PATIENT COUNSELING INFORMATION

See FDA-Approved Patient Labeling (Patient Information)

Patients using topical corticosteroids should receive the following information and instructions:

1.      This medication is to be used as directed by the physician. It is for external use only. Avoid contact with the eyes or other mucous membranes. The medication should not be dispensed directly onto the face. Dispense in hands and gently massage into affected areas of the face until the medication disappears. For areas other than the face, the medication may be dispensed directly on the affected area. Wash hands after use.

2.      This medication should not be used for any disorder other than that for which it was prescribed.

3.      The treated skin area should not be bandaged, otherwise covered, or wrapped so as to be occlusive unless directed by the physician.

4.      Patients should report any signs of local or systemic adverse reactions to the physician.

5.      Patients should inform their physicians that they are using DESONIDE Foam if surgery is contemplated.

6.      Therapy should be discontinued when control is achieved. If no improvement is seen within 4 weeks, contact the physician.

7.      Do not use other corticosteroid-containing products while using DESONIDE Foam without first consulting your physician.

8.      The propellant in DESONIDE Foam is flammable. Avoid fire, flame, or smoking during and immediately following application.

DESONIDE is a registered trademark of Stiefel Laboratories, Inc.

DOSAGE FORMS AND STRENGTHS

Foam, 0.05%. Each gram of DESONIDE Foam contains 0.5 mg of desonide in a white to off-white petrolatum-based emulsion aerosol foam.

CONTRAINDICATIONS

WARNINGS AND PRECAUTIONS

Hypothalamic-Pituitary-Adrenal Axis Suppression

patients for HPA axis suppression. If HPA axis suppression is documented, an attempt should be made to gradually withdraw the drug, to reduce the frequency of application, or to substitute a less potent steroid. Manifestations of adrenal insufficiency may require supplemental systemic corticosteroids. Recovery of HPA axis function is generally prompt and complete upon discontinuation of topical corticosteroids.

The effect of DESONIDE Foam on HPA axis function was investigated in pediatric subjects in one trial. In this trial, subjects with atopic dermatitis covering at least 25% of their body applied DESONIDE Foam twice daily for 4 weeks. Three out of 75 subjects (4%) displayed adrenal suppression after 4 weeks of use based on the cosyntropin stimulation test. The laboratory suppression was transient; all subjects had returned to normal when tested 4 weeks posttreatment.

Pediatric patients may be more susceptible than adults to systemic toxicity from equivalent doses of DESONIDE Foam due to their larger skin surface-to-body mass ratios [see Use in Specific Populations (8.4)].

Concomitant therapy with topical corticosteroids should be used with caution because a cumulative effect may occur.

ADVERSE REACTIONS

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinicaltrials of another drug and may not reflect the rates observed in clinical practice.

In a controlled clinical trial of 581 subjects aged 3 months to 17 years, adverse reactions occurred at the application site in 6% of subjects treated with DESONIDE Foam and 14% of subjects treated with vehicle foam. Other commonly reported adverse reactions for DESONIDE Foam and vehicle foam are noted in Table 1.

Table 1. Adverse Reactions in the Clinical Trial

Other local adverse events occurred at rates less than 1.0%. The majority of adverse reactions were transient and mild to moderate in severity, and they were not affected by age, race, or gender.

The following additional local adverse reactions have been reported with topical corticosteroids. They may occur more frequently with the use of occlusive dressings and higher potency corticosteroids. These reactions are listed in an approximate decreasing order of occurrence: folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection, striae, and miliaria.

USE IN SPECIFIC POPULATIONS

DESCRIPTION

DESONIDE (desonide) Foam, 0.05% is a white to off-white petrolatum-based emulsion aerosol foam containing the active ingredient desonide, a low-potency topical corticosteroid.

Chemically, desonide is (11β,16α)-11,21-dihydroxy-16,17-[(1-methylethylidene)- bis(oxy)]-pregna-1,4-diene-3,20-dione.

The structural formula of desonide is represented below

mg desonide. The foam also contains anhydrous citric acid, cetyl alcohol, cyclomethicone, isopropyl myristate, light mineral oil, white petrolatum, polyoxyl 20 cetostearyl ether, potassium citrate (monohydrate), propylene glycol, purified water, sorbitan monolaurate, and phenoxyethanol as a preservative.

DESONIDE Foam is dispensed from an aluminum can pressurized with a hydrocarbon (propane/butane) propellant.

CLINICAL PHARMACOLOGY

NONCLINICAL TOXICOLOGY

INDICATIONS AND USAGE

necessary to achieve the desired results because of the potential for DESONIDE Foam to suppress the hypothalamic-pituitary-adrenal (HPA) axis. Treatment should not exceed 4 consecutive weeks.

