Diflucortolone valerate

How it works

It binds glucocorticoid receptors in the skin to suppress inflammatory mediators and immune activity and to produce local vasoconstriction.

Prescribing in practice

• As a potent steroid it can cause skin atrophy and, with extensive or prolonged use, systemic absorption and HPA-axis suppression, so apply sparingly for the shortest effective period.
• Use with caution on the face and flexures and avoid occlusion unless specifically directed, as occlusion increases absorption.
• Step down to a less potent steroid once the flare is controlled and reassess if there is no improvement.

Monitoring

Monitor the treated skin for local steroid effects and, with widespread or prolonged use, for features of systemic corticosteroid exposure.

Counselling the patient

• Apply a thin layer to affected skin only and avoid the face unless told otherwise.
• Do not stop suddenly after prolonged use; follow the stepping-down plan.
• Report skin thinning, stretch marks or worsening of the rash.

Evidence & guidelines

Use follows established topical corticosteroid potency principles and NICE guidance on using the lowest effective potency for eczema and psoriasis.