Nerisone (Diflucortolone) is a potent corticosteroid that is used in the treatment of acute and chronic inflammatory skin conditions.

Diflucortolone (Nerisone) Uses:

• Acute and chronic skin disease:
  • Treatment of acute and chronic skin diseases that are responsive to the anti-inflammatory, antipruritic, and antiallergic effects of topical corticosteroids.

Diflucortolone (Nerisone) Dose in Adults:

Diflucortolone (Nerisone) Dose in the treatment of acute and chronic skin disease:

• Topical:
  • Apply a light coating 1–2 times each day, using just enough to cover the afflicted region.
  • Lack of improvement or worsening of condition after 2 to 4 weeks of therapy may require further evaluation.
  • The maximum duration of therapy: 4 weeks

Diflucortolone (Nerisone) Dose in Childrens:

Nerisone (Diflucortolone) Dose in the treatment of acute and chronic skin disease:

• Children >1 year and Adolescents:
  • Topical:
    • Use the least quantity possible for the shortest length of time to provide the desired therapeutic result.
    • Apply a little coating only thick enough to cover the afflicted region once or twice a day.
    • Lack of improvement or worsening of condition after 2 to 4 weeks of therapy may necessitate further evaluation
    • The maximum duration of therapy: 4 weeks

Pregnancy Risk Category: C

• Diflucortolone and other corticosteroids have been associated to undesirable outcomes in research on animal reproduction.
• It is not advised to use topical products for:
  • Extensive use
  • in large quantities
  • Pregnant women may be exposed to the drug for longer periods of time
• Systemic therapy is preferred over topical corticosteroids for illnesses including
  • Pregnant women may experience psoriasis, atopic dermatitis or both.
  • High-potency corticosteroids should not be used in the first trimester.

Diflucortolone use during breastfeeding:

• Human milk contains corticosteroids. It is unknown if there are detectable amounts in human milk due to systemic absorption after topical administration.
• Avoid applying topical corticosteroids on breasts. Hypertension has been reported in infants who were given topical corticosteroids while they were breastfeeding.
• The manufacturer warns breastfeeding mothers to take caution when administering diflucortolone since systemic maternal use of corticosteroids might have harmful consequences on nursing infants (e.g., growth suppression, & interference with endogenous corticosteroid production).

Nerisone Dose in Kidney Disease:

• No specific dose adjustments have been provided in the manufacturer’s labeling
• To obtain the intended therapeutic effect, the manufacturer advises using the least dosage for the shortest amount of time.

Nerisone Dose in Liver disease:

• No specific dose adjustments have been mentioned in the manufacturer’s labeling
• To obtain the intended therapeutic effect, the manufacturer advises using the least dosage for the shortest amount of time.

Side effects of Nerisone (diflucortolone):

Reactions listed are based on reports from other topical steroids and may not be specifically reported for diflucortolone.

• Cardiovascular:
  • Hypertension
• Central Nervous System:
  • Localized Burning
  • Steroid Withdrawal Syndrome
• Dermatologic:
  • Acneiform Eruption
  • Alopecia
  • Atrophic Striae
  • Contact Dermatitis
  • Dermatitis
  • Dyschromia
  • Epidermal Thinning
  • Erythema
  • Folliculitis
  • Hair Breakage
  • Hypertrichosis
  • Miliaria
  • Perioral Dermatitis
  • Pruritus
  • Pustular Psoriasis
  • Skin Atrophy
  • Skin Pain
  • Skin Rash
  • Telangiectasia
  • Urticaria
  • Wrinkling Of Skin
  • Xeroderma
• Endocrine & Metabolic:
  • Cushingoid Appearance
  • Decreased Plasma Cortisol
  • Glycosuria
  • Hpa-Axis Suppression
  • Hyperglycemia
  • Obesity
  • Weight Gain
• Infection:
  • Secondary Infection
• Hypersensitivity:
  • Local Hypersensitivity Reaction
• Immunologic:
  • Immunosuppression (Underlying Symptom Exacerbation)
• Neuromuscular & Skeletal:
  • Decreased Linear Skeletal Growth Rate
  • Osteoporosis
• Local:
  • Application Site Irritation
  • Application Site Pain
• Ophthalmic:
  • Cataract
  • Glaucoma
• Miscellaneous:
  • Failure To Thrive

Contraindications to Diflucortolone (Nerisone):

