A female adult client with atopic dermatitis is prescribed a potent topical corticosteroid, to be covered with an occlusive dressing. To address a potential client problem associated with this treatment, the nurse formulates the nursing diagnosis of Risk for injury. To complete the nursing diagnosis statement, the nurse should add which “related-to” phrase?
A. Related to potential interactions between the topical corticosteroid and other prescribed drugs
B. Related to vasodilatory effects of the topical corticosteroid
C. Related to percutaneous absorption of the topical corticosteroid
D. Related to topical corticosteroid application to the face, neck, and intertriginous sites
Correct Answer: C. Related to percutaneous absorption of the topical corticosteroid
A potent topical corticosteroid may increase the client’s risk for injury because it may be absorbed percutaneously, causing the same adverse effects as systemic corticosteroids. Corticosteroids are better absorbed and more permeable in regions of thin epidermis, such as the eyelid, compared to thicker regions of epidermis, such as the sole. The penetration difference between the two varies by 300 fold. The penetration increases two- to ten-fold in diseased states, such as inflammation and desquamation.
Option A: Topical corticosteroids aren’t involved in significant drug interactions. Patients need to be monitored carefully as unsupervised use of these medications can result in local and systemic adverse effects. The duration of treatment should not be greater than 2 to 4 weeks, regardless of potency. High-potency steroids should not be administered for longer than 2 weeks, and after this period, should be tapered to avoid adverse effects.
Option B: These preparations cause vasoconstriction, not vasodilation. The anti-inflammatory effect of topical corticosteroids consists of vasoconstriction, inhibition of the release of phospholipase A2, and a direct inhibitory effect on DNA and inflammatory transcription factors. Vasoconstriction of the blood vessels within the upper dermis decreases the number of inflammatory mediators being delivered to the region applied.
Option D: A potent topical corticosteroid rarely is prescribed for use on the face, neck, or intertriginous sites because the application in these areas may lead to increased adverse effects. The adverse effects of topical corticosteroids can be divided into local and systemic effects. Local adverse effects occur with prolonged treatment and are based on the topical steroid potency, vehicle, and application site. The most commonly local effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura.
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