Article

Fluocinonide (Lidemol, Lidex, Lydex-E, Lyderm, Metosyn, Tiamol, Vanos)
February 02, 201901,131

What is Fluocinonide (Lidemol, Lidex, Lydex-E, Lyderm, Metosyn, Tiamol, Vanos)?

Fluocinonide is a prescription corticosteroid used to treat skin conditions.5,6

Fluocinonide is the generic name of the drug. It is available under many brand names. Which brand names are available to you depend on what country you live in.

In the United States, the brand names of fluocinonide are7:

  • Lidex
  • Vanos

In Canada, the drug is sold under the brand names7:

  • Lidemol
  • Lidex Mild
  • Lidex Regular
  • Lyderm
  • Tcis
  • Topsyn
  • Tiamol
  • Trisyn

In the United Kingdom, the drug is available under the brand name Metosyn.8

  • How does Fluocinonide work?

Fluocinonide belongs to a class of drugs called corticosteroids.5

Corticosteroids are natural compounds made by your adrenal gland. Their job in your body is to help regulate your immune system. Specifically, they keep your immune system from causing too much inflammation by2,9:

  • preventing pro-inflammatory substances from working
  • stimulating the production of anti-inflammatory substances.

 

Figure 1: Structures of important corticosteroids: cortisol, cortisone, corticosterone.

(iStockphoto/chromatos)

 

Corticosteroid drugs work the same way in your body as the natural compounds do.2 This allows them to treat inflammation due to injuries or dysregulation of your immune system.

Since fluocinonide is made to rub on your skin, it is useful for treating inflammation in your skin, such as rashes.5

 

Fluocinonide Uses

Fluocinonide is used to treat the symptoms of skin conditions caused by inflammation. These symptoms include7,11:

  • Itching
  • Swelling
  • Redness
  • Blistering
  • Scaliness
  • Crusting

Three of most common inflammatory skin conditions treated with fluocinonide are:

  • Dandruff
  • Eczema
  • Psoriasis

 

Fluocinonide for Dandruff

Dandruff is a chronic inflammatory disorder that affects the scalp and trunk. It is caused by a fungus called Malessezia.12

The primary symptom of dandruff is flaky skin. It can range from localized and mild to wide-spread and intense. While dandruff symptoms are most common on the scalp, they can also occur on the face, ears and trunk of the body.12

 

Figure 2: Dandruff in hair.

Excessive Dandruff by Hmochoa95 is licensed under CC 3.0.

 

Though the condition is not life-threatening, many people find the flaky skin caused by dandruff embarrassing and wish to treat the symptoms as soon as possible.12

Antifungal drugs are needed to cure dandruff, but fluocinonide may be prescribed to help reduce the embarrassing flaking as quickly as possible.12 In most cases, your doctor will prescribe fluocinonide as a liquid to treat your dandruff.6

Fluocinonide for Eczema

Eczema is another inflammatory skin condition for which your doctor may prescribe fluocinonide.3

Eczema causes patches of red, itchy skin to form on your body. The itchiness can be worse at night and can prevent you from getting a good night’s sleep.13

 

Figure 3: Eczema on the arms and hands.

Eczema by OpenStax College is licensed under CC 3.0.

 

Eczema symptoms can be mild to severe. Often, eczema symptoms come and go, switching between no symptoms or mild symptoms and severe symptoms. Periods of severe symptoms are called “flares”.13

The cause of eczema is not completely clear. Scientists think it might be caused by abnormalities in the way your body responds to inflammation.
It is also not clear why some people’s eczema “flares” appear to be triggered by certain stimuli (like heat), while others or not.13
The first line of treatment for eczema is moisturization. If this is not enough to control your symptoms, your doctor may prescribe fluocinonide.3

Fluocinonide for Psoriasis

Psoriasis is a chronic inflammatory skin condition that is characterized by rapid growth of skin cells. This causes the skin to thicken and form itchy, red scales or patches.14

 

Figure 4: Psoriasis on back and arms.

Psoriasis on Back by The Wednesday Island is licensed under CC 3.0.

 

Psoriasis is an autoimmune disease in which your immune system starts attacking your healthy skin. What causes some people’s immune systems to start attacking their skin is unknown. Scientists think it is likely that both genetics and environmental factors play a role.15 Some factors scientists have identified that are likely involved in triggering psoriasis include15:

  • smoking
  • being overweight
  • drinking a lot of alcohol
  • having a vitamin D deficiency.

