Usage
Diflorasone diacetate is a potent topical corticosteroid indicated for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, such as eczema, psoriasis, and atopic dermatitis. It is classified as a glucocorticosteroid. The drug works by binding to glucocorticoid receptors in the skin, which leads to decreased production of inflammatory mediators like prostaglandins and leukotrienes. This action reduces inflammation, itching, and vasoconstriction in the affected area.
Alternate Names
Diflorasone diacetate does not have any official alternate names. Brand names include Apexicon E, Psorcon, Maxiflor, and Florone (discontinued).
How It Works
Pharmacodynamics: Diflorasone diacetate exerts its effects by binding to glucocorticoid receptors in the skin cells. This binding modulates gene transcription, leading to the suppression of inflammatory mediators, such as prostaglandins, leukotrienes, and cytokines. The drug also inhibits the migration of inflammatory cells to the affected area and reduces vascular permeability, thereby minimizing swelling and redness.
Pharmacokinetics: Diflorasone diacetate is minimally absorbed through intact skin (approximately 1%). Absorption is increased if the skin is inflamed or damaged or if occlusive dressings are used. The absorbed drug is metabolized primarily in the liver via CYP enzymes and is excreted through the kidneys.
Mode of Action: Upon entering the target cell, diflorasone diacetate binds to glucocorticoid receptors. This complex translocates to the nucleus and binds to specific DNA sequences, influencing gene expression. As a result, the production of inflammatory mediators is downregulated, ultimately leading to a reduction in skin inflammation and itching.
Elimination Pathways: Primarily hepatic metabolism through CYP enzymes, followed by renal excretion.
Dosage
Standard Dosage
Adults: Apply a thin film to the affected area 1 to 3 times daily.
Children: Apply a thin film to the affected area 1 to 3 times daily. Monitor growth parameters regularly due to the potential for HPA axis suppression and growth retardation.
Special Cases:
- Elderly Patients: Start with the lowest effective dose and monitor for adverse effects.
- Patients with Renal Impairment: Dose adjustment might be necessary. Monitor closely.
- Patients with Hepatic Dysfunction: Dose adjustment might be necessary. Monitor closely.
- Patients with Comorbid Conditions: Use cautiously in patients with diabetes, hypertension, or other conditions that may be exacerbated by corticosteroids.
Clinical Use Cases
Diflorasone diacetate is intended for topical use only and is not indicated for clinical use cases like intubation, surgical procedures, mechanical ventilation, ICU use, or emergency situations.
Dosage Adjustments
Dose adjustments are typically based on patient response and tolerability. Consider lower doses in patients with renal or hepatic impairment, children, and the elderly.
Side Effects
Common Side Effects:
Burning, stinging, itching, irritation, dryness, redness, acne, folliculitis, hypopigmentation, perioral dermatitis.
Rare but Serious Side Effects:
Allergic contact dermatitis, skin atrophy, striae, telangiectasia, glaucoma, cataracts, HPA axis suppression, Cushing’s syndrome.
Long-Term Effects:
Skin atrophy, striae, telangiectasia, glaucoma, cataracts, HPA axis suppression.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), skin infections (secondary to immunosuppression).
Contraindications
Hypersensitivity to diflorasone diacetate or any component of the formulation. Underlying skin infections (viral, bacterial, fungal) in the area to be treated. Rosacea, perioral dermatitis. Ophthalmic use.
Drug Interactions
Limited information on clinically significant drug interactions is available. It is possible that it can increase glucose levels. Avoid concomitant use of other topical medications on the same area unless directed by a physician.
Pregnancy and Breastfeeding
Pregnancy Safety Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is unknown if diflorasone diacetate is excreted in breast milk. Exercise caution when administering to breastfeeding mothers.
Drug Profile Summary
- Mechanism of Action: Binds to glucocorticoid receptors, reducing inflammatory mediator production.
- Side Effects: Burning, itching, irritation, skin atrophy, striae, glaucoma, HPA axis suppression.
- Contraindications: Hypersensitivity, active skin infections, rosacea, ophthalmic use.
- Drug Interactions: Limited data available.
- Pregnancy & Breastfeeding: Category C; caution advised.
- Dosage: Apply thinly 1-3 times daily.
- Monitoring Parameters: Growth parameters in children, signs of HPA axis suppression, intraocular pressure, skin condition.
Popular Combinations
Diflorasone diacetate is sometimes combined with antifungal agents like nystatin to treat dermatoses complicated by fungal infections.
Precautions
-
General Precautions: Monitor for local and systemic adverse effects, especially with prolonged use or high doses. Avoid use on the face, groin, or underarms unless directed by a physician. Do not use occlusive dressings unless prescribed.
-
Specific Populations: Use with caution in pregnant/breastfeeding women, children, and the elderly.
-
Lifestyle Considerations: No specific lifestyle considerations are associated with topical diflorasone diacetate use.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Diflorasone Diacetate?
A: Apply a thin film to the affected area 1 to 3 times daily for adults and children. Dose adjustments may be needed for special populations.
Q2: How long does it take for Diflorasone Diacetate to work?
A: Improvement can be seen within a few days, but it may take several weeks for full effect.
Q3: Can Diflorasone Diacetate be used on the face?
A: Generally, it’s best to avoid using it on the face due to the increased risk of skin thinning and other adverse effects. If prescribed for the face, use it sparingly and for short periods only.
Q4: What should I do if I miss a dose?
A: Apply the missed dose as soon as you remember, unless it is close to the time for the next dose. Do not apply extra to make up for a missed dose.
Q5: Can Diflorasone Diacetate be used during pregnancy?
A: It’s a Pregnancy Category C drug. Consult with an obstetrician before use during pregnancy to assess the risks and benefits.
Q6: Can I use Diflorasone Diacetate with other topical medications?
A: Avoid using other topical medications on the same area unless specifically directed by a physician.
Q7: What are the signs of an allergic reaction to Diflorasone Diacetate?
A: Hives, difficulty breathing, swelling of the face, lips, tongue, or throat, severe itching or burning at the application site. Seek immediate medical attention if any of these occur.
Q8: How should I store Diflorasone Diacetate?
A: Store at room temperature away from heat and moisture. Keep out of reach of children.
Q9: What are the long-term effects of using Diflorasone Diacetate?
A: Potential long-term effects include skin thinning, striae, telangiectasia, glaucoma, cataracts, and HPA axis suppression.
Q10: Can Diflorasone Diacetate be used for diaper rash?
A: Use with caution in the diaper area and avoid tight-fitting diapers or plastic pants, as they can increase absorption and the risk of side effects. Consult a pediatrician.
