Fluocinonide (Lidex) is a potent corticosteroid drug that is used topically for the treatment of inflammatory conditions of the skin such as psoriasis and seborrheic dermatitis.

Indications of Fluocinonide (Lidex):

• Inflammatory and pruritic dermatologic conditions:

  It works well to reduce the inflammatory and itchy symptoms of dermatoses that respond to corticosteroids.

Fluocinonide (Lidex) Dose in Adults:

 Use in Atopic dermatitis: Topical:

• Apply a thin layer of cream, gel, ointment, or solution (0.05%) 2–4 times a day to the affected area. 
• Apply a thin coating of cream (0.1%) once daily to the troubled regions. Not advised for use for two weeks in a row or for exposures exceeding 60 g per week.  Therapy should be discontinued once symptoms have been under control.  If progress is not noticed after two weeks, a different diagnosis should be taken into account.

Fluocinonide (Lidex) cream for Psoriasis: Topical:

• Apply a thin layer of cream, gel, ointment, or solution (0.05%) to the afflicted area 2 to 4 times each day. Cream (0.1%)
• Apply a thin coating of cream (0.1%) to the afflicted regions once or twice daily. Not advised for use for two weeks in a row or for exposures exceeding 60 g per week.  Therapy should be discontinued once symptoms have been under control. If progress is not noticed after two weeks, a different diagnosis should be taken into account.

Dose in the treatment of Other inflammatory and pruritic dermatologic conditions: Topical:

• Apply a thin layer of cream, gel, ointment, or solution (0.05%) to the afflicted area 2 to 4 times each day. 
• Apply a thin layer of cream (0.1%) once or twice a day to the afflicted region. They are not advised for use for two weeks in a row or for exposures exceeding 60 g per week. 
  Therapy should be discontinued once symptoms have been under control. 
  If progress is not noticed after two weeks, a different diagnosis should be taken into account. 

Fluocinonide (Lidex) dose in children:

Dose in Atopic dermatitis:

• Cream, gel, ointment, topical solution (0.05%):

  • Children and Adolescents:
    • Topical: Depending on how severe the condition is, apply a thin layer to the affected area 2 to 4 times per day. 
  • Note: NICE recommendations advise applying just once or twice daily to children under the age of 12.

• Cream (0.1%):

  • Children ≥12 years and Adolescents:
    • Topical: Apply a little coating to the afflicted regions once daily. Use beyond two weeks in a row or an exposure rate of more than 60 g per week is not advised.
    • Therapy should be discontinued once symptoms have been under control.
    • If progress is not noticed after two weeks, a different diagnosis should be taken into account.

Dose in the treatment of Corticosteroid-responsive dermatoses (including psoriasis):

• Cream, gel, ointment, topical solution (0.05%):

  • Children and Adolescents:
    • Topical: Depending on the severity of the condition, apply a thin layer to the affected area 2 to 4 times daily.
    • Psoriasis and other resistant disorders can be treated with occlusive dressings.

• Fluocinonide (Lidex) Cream (0.1%):

  • Children ≥12 years and Adolescents:
    • Topical: Dab the afflicted regions with a thin coating once or twice daily. They are not advised for use for two weeks in a row or for exposures exceeding 60 g per week.
    • Therapy should be discontinued once symptoms have been under control.
    • If progress is not noticed after two weeks, a different diagnosis should be taken into account.

Pregnancy Risk Factor C

• Corticosteroids have been shown to cause adverse effects in animal reproduction.
  • Topical corticosteroids for atopic dermatitis or psoriasis are better than systemic during pregnancy.
  • It is not recommended that you use topical steroids during pregnancy for a prolonged period or in higher dosages.
  • It is not recommended that high-potency corticosteroids be used during the first trimester.
  • There is not much information available on the use of fluocinonide in pregnancy.

Use of fluocinonide during breastfeeding

• Human milk contains systemic corticosteroids.
• It is unknown if enough fluocinonide has been absorbed by topical administration to cause detectable amounts of fluocinonide in breast milk.
• Nuples should not be treated with topical corticosteroids.
• Breastfeeding infant with hypertension was exposed to topical corticosteroids during breastfeeding.
• Fluocinonide 0.05% should be administered to breastfeeding women with caution, according to the manufacturer.
• Breastfeeding infants can be adversely affected by systemic corticosteroids during pregnancy (eg, growth suppression or interference with endogenous corticosteroid manufacturing).
• The manufacturer recommends that the decision to discontinue breastfeeding or discontinue using the drug be made based on the importance of the treatment for the mother during fluocinonide 0.1%.