DOSAGE AND ADMINISTRATION

DESONIDE Foam is not for oral, ophthalmic, or intravaginal use.

A thin layer of DESONIDE Foam should be applied to the affected area(s) twice daily. Shake the can before use. DESONIDE Foam should be dispensed by inverting the can (upright actuation will cause loss of the propellant which may affect product delivery). Dispense the smallest amount of foam necessary to adequately cover the affected area(s) with a thin layer.

The medication should not be dispensed directly on the face. Dispense in hands and gently massage into affected areas of the face until the medication disappears. For areas other than the face, the medication may be dispensed directly onto the affected area. Take care to avoid contact with the eyes or other mucous membranes.

Patients should dispense the smallest amount of foam necessary to adequately cover the affected area with a thin layer. Therapy should be discontinued when control is achieved. If no improvement is seen within 4 weeks, reassessment of diagnosis may be necessary. The safety and efficacy of DESONIDE Foam has not been established beyond 4 weeks of use. Treatment should not exceed 4 consecutive weeks.

Unless directed by a physician, DESONIDE Foam should not be used with occlusive dressings.

Skin Irritation

DESONIDE Foam may cause local skin adverse reactions [see Adverse Reactions (6)]. If irritation develops, DESONIDE Foam should be discontinued and appropriate therapy instituted. Allergic contact dermatitis with corticosteroids is usually diagnosed by observing a failure to heal rather than noticing a clinical exacerbation. Such an observation should be corroborated with appropriate diagnostic patch testing. 

Concomitant Skin Infections

If concomitant skin infections are present or develop, the use of an appropriate antifungal, antibacterial, or antiviral agent should be instituted. If a favorable response does not occur promptly, use of DESONIDE Foam should be discontinued until the infection has been adequately controlled.

CLINICAL STUDIES

In a double-blind, randomized trial of 581 subjects aged 3 months to 17 years, with mild to moderate atopic dermatitis, DESONIDE Foam was applied twice daily for 4 weeks. Success was defined as the proportion of subjects who had all of the following: an Investigator’s Static Global Assessment (ISGA) score of clear or almost clear, a minimum improvement in the 5- point ISGA score of 2 grades from Baseline to Week 4, and a score of absent or minimal for both erythema and induration/papulation at Week 4. The results of this trial are presented in the following table.

Flammable Contents

The contents of DESONIDE Foam include alcohol and propane/butane, which are flammable. Avoid fire, flame, and/or smoking during and immediately following application. Do not puncture and/or incinerate the containers. Do not expose containers to heat and/or store at temperatures above 120°F (49°C).

Laboratory Tests

The cosyntropin (ACTH_1-24) stimulation test may be helpful in evaluating patients for HPA axis suppression.

Postmarketing Experience

Pregnancy

Teratogenic Effects: Pregnancy Category C. There are no adequate and well-controlled studies of DESONIDE Foam in pregnant women. Therefore, DESONIDE Foam should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Corticosteroids have been shown to be teratogenic in laboratory animals when administered systemically at relatively low dosage levels. Some corticosteroids have been shown to be teratogenic after dermal application in laboratory animals.

No long-term reproductive studies in animals have been performed with DESONIDE Foam. Dermal embryofetal development studies were conducted in rats and rabbits with a desonide cream, 0.05% formulation. Topical doses of 0.2, 0.6, and 2.0 g cream/kg/day of a desonide cream, 0.05% formulation or 2.0 g/kg of the cream base were administered topically to pregnant rats (gestational days 6 to 15) and pregnant rabbits (gestational days 6 to 18). Maternal body weight loss was noted at all dose levels of the desonide cream, 0.05% formulation in rats and rabbits. Teratogenic effects characteristic of corticosteroids were noted in both species. The desonide cream, 0.05% formulation was teratogenic in rats at topical doses of 0.6 and 2.0 g cream/kg/day and in rabbits at a topical dose of 2.0 g cream/kg/day. No teratogenic effects were noted for the desonide cream, 0.05% formulation at a topical dose of 0.2 g cream/kg/day in rats and at a topical dose of 0.6 g cream/kg/day in rabbits. These doses (0.2 g cream/kg/day in rats and 0.6 g cream/kg/day in rabbits) are similar to the maximum recommended human dose based on body surface area comparisons.

Nursing MotherS

Systemically administered corticosteroids appear in human milk and could suppress growth, interfere with endogenous corticosteroid production, or cause other untoward effects. It is not known whether topical administration of corticosteroids could result in sufficient systemic absorption to produce detectable quantities in human milk. Because many drugs are excreted in human milk, caution should be exercised when DESONIDE Foam is administered to a nursing woman.