• Hypersensitivity to diflucortolone or any other corticosteroids, including any component of the formulation
• Infants under 1-year-old
• Parasitic diseases
• Skin symptoms associated with syphilis and TB
• Symptoms of an eruption following vaccinations
• Rosacea
• Varicella and herpes virus-related skin lesions
• Bacterial or fungal skin infections
• Pruritus with no inflammation
• Perianal and genital pruritus
• perioral dermatitis;
• acne vulgaris;
• Ophthalmic application

Warnings and precautions

• Suppression of the adrenals:
  • The hypothalamic-pituitary-adrenal (HPA) axis may be suppressed or hypercortisolism may occur, especially in younger individuals or those who receive large dosages for extended periods of time.
  • HPA axis suppression may cause an adrenal crisis.
  • Patients who use a lot of topical steroids should be monitored for HPA suppression with urinary-free cortisol and ACTH stimulation on a regular basis.
  • You should withdraw from a corticosteroid and stop using it. Reduce the frequency of use and substitute a more potent steroid.
  • Most people recover quickly and completely after stopping taking steroid drugs. However, if withdrawal symptoms occur, you may need to take supplemental systemic steroids.
• Contact dermatitis:
  • Contact dermatitis from allergies might happen. Instead of clinical aggravation, failure of healing is frequently used to diagnose it.
  • To confirm the diagnosis, patch testing can be performed.
• Hypersensitivity
  • It is possible to experience localized hypersensitivity reactions.
  • If hypersensitivity develops, discontinue use and consult your doctor immediately.
  • Failure to heal rather than clinical aggravation can be used to identify allergy contact dermatitis.
  • Patch testing can be done to verify the diagnosis.
• Immunosuppression:
  • Additionally, corticosteroids can be used for extended periods of time to reduce the effectiveness of vaccines, raise the risk of secondary infections, conceal acute illnesses (including fungal infections), prolong and worsen viral infections, and disguise fungal infections.
  • If concurrent skin infections develop, stop using the medication and seek appropriate treatment.
  • Avoid exposure to varicella-zoster, also known as chickenpox.
  • Corticosteroids should not be used to treat ocular herpes simplex.
• Kaposi Sarcoma:
  • Kaposi sarcoma can be caused by prolonged treatment with corticosteroids
  • If this is the case, it's worth considering discontinuing therapy.
• Systemic effects
  • It is possible for topical corticosteroids to enter the body through the skin.
  • Topical corticosteroids that are absorbed can cause Cushing syndrome, hyperglycemia, or glycosuria.
  • Absorption can be boosted by applying to skin that is dehydrated or using occlusive dressings.
• Psoriasis:
  • Take care and be careful.
  • There have been reports of rebound relapses, tolerance development, risk of generalized pustular pisoriasis and the development of localized or global toxicity from an impaired skin barrier.
  • If you experience severe irritation, discontinue use and consult your doctor immediately.

Diflucortolone (United States: Not available): Drug Interaction

Monitoring parameters:

• Extensive/prolonged usage that suppresses the adrenal glands (ACTH stimulation test)
• Monitor the response to treatment
• Monitor growth in children when used for a prolonged period of time.

How to administer Diflucortolone (Nerisone)?

• Only for localised usage.
• Apply just enough to cover the afflicted region and gently rub it in.
• Use of occlusive dressings should be avoided.
• Do not apply in or near the eye or on other mucous membranes.

Mechanism of action of Diflucortolone (Nerisone):

• The anti-inflammatory, anti-pruritic, and vasoconstrictive properties of topical corticosteroids.
• Through the activation and inhibition of sequential arachidonic acid release and phospholipase A2 inhibitory protein, they can reduce the generation, release, and activity of endogenous chemical mediators (kinins and histamines) (lipocortins).
• Diflucortolone is a potent drug with an intermediate range of potency.

Metabolism:

• Hepatic

Absorption:

• Percutaneous absorption can vary and is influenced by a number of variables, such as the vehicle utilised, the thickness and integrity of the epidermis, the amount of surface area, and the use of occlusive dressings (not advised).

Excretion:

• Urine and feces  

International Brands of Diflucortolone:

• Nerisone Oily
• Nerisone
• Claral
• Cortical
• Dermaval
• Dervin
• Diflucor
• Difuco
• Isolone
• Nericid
• Neriderm
• Neriforte
• Nerilon
• Nerisona
• Nerisone
• Nerisone Forte
• Temetex
• Valeron

Diflucortolone Brand Names in Pakistan: