SYNALAR (Fluocinolone Acetonide 0.025%) Gel 60g

Synalar gel is an effective topical steroid formulated as a clear, non-greasy gel. It is designed for application to the scalp and other hairy regions, but can equally well be applied elsewhere on the body. Specific indications for 'Synalar' Gel are Seborrhoea, seborrhoeic dermatitis and psoriasis of the scalp, but it may be applied satisfactorily to inflammatory dermatoses on other parts of the body.

Adults (including the elderly) and children

A small quantity of the Synalar Gel is massaged into the scalp night and morning using the fingertips. For maintenance therapy, treatment should be repeated once or twice weekly.

Synalar is contraindicated in primary infections of the skin caused by bacteria, fungi or viruses and in rosacea, acne, perioral dermatitis, anogenital pruritus and napkin eruptions.

'Synalar' Gel should not be used in patients that are hypersensitive to any of the ingredients.

Synalar preparations are not advised in the treatment of children under one year of age.

Long term continuous steroid therapy can produce local atrophic skin changes and dilatation of the superficial blood vessels, particularly when occlusive dressings are used or when skin folds are involved. Prolonged use of topical steroids or treatment of extensive areas, even without occlusion, can result in sufficient absorption of the steroid to produce the features of hypercorticalism and underlying adrenal suppression, especially in infants and children.

Long term use of topical steroids can result in the development of rebound flares after stopping treatment (topical steroid withdrawal syndrome). A severe form of rebound flare can develop which takes the form of a dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area. It is more likely to occur when delicate skin sites such as the face and flexures are treated. Should there be a reoccurrence of the condition within days to weeks after successful treatment a withdrawal reaction should be suspected. Reapplication should be with caution and specialist advise is recommended in these cases or other treatment options should be considered.

It is recommended that treatment on the face and for children should not normally be extended beyond five days, and occlusion in such cases should not be used.

The eyes should be avoided.

When there is an infection associated with an inflammatory skin condition, Synalar should only be administered if adequate anti-infective cover is given.

When using topical steroids to treat psoriasis there are risks both of rebound relapse following the development of tolerance, and of generalised pustular psoriasis. Impairment of the barrier function of the skin may lead to local and systemic toxicity. Careful patient supervision is important.

Treatment should be discontinued if unfavourable reactions are seen.

Visual disturbance may be reported with systemic and topical corticosteroid use. If a patient presents with symptoms such as blurred vision or other visual disturbances, the patient should be considered for referral to an ophthalmologist for evaluation of possible causes which may include cataract, glaucoma or rare diseases such as central serous chorioretinopathy (CSCR) which have been reported after use of systemic and topical corticosteroids.

Some of the ingredients in the cream may cause a reaction:-

Methyl and propylparahydroxybenzoates – may cause local skin reactions (possibly delayed).

Propylene glycol – may cause skin irritation.

The label will state strong steroid.

None known

Pregnancy: There is inadequate evidence of safety in human pregnancy. Topical administration of steroids to pregnant animals can cause abnormalities of foetal development. Including cleft palate and intrauterine growth retardation. There may therefore be a very small risk of such effects on the human foetus.

Lactation: Topical steroids should not be applied to the breasts prior to nursing. When steroid treatment is considered necessary during breast feeding, both the amount applied and the length of treatment should be minimised.

No precautions are necessary.

As with all topical steroids the occasional patient may develop an adverse reaction. Adverse reactions are listed by system organ class. The frequency of adverse reactions is not known (cannot be estimated from the available data).

Infections and Infestations

The use of topical steroids on infected lesions, without the addition of appropriate anti- infective therapy, can result in the spread of opportunist infections.

Immune System Disorders

Local hypersensitivity reactions

Endocrine Disorders

Adrenal suppression.

Eye disorders

Vision, blurred (see also section 4.4)

Skin and Subcutaneous Tissue Disorders

Dermatitis Perioral dermatitis

Acne or worsening of acne

Acne rosacea

Extensive treatment, particularly involving occlusive dressings or where skin folds are involved, can result in both local atrophic changes, such as striae, skin thinning and telangiectasia. Mild depigmentation, which may be reversible, hypertrichosis and irreversible striae.

Withdrawal reactions - redness of the skin which may extend to areas beyond the initial affected area, burning or stinging sensation, itch, skin peeling, oozing pustules. (see section 4.4)

General Disorders and Administration Site Conditions

Irritation at the site of application.

Reporting of suspected adverse reactions

Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

Accidental ingestion: The 30g tube of Synalar contains 7.5mg of the steroid. No toxic effects are likely to occur even if the full contents of a 30g tube are ingested. Similarly the ingredients of the base are unlikely to have any toxic effect in the quantities in which they occur; therefore no remedial action is required in the event of accidental ingestion.

Pharmacotherapeutic group: Corticosteroids, dermatological preparations; Corticosteroids, potent (group III)

ATC code: D07AC04

Fluocinolone acetonide is a synthetic anti-inflammatory corticosteroid. Its mechanisms of action are related to vasoconstriction and suppression of membrane permeability, mitotic activity, the immune response and release of inflammatory mediators.

Synalar Gel is classed as a potent corticosteroid product.

The extent of percutaneous absorption of fluocinolone acetonide is determined by many factors including the vehicle, the integrity of the epidermal barrier and the use of occlusive dressings. Following absorption, fluocinolone acetonide is metabolised primarily in the liver and excreted by the kidneys.

Fluocinolone acetonide is a drug on which extensive clinical experience has been obtained. All relevant information for the prescriber is provided elsewhere in the in the summary of product characteristics.

None known

36 months

Store below 25°C

Collapsible aluminium tube, coated internally with an epoxy resin lacquer, with an elongated nozzle and fitted with a white HDPE screw cap.

Pack sizes: 30g and 60g.

Not all pack sizes may be marketed.

Not applicable