Dose adjustment in kidney disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Dose adjustment in liver disease:

There are no dosage adjustments provided in the manufacturer's labeling.

Side effects of Fluocinonide (Lidex):

• Endocrine & Metabolic:

  • Cushing's Syndrome
  • Glycosuria
  • Growth Suppression
  • HPA-Axis Suppression
  • Hyperglycemia

• Central Nervous System:

  • Intracranial Hypertension
  • Localized Burning

• Infection:

  • Secondary Infection
•  

• Dermatologic:

  • Skin Atrophy
  • Telangiectasia
  • Xeroderma
  • Contact Dermatitis
  • Folliculitis
  • Hypertrichosis
  • Hypopigmentation
  • Acne Vulgaris
  • Allergic Dermatitis
  • Atrophic Striae
  • Maceration Of The Skin
  • Miliaria
  • Perioral Dermatitis
  • Pruritus

• Local:

  • Local Irritation

Contraindications to Fluocinonide (Lidex):

• Intolerance to fluocinonide and any other ingredients in the formulation

Warnings and precautions

• Suppression of the adrenals:

  • Patients receiving greater doses, receiving medication for a longer period of time, or having younger children may experience hypercortisolism or hypothalamic-pituitary-adrenal (HPA) axis suppression.
  •  An adrenal crisis may result from suppression of the HPA axis.

• Contact dermatitis:

  • Allergy-related contact dermatitis brought on by fluocinonide is characterised by the inability to heal rather than clinical aggravation.

• Local effects

  • Local side effects can occur if the treatment is prolonged or not completed.
  • Local effects of fluocinonide include itching, burning and irritation.
  • In the event of irritation, alternative therapy should be considered.

• Kaposi Sarcoma:

  • Kaposi sarcoma may occur from prolonged corticosteroid treatment.
  • In such cases, treatment should be stopped immediately
•  

• Skin infections

  • Concomitant skin infections may occur during therapy.
  • If persistent infections persist despite treatment, it is important to stop taking medication.

• Systemic effects

  • Percutaneous absorption of topical corticosteroids is possible.
  • The topical absorption and use of steroids can lead to hypo/hyperglycemia, glycosuria or Cushing syndrome.
  • Applying steroids to big regions, covering wounds with occlusive bandages, and applying to skin that hasn't been denuded can all raise the risk of infection.

Fluocinonide: Drug Interaction

Monitoring parameters:

Indications of bacterial or fungal infections: HPA axis suppression (ACTH stimulation test, AM plasma cortisol test, urine free cortisol test).

How to administer Fluocinonide (Lidex)?

• For topical use only.
• A thin film should be applied and lightly rubbed avoiding contact with the eyes.
• After use, hands should be completely cleansed (unless hands are part of the treatment area).
• Lower-strength formulations (0.05%) should be used with caution on areas like the face or opposing skin surfaces that may rub or touch (e.g., the creases of the groyne, axilla, and breasts).
• The use of a higher-strength (0.1%) formulation in these areas should be avoided.
• Occlusive dressings dramatically increase percutaneous absorption and should only be used in conjunction with fluocinonide 0.05% as established by a healthcare professional for the treatment of psoriasis or other resistant disorders. It is essential to closely check any negative consequences.

Mechanism of action of Fluocinonide (Lidex):

• Fluocinonide, a fluorinated corticosteroid, is high in potency. Topical corticosteroids are anti-inflammatory, vasoconstrictive, and antipruritic.
• They cause the production of lipocortins, a phospholipase A2 inhibitory protein that prevents the release of arachidonic acids.
• As a result, the production, release, and activity of endogenous chemical mediators of inflammation are suppressed (kinins and histamines, liposomal enzymes and prostaglandins).

Metabolism:

• Hepatic

Absorption:

• It may increase with inflammation or occlusion depending on the formulation, the volume applied, and the type of skin at the application location.

Excretion:

• Primarily urine and bile.

International Brands of Fluocinonide:

• Flunide
• Glycobase
• Hakelon
• KC-F
• Lidex
• Topactin
• Topactin Emollient
• Vanos
• Lidemol
• Lidex
• Lyderm
• Etonalin F
• Flu-21
• Flubiol
• Acderma
• Macerybest
• Medrexim
• Metosyn
• Murukos F
• Novoter
• Rauracid
• Rufull
• Simaron
• Solunim
• Tohsino
• Topsym
• Topsym F
• Tiamol
• Amfulan
• Biscosal
• Cusigel
• Delipo
• Dermadex
• Topsym Polyol
• Topsyn
• Topsyne
• Trappen

Fluocinonide Brand Names in Pakistan:

Top Gel Top Gel Plus