Comments on: Q: Can ingestion of a steroid cream be equivalent to ingested prednisone for acute asthma or anaphylaxis? http://www.wildmed.com/blog/q-can-ingestion-of-a-steroid-cream-be-equivalent-to-ingested-prednisone-for-acute-asthma-or-anaphylaxis/ Face any challenge, anywhere. Thu, 22 Dec 2011 03:54:14 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Michael A. Ganz M.D. http://www.wildmed.com/blog/q-can-ingestion-of-a-steroid-cream-be-equivalent-to-ingested-prednisone-for-acute-asthma-or-anaphylaxis/comment-page-1/#comment-7764 Michael A. Ganz M.D. Tue, 08 Jun 2010 10:29:07 +0000 http://www.wildmed.com/blog/?p=909#comment-7764 Topical Corticosteroids, in any of the currently available forms to treat allergic diseases (skin topicals, nasal corticosteroid sprays for treatment of allergic rhinitis or inhaled corticoids for asthma, i.e. Advair or Symbicort), are by definition not systemically active in current dosage forms. They (the topical skin agents in particular) are not designed or have been shown in any of the clinical trials to be systemically active , if ingested. Nor is absorption thru nasal or bronchial epithelial lining effective enough to be to show any systemic or clinical benefit. This is because enough cannot reach the bloodstream through these portals, but more importantly any drug that is absorbed is rapidly degraded by the liver and the active metabolites are not designed to be clinically active. Slurping down a tube of Cortaid (1% hydrocortisone OTC) may give you an upset stomach but won't help your allergies. The only topical corticosteroid to have shown systemic effects was Decadron Turbinaire spray, for the nose, long since discontinued. Ultra-high potency corticosteroid creams for eczema in infants or children, however, are best avoided for reasons shown below. In infants with atopic dermatitis (allergic eczema), especially if the skin is excoriated or actively inflammed, it has been shown that some corticosteroid may be absorbed (due to the small surface area and open skin). But almost all experts agree that it is essentially clinically negligible and irrelevant. As a double board-certified physician in Internal Medicine and Allergy/Clinical immunology trained at Northwestern University in Chicago with 19 years of treating patients, I have not seen in any of my patients benefit of a topical in any form, over a parental form, i.e. Prednisone, IM Kenalog, IM Depo-Medrol, or oral Methyprednisolone, ("Medrol Dose Pack"). But these meds are safe in short bursts. The Adrenal Cortex produces on a daily basis 7.5mg of prednisolone equivilent, so a short 6 day tapering dose of Prednisone or Medrol is virtually side effect free and systemic effects of relevance are negligable and by and large these parenteral or systemic forms are very well-tolerated. Great question, something my patients ask about frequently. Thanks Mike Ganz M.D. Topical Corticosteroids, in any of the currently available forms to treat allergic diseases (skin topicals, nasal corticosteroid sprays for treatment of allergic rhinitis or inhaled corticoids for asthma, i.e. Advair or Symbicort), are by definition not systemically active in current dosage forms. They (the topical skin agents in particular) are not designed or have been shown in any of the clinical trials to be systemically active , if ingested. Nor is absorption thru nasal or bronchial epithelial lining effective enough to be to show any systemic or clinical benefit. This is because enough cannot reach the bloodstream through these portals, but more importantly any drug that is absorbed is rapidly degraded by the liver and the active metabolites are not designed to be clinically active.
Slurping down a tube of Cortaid (1% hydrocortisone OTC) may give you an upset stomach but won’t help your allergies. The only topical corticosteroid to have shown systemic effects was Decadron Turbinaire spray, for the nose, long since discontinued. Ultra-high potency corticosteroid creams for eczema in infants or children, however, are best avoided for reasons shown below.

In infants with atopic dermatitis (allergic eczema), especially if the skin is excoriated or actively inflammed, it has been shown that some corticosteroid may be absorbed (due to the small surface area and open skin).
But almost all experts agree that it is essentially clinically negligible and irrelevant.
As a double board-certified physician in Internal Medicine and Allergy/Clinical immunology trained at Northwestern University in Chicago with 19 years of treating patients, I have not seen in any of my patients benefit of a topical in any form, over a parental form, i.e. Prednisone, IM Kenalog, IM Depo-Medrol, or oral Methyprednisolone, (“Medrol Dose Pack”).
But these meds are safe in short bursts. The Adrenal Cortex produces on a daily basis 7.5mg of prednisolone equivilent, so a short 6 day tapering dose of Prednisone or Medrol is virtually side effect free and systemic effects of relevance are negligable and by and large these parenteral or systemic forms are very well-tolerated.
Great question, something my patients ask about frequently.
Thanks
Mike Ganz M.D.

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