Desoximetasone (Topicort), a topical corticosteroid of medium to high potency, is used to treat the symptoms of plaque psoriasis and eczema in patients.

Desoximetasone Uses:

• Cream, gel, and ointment:
  • It is prescribed to treat the inflammatory and itchy symptoms of dermatoses that respond to corticosteroids.
• Spray:
  • Plaque psoriasis treatment.

Desoximetasone (Topicort) Dose in Adults

Note: The treatment should be discontinued as soon as the condition improves. If no improvement is noted after 4 weeks of the treatment, the diagnosis should be reassessed.

Desoximetasone (Topicort) Dose in the therapy of Corticosteroid-responsive dermatoses:

• Topical: Cream, gel, ointment:
  • Two times each day, apply a thin coating to the afflicted region.

Desoximetasone (Topicort) Dose in treatment of Plaque psoriasis:

• Topical: Spray:
  • Two times each day, apply a thin coating to the afflicted region.

Desoximetasone (Topicort) Dose in Children

Note:

• It is advised to use the least amount necessary for the shortest amount of time. Depending on the affected area and the disease's severity, the dose may change.
• When the situation gets better, the therapy should be stopped. If no progress is seen after receiving therapy for four weeks, patients may need to be reevaluated.

Desoximetasone (Topicort) Dose in the treatment of steroid-responsive dermatoses including contact dermatitis and atopic dermatitis:

• Cream/gel: Children and Adolescents:
  • Two times each day, apply a thin coating to the afflicted region.
• Ointment: Children ≥10 years and Adolescents:
  • Two times each day, apply a thin coating to the afflicted region.

Pregnancy Risk Factor C

• Corticosteroids have been shown to be teratogenic in animal reproduction studies. 
• While topical corticosteroids are not a risk to the fetus in humans, they can cause intrauterine growth retardation.
• Pregnant females should avoid long-term use and applications over a greater surface area.

Use during breastfeeding:

• Human breastmilk contains systemic corticosteroids. 
• Although it is unknown how much drug is absorbed from topical application, neonatal hypertension has been caused by the application of systemic corticosteroids to the nipples of lactating mothers. Breastfeeding infants should not use it.

Dose in Kidney Disease:

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

Dose in Liver disease:

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

Common Side Effects of Desoximetasone (Topicort):

• Endocrine & metabolic:
  • HPA-axis suppression
  • Cushings syndrome
• Others:
  • Infections (Bacterial and Fungal)
  • Skin atrophy

Contraindications to Desoximetasone (Topicort):

Cream, gel, ointment:

• Allergy to desoximetasone and any component of the formulation

Spray:

• The manufacturer's labeling does not list any contraindications.

Warnings and precautions

• Suppression of the adrenals:
  • Extended use can result in suppression of cortisol endogenous secretion via HPA suppression
  • HPA suppression is more common in children younger than those who have been treated for a long time. In stress-like situations, patients may experience adrenal crisis.
• Contact dermatitis:
  • Allergy contact dermatitis can be diagnosed in patients who have not healed from their primary lesion.
• Immunosuppression:
  • Topical use can lead to the development of superinfections due to immunosuppression. You should stop using the topical and get antimicrobial treatment.
• Kaposi's Sarcoma:
  • Kaposi's Sarcoma case reports have been published using topical corticosteroids. If suspected, treatment must be stopped immediately.
• Reactions to skin:
  • Local skin reactions can occur from topical application, such as striae, telangiectasias and atrophic skin.
  • Patients who are exposed to higher doses of medication, those wearing occlusive dressings or for extended periods of time may experience local reactions that may not be reversed.
• Systemic effects
  • Patients may experience systemic absorption. This can lead to side effects such as Cushing's syndrome or secondary diabetes.
  • Occlusive dressings are applied over large areas and on skin that is not denuded to increase systemic absorption.
• Skin infections
  • Long-term treatment may lead to superinfections. It is possible that the treatment must be stopped.
  • Antifungals and antibiotics should be used to treat the patient as appropriate.

Desoximetasone: Drug Interaction

Note: Drug Interaction Categories:

• Risk Factor C: Monitor When Using Combination
• Risk Factor D: Consider Treatment Modification
• Risk Factor X: Avoid Concomitant Use

Monitoring parameters:

• Monitor for the response to treatment.
• Monitor for HPA suppression and features of Cushing's syndrome in patients on long-term glucocorticoid treatment.
• Observe for skin atrophy and monitor for superinfections (bacterial or fungal infections).   

How to administer Desoximetasone (Topicort)?

Topical:

• It is only intended for usage outside.
• Wash your hands well before and after applying the medication.
• If not instructed to do so by a professional, avoid using occlusive dressings.
• Apply to dry, clean skin and gently massage in.

Spray:

• Avoid applying the medicine over the face, axilla, groin, atrophic skin, or mucous membranes.
• Avoid heat, flame, or smoking when applying the medicine (it is flammable).
• Discard the unused medicine after 30 days.

Cream, gel, and ointment:

• Avoid any contact with your eyes

Mechanism of action of Desoximetasone (Topicort):

• It is a synthetic medium-high potency glucocorticoid.
• It binds to intracellular cells and modifies gene expression. 
• It prevents the production and release endogenous chemical mediators like kinins and prostaglandins. 
• It is anti-inflammatory, antipruritic and antiallergic.
• It can be used in combination with other drugs to treat steroid-responsive skin diseases.

Metabolism:

• Its metabolism occurs in the liver.

Absorption:

• Absorption is increased with occlusion, inflammation, and vary with the site of application.

Excretion:

• Urine and  feces

International Brand Names of Desoximetasone:

• Topicort
• Topicort Spray
• Topicort Mild
• Desoxi
• Actiderm
• Decilone
• Decilone Forte
• Deoxon Gel
• Deoxon Lotion
• Dercason
• Dermacorte
• Desomex
• Desone
• Dethasone
• Dexigen
• Dexocort
• Esperson
• Flubason
• Ibaril
• Pyderma
• Stiedex
• Teracorte
• Topcort
• Topicort
• Topicorte
• Topisolon
• Topoxy

Desoximetasone Brand Names in Pakistan:

No Brands Available in Pakistan.