Comprehensive Monograph: Desoximetasone (DB00547)

Executive Summary

Desoximetasone is a synthetic, high-potency, fluorinated topical corticosteroid engineered for its pronounced anti-inflammatory, anti-pruritic, and vasoconstrictive properties.[1] Classified pharmacologically as a Corticosteroid Hormone Receptor Agonist, its primary clinical application is in the management of corticosteroid-responsive dermatoses, including moderate-to-severe plaque psoriasis, atopic dermatitis, and eczema.[1] It is available in various formulations such as cream, ointment, gel, and spray, typically in strengths of 0.05% and 0.25%, allowing for therapeutic flexibility based on lesion type and location.[4]

The therapeutic efficacy of Desoximetasone is well-established, with clinical studies demonstrating its superiority over other corticosteroids like betamethasone valerate for certain indications.[6] However, its high potency necessitates a cautious approach to its use, as the therapeutic benefits are intrinsically linked to a significant risk profile. The principal safety concern is the potential for systemic absorption, particularly with use over large surface areas, on compromised skin barriers, for prolonged durations, or under occlusive dressings. Such absorption can lead to clinically significant systemic adverse effects, most notably reversible Hypothalamic-Pituitary-Adrenal (HPA) axis suppression, manifestations of Cushing's syndrome, hyperglycemia, and ocular complications such as glaucoma and cataracts.[7] Consequently, clinical guidelines strictly limit the duration of therapy, typically to four weeks or less, and emphasize careful patient selection and monitoring, especially in pediatric populations who are more susceptible to systemic toxicity.[10]