There is no cure for psoriasis. However, fluocinonide, and other anti-inflammatory drugs, can help relieve your symptoms.14,16

 

Dosage

How do you use fluocinonide?  How much do you use?  How often do you use it?

The answers to these questions depend on the type of fluocinonide your doctor prescribed for you and the condition you are using it for.3

Fluocinonide is available as a3:

  • Cream
  • Ointment
  • Liquid

 

Dosage for Adults17

 Eczema

The most common dose and form of fluocinonide to treat eczema is a 0.1% cream. Usually, your doctor will instruct you to apply a thin layer of this cream to the affected area once a day.  Treatment is not recommended for more than 2 weeks.

Psoriasis

To treat the symptoms of psoriasis, doctors usually prescribe a 0.1% fluocinonide cream. A thin layer of this cream is usually applied to the affected area once per day. Your doctor will likely suggest you continue this treatment for 2 weeks or less.

Other Skin Conditions

To treat other skin conditions your doctor may prescribe a 0.05% fluocinonide cream, ointment or liquid. Your doctor may ask you to apply a thin layer of the medication to the affected area between two and four times a day.

Alternatively, your doctor may prescribe a 0.1% fluocinonide cream. If your doctor prescribes this more concentrated form of fluocinonide, you will likely be asked to use it only once per day.

 

Dosage for Children17

Eczema

To treat eczema, your child’s doctor may prescribe either:

  • A 0.05% fluocinonide cream, ointment or topical solution to be used one or two times per day (for children under 12) or two to four times per day (for children over 12)

OR

  • A 0.1% fluocinonide cream to be used once daily.

This dose should not be used for children younger than 12 years old.

Psoriasis and Other Skin Conditions

To treat psoriasis or another skin condition, your child’s doctor may prescribe either:

  • A 0.05% fluocinonide cream, ointment or topical solution to be used two to four times per day

OR

  • A 0.1% fluocinonide cream to be used once a day.

This dose should not be used for children younger than 12 years old.

  •  
  • Fluocinonide vs. Other Drugs

Fluocinonide is one of several topical corticosteroids available. These corticosteroids differ in strength, available forms and cost. Depending on these factors, different corticosteroid creams may be better for different conditions.3

Weaker and cheaper creams, such as hydrocortisone, are often used as a first line of treatment for skin condtions.3

Fluocinonide is a relatively strong and expensive corticosteroid. It is often reserved for more serious skin conditions.3

Below is a comparison of the strengths and available forms of selected corticosteroids.

Drug NameStrength3Forms Available
Hydrocortisone 1% (28g cream)LowestCream, lotion, ointment3
Dexamethosone 0.1%LowestCream3
Desonide 0.05% (60g cream)LowCream, gel, foam, ointment3
Fluocinolone acetonide 0.01% (15g cream)LowCream, solution3
Hydrocortisone valerate 0.2% (15g cream)Low-mediumCream, ointment3
Triamcinolone acetonide 0.1% (15g cream)MediumCream, ointment3
Betamethasone valerate 0.1% (15g cream)MediumCream, foam, lotion, ointment3
Triamcinolone acetonide 0.5% (15g cream)HighCream, ointment3
Betamethasone dipropionate 0.05% (15g cream)HighCream, foam, ointment, solution3
Fluocinonide 0.05% (15g cream)HighCream, gel, ointment, solution3
Clobetasol 0.05% (15g cream)Very highCream, foam, ointment3
Augmented betamethasone dipropionate 0.05% (15g cream)Very highOintment18

 

Side Effects of Fluocinonide

No drug is without potential side effects. Some side effects are more common than others. While some side effects are mild, others may be serious or even life threatening.

Side effects of topical corticosteroids occur more often when3:

  • You use a higher strength corticosteroid (see above)
  • You use them for a long period of time
  • You use them on large areas of skin
  • You use them on skin that has open cuts or sores

Listed below are some of the more common side effects of fluocinonide, as well as some of the more serious side effects of the drug. Most of these side effects go away on their own once you stop using the drug.

