fluocinonide
Sources réglementaires consultées
Indications approuvées
- Eczémas aigus exogènes ou endogènes, eczéma séborrhéique et traitement adjuvant du psoriasis.
Contre-indications
Absolues
- Hypersensibilité à la fluocinonide ou à l’un des composants.
- Tuberculose ou syphilis cutanée, infection virale, bactérienne ou fongique, rosacée, dermatite périorale, ulcère, acné, atrophie cutanée, usage oculaire ou plaies profondes.
Mises en garde cliniques
- Mise en garde majeure · Utiliser la plus petite quantité efficace pendant la durée la plus courte possible. Les grandes surfaces, l’usage prolongé, l’altération de la barrière cutanée et l’occlusion augmentent l’absorption et peuvent provoquer une suppression réversible de l’axe HHS, un syndrome de Cushing, une hyperglycémie ou une glycosurie ; les enfants sont plus sensibles. — CIMA/AEMPS, ficha técnica 54036
- Éviter le contact avec les yeux. Arrêter en cas d’irritation ou de sensibilisation. Traiter toute infection cutanée ; en l’absence de réponse rapide, arrêter le corticoïde jusqu’à son contrôle. — CIMA/AEMPS, ficha técnica 54036
- Ne pas appliquer dans les zones intertrigineuses, sur de grandes surfaces ou sous occlusion. Utiliser avec prudence en cas de circulation altérée en raison du risque d’ulcération. — CIMA/AEMPS, ficha técnica 54036
Grossesse et allaitement
Éviter pendant le premier trimestre ; ensuite, n’utiliser que si le bénéfice justifie le risque et éviter les grandes surfaces, l’usage prolongé ou l’occlusion. Ne pas appliquer sur le sein pendant l’allaitement.
Bibliographie récente (PubMed)
To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.
To examine the impact of fluocinonide 0.05% gel formulation for the topical treatment of oral lichen planus (OLP). Through an RCT design, 47 patients with OLP were randomly allocated for topical OLP treatment with fluocinonide 0.05% (n = 23) or placebo (n = 24). Patients were examined for OLP symptoms, signs, disease severity, and extension score changes over 6-month follow-up. After 6 months, in comparison with placebo, patients treated with fluocinonide experienced a significant reduction of OLP symptoms (p = 0.024), signs (p = 0.014), and OLP extension score (p = 0.028). The two-way ANOVA estimation models revealed that treatment with fluocinonide determined, at 6 months, a positive significant effect on the reduced OLP signs (p = 0.017), OLP symptoms (p = 0.026), and OLP extension score (p = 0.028). The multivariate regression analysis highlighted that anxiety, stress, and depression were significant predictors of every analyzed OLP outcome (p < 0.05 for each parameter) and that patients who had baseline anxiety, depression, and stress gained more benefits from fluocinonide at 6-month follow-up. Topical fluocinonide 0.05% was more efficacious compared to placebo in reducing OLP outcomes at 6-month follow-up. Anxiety, depression, and stress were significant predictors of OLP outcomes and positively impacted the treatment with fluocinonide at 6 months.