If used during lactation, DESONIDE Foam should not be applied on the chest to avoid accidental ingestion by the infant.

Pediatric Use

Safety and efficacy in pediatric patients younger than 3 months have not been established; therefore, the use of DESONIDE Foam is not recommended.

Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of HPA axis suppression and Cushing’s syndrome when they are treated with topical corticosteroids. They are therefore also at greater risk of adrenal insufficiency during and/or after withdrawal of treatment. Adverse effects including striae have been reported with inappropriate use of topical corticosteroids in infants and children. HPA axis suppression, Cushing’s syndrome, linear growth retardation, delayed weight gain, and intracranial hypertension have been reported in children receiving topical corticosteroids. Manifestations ofadrenal suppression in children include low plasma cortisol levels and an absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema. Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children.

HOW SUPPLIED/STORAGE AND HANDLING

Geriatric Use

Clinical trials of DESONIDE Foam did not include any subjects aged 65 or over to determine whether they respond differently from younger subjects. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

OVERDOSAGE

Topically applied DESONIDE Foam can be absorbed in sufficient amounts to produce systemic effects.

Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of HPA axis suppression and Cushing’s syndrome when they are treated with topical corticosteroids.

Mechanism of Action

Corticosteroids play a role in cellular signaling, immune function, inflammation, and protein regulation; however, the precise mechanism of action in the treatment of atopic dermatitis is unknown.

The contribution to efficacy by individual components of the vehicle has not been established.

Pharmacodynamics

In an HPA axis suppression trial, three of 75 (4%) pediatric subjects with mild to moderate atopic dermatitis covering at least 25% body surface area, who applied DESONIDE Foam twice daily, experienced reversible suppression of the adrenal glands (as indicated by a 30- minute post-stimulation cortisol level £18 mcg/dL) following 4 weeks of therapy. [See Warnings and Precautions (5.1) and Pediatric Use (8.4)].

Pharmacokinetics

The extent of percutaneous absorption of topical corticosteroids is determined by many factors, including the product formulation, the integrity of the epidermal barrier, and age.

Occlusion, inflammation, and/or other disease processes in the skin may also increase percutaneous absorption. Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. They are metabolized primarily in the liver and are then excreted by the kidneys. Some corticosteroids and their metabolites are also excreted in the bile.

Storage and Handling

Store at USP controlled room temperature 68°F to 77°F (20°C to 25°C) with excursions permitted between 15°C (59°F) and 30°C (86°F).

WARNING: FLAMMABLE. AVOID FIRE, FLAME, OR SMOKING DURING AND IMMEDIATELY FOLLOWING APPLICATION.

Contents under pressure. Do not puncture or incinerate. Do not expose containers to heat, and/or store at temperatures above 120^oF (49^oC).

Avoid contact with eyes or other mucous membranes. Keep out of reach of children.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term animal studies have not been performed to evaluate the carcinogenic potential of DESONIDE Foam or desonide. The effects of desonide on fertility have not been evaluated.

In a 90-day repeat-dose toxicity study in rats, topical administration of DESONIDE Foam at dose concentrations from 0.025% to 0.125% or from 0.075 to 0.375 mg/kg/day of desonide resulted in a toxicity profile consistent with long-term exposure to corticosteroids including adrenal atrophy, histopathological changes in several organs systems indicative of severe immune suppression, and opportunistic fungal and bacterial infections. A no observable adverse effect level (NOAEL) could not be determined in this study. Although the clinical relevance of the findings in animals to humans is not clear, sustained glucocorticoid-related immune suppression may increase the risk of infection and possibly the risk for carcinogenesisTopical doses of 0% (foam vehicle), 0.025%, 0.05%, and 0.125% desonide foam were evaluated in a 52-week dermal photocarcinogenicity study (40 weeks of treatment followed by 12 weeks of observation) conducted in albino hairless mice with concurrent exposure to low level ultraviolet radiation. Topical treatment with increasing concentrations of desonide foam did not have an adverse effect in this study. The results of this study suggest that topical treatment with DESONIDE Foam did not enhance photocarcinogenicity.

Desonide revealed no evidence of mutagenic potential based on the results of two in vitro genotoxicity tests (Ames assay, mouse lymphoma cell assay) and an in vivo genotoxicity test (mouse micronucleus assay).

How Supplied

DESONIDE Foam is a white to off-white aerosol foam supplied in 100-g (NDC 63032- 111-00) and 50-g (NDC 63032-111-50) aluminum cans.