 

Common Side Effects3,17

  • Spider veins
  • Stretch marks
  • Bruising
  • Acne
  • Rosacea-like rash
  • Excessive amounts of hair growth
  • Skin discoloration
  • Skin becoming delicate, thin or fragile

 

Serious Side Effects

  • Hypothalamic-pituitary-adrenal (HPA) axis suppression

Sometimes referred to as “adrenal insufficiency”, HPA-axis suppression occurs when the adrenal glands stop producing enough hormones.1,17 Symptoms of adrenal insufficiency include tiredness that does not go away, depression, abdominal pain, weight loss and loss of appetite.

HPA axis suppression is uncommon when fluocinonide is used at prescribed doses.19

If you have symptoms of HPA axis suppression, it is important to call your doctor right away.

  • Skin Cancer

Organ transplant patients taking oral corticosteroids long-term are at an increased risk of getting a type of skin cancer called basal cell carcinoma.5 Basal cell is a type of skin cancer thought to be caused by a lot of exposure to UV light from the sun.20

The use of corticosteroids on the skin, such as fluocinonide cream, has not been associated with an increased risk of basal cell carcinoma, but is a theoretical risk.4

  • Cushing Syndrome

Cushing syndrome results from high levels of a specific corticosteroid, called cortisol, in the body.  This causes a roundness of the face, weight gain, increased blood pressure, bone loss and diabetes.17 Cushing syndrome can also slow healing.21

 

Warnings

General Warnings

You should not use fluocinonide if you are allergic to it or any of its ingrediants.7

 

Warnings for Special Groups

Children

You should watch children under the age of 12 closely if they are taking fluocinonide.5,17  Young children absorb fluocinonide better than adults. This can let it build up in their bodies and may lead to Cushing syndrome.3,5  Too much fluocinonide may also affect the child’s growth.5

Women Who are Pregnant

Fluocinonide is a pregnancy category C drug. This means that studies on animals showed negative effects on unborn babies, but this has not been proven in humans. Your doctor will decide if the benefits of fluocinonide outweigh the risks for you.7,17

Women Who are Breastfeeding

Doctors do not know how much fluocinonide can pass into breast milk if it is applied to your skin.5,17 It is known, however, that exposure to corticosteroids in breast milk can affect the growth of infants and children.5,17 This makes using fluocinonide while you are nursing potentially risky. As in pregnancy, your doctor will decide if the benefits of fluocinonide outweigh the risks for you and your baby if you are nursing.5

Elderly

Scientists have not studied whether or not the common doses of fluocinonide are safe and effective for older adults.3

 

Fluocinonide Drug Interactions

You should not take fluocinonide with any other corticosteroids.

There are no other significant drug-drug interactions with fluocinonide.17

 

Abuse of Fluocinonide

Fluocinonide is not addictive and does not cause dependence.5

 

Other Important Information17

  • Wash your hands after applying fluocinonide.
  • Do not bandage or cover the area of skin being treated with fluocinonide.
  • Do not use fluocinonide for more than 2 weeks in a row.
  • Do not use more than 60 g of fluocinonide in 1 week.
  • Do not put fluocinonide in your mouth.
  • Do not put fluocinonide in your eyes, the inside of your nose, or on your genitals unless directed to do so by your doctor.
  • Contact your doctor if your symptoms have not gone away in 2 weeks.
  • Keep all of your doctors’ appointments.
  • Ask your doctor or pharmacist any questions you have about your medication.

Keep an updated list of all of your prescription and over-the-counter drugs, supplements and alternative remedies. Bring this list with you whenever you visit a doctor or are admitted to the hospital.

 

How to Store Fluocinonide

Keep fluocinonide tightly closed and in its original container. Store it at room temperature (between 68 and 77 degrees F), away from areas with excess heat. Fluocinonide should not be frozen.  Keep fluocinonide and all other drugs out of the reach of children.17

 

Discarding Fluocinonide

Ask your pharmacist about how to dispose fluocinonide once you’ve finished using it or it is past its expiration date.11

 

