemic (rare, with extensive/prolonged use)
-
Hypothalamic-pituitary-adrenal (HPA) axis suppression - especially in young children with large surface area application
-
Growth retardation in children with excessive use
-
Cushing-like features
-
The Harriet Lane Handbook, 23rd ed., p. 1537
Contraindications & Precautions
- Avoid on the face, axillae, or groin (higher absorption, skin thinning risk)
- Do not use under occlusive dressings unless directed - increases systemic absorption
- Reassess diagnosis if no improvement within 2 weeks
- Pregnancy: Use with caution; systemic absorption is low but topical corticosteroids can cause fetal harm in animal studies
- CYP3A4 inhibitors (e.g., ritonavir, ketoconazole): Can increase systemic fluticasone levels, increasing risk of HPA suppression and Cushing syndrome
- Do not use for perioral dermatitis or rosacea (can worsen both)
Practical Tips
- Apply only to affected areas - not as a general moisturiser
- Use the smallest effective amount for the shortest duration
- Avoid wrapping or covering treated areas with bandages
- Once inflammation is controlled, taper to a lower-potency agent or switch to a non-steroidal maintenance therapy (e.g., tacrolimus or pimecrolimus for atopic dermatitis)
- Intermittent ("weekend") dosing of fluticasone propionate cream has evidence for reducing relapse risk in atopic dermatitis - Dermatology 2-Volume Set 5e
Available Formulations Summary
| Formulation | Concentration | Approved Age |
|---|---|---|
| Cream (Cutivate) | 0.05% | ≥3 months |
| Lotion | 0.05% | ≥3 months |
| Ointment | 0.005% | Adults only |
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