References

  1. Chapter 6. Adrenal Gland. In: Molina PE. Molina P.E. Ed. Patricia E. Molina.eds. Endocrine Physiology, 4e New York, NY: McGraw-Hill; 2013. http://accessmedicine.mhmedical.com/content.aspx?bookid=507&sectionid=42540506. Accessed June 08, 2017.
  2. Chrousos GP. Adrenocorticosteroids & Adrenocortical Antagonists. In: Katzung BG, Trevor AJ. Katzung B.G., Trevor A.J. Eds. Bertram G. Katzung, and Anthony J. Trevor.eds. Basic & Clinical Pharmacology, 13e New York, NY: McGraw-Hill; 2015. http://accessmedicine.mhmedical.com/content.aspx?bookid=1193&sectionid=69109924. Accessed June 08, 2017.
  3. Eichenfield, LF, et al. Guidelines of care for the management of atopic dermatitis: Section 2.  Management and treatment of atopic dermatitis with topical therapies.  Journal of the American Academy of Dermatology. 2014; 71(1): 116-132.  doi: https: /tdoi.org/10.1016/j/jaad.2014.03.023.  Accessed June 8, 2017.
  4. Sørensen, HT, Mellemkjær, L, Nielsen, GL, et al. Skin Cancers and Non-Hodgkin Lymphoma Among Users of Systemic Glucocorticoids: A Population-Based Cohort Study. Journal of the National Cancer Institute. 2004; 96 (9): 709-711. doi: 10.1093/jnci/djh118. Accessed June 8, 2017.
  5. Vanos. US Food and Drug Administration (2006). at <https://www.accessdata.fda.gov/drugsatfda_docs/label/2006/021758s00lbl.pdf>. Accessed August 30, 2017.
  6. Orange Book: Approved Drug Products with Therapeutic Equivalence Evaluations. Accessdata.fda.gov (2017). at <https://www.accessdata.fda.gov/scripts/cder/ob/search_product.cfm>. Accessed August 30, 2017.
  7. Fluocinonide (Topical application route). PubMed Health (2017). at <https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0045075/>. Last updated August 1, 2017. Accessed August 30, 2017.
  8. Metosyn | The Psoriasis and Psoriatic Arthritis Alliance – PAPAA. Papaa.org. at <http://www.papaa.org/potent-steroids/metosyn>. Accessed August 30, 2017.
  9. 1.The role of cortisol in the body. Healthdirect.gov.au. Last updated June 2016. at <https://www.healthdirect.gov.au/the-role-of-cortisol-in-the-body>. Accessed August 30, 2017.
  10. Atopic dermatitis (eczema) – Overview. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/home/ovc-20341956>. Accessed August 30, 2017.
  11. Fluocinonide Topical: MedlinePlus Drug Information. Medlineplus.gov. Last updated January 8, 2010. at <https://medlineplus.gov/druginfo/meds/a601054.html>. Accessed August 30, 2017.
  12. Clark, G., Pope, S. & Jaboori, K. Diagnosis and Treatment of Seborrheic Dermatitis. Aafp.org (2015). at <http://www.aafp.org/afp/2015/0201/p185.html>. Accessed August 30, 2017
  13. Atopic dermatitis (eczema) – Symptoms and causes. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/atopic-dermatitis-eczema/symptoms-causes/dxc-20341958>. Accessed August 30, 2017
  14. Psoriasis – Overview. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/psoriasis/home/ovc-20317577>. Accessed August 30, 2017
  15. Psoriasis – Symptoms and causes. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/psoriasis/symptoms-causes/dxc-20317579>.Accessed August 30, 2017
  16. Psoriasis – Treatment. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/psoriasis/diagnosis-treatment/treatment/txc-20317590>. Accessed August 30, 2017
  17. Fluocinonide topical Adult Dosing – Epocrates Online. Online.epocrates.com at <https://online.epocrates.com/drugs/28/fluocinonide-topical>. Accessed August 30, 2017
  18. Epocrates Online. Online.epocrates.com at <http://online.epocrates.com>. Accessed August 30, 2017
  19. Adrenal suppression – Diagnosis – Approach – Best Practice – English. Bestpractice.bmj.com (2016). at <http://bestpractice.bmj.com/best-practice/monograph/863/diagnosis/step-by-step.html>. Last updated September 5, 2016. Accessed August 30, 2017.
  20. Basal cell carcinoma – Overview. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/home/ovc-20251803>. Accessed August 30, 2017
  21. Cushing syndrome – Symptoms and causes. Mayo Clinic at <http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/dxc-20197177>. Accessed August 30, 2017

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