Dermatology Book

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Topical CorticosteroidAka: Topical Steroid

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  1. See Also
    1. Topical Dermatologic Preparations
    2. Preparation Bases
  2. Corticosteroid Potency Selection
    1. Low potency topical Corticosteroids
      1. Face
      2. Groin
      3. Intertriginous areas
    2. Mid-potency topical Corticosteroids
      1. Thin skin trunk areas
      2. Extremity lesions
    3. High potency topical Corticosteroids
      1. Thick skin trunk areas
      2. Extremity lesions
    4. Very high or super-potent Corticosteroids
      1. Very thick-skinned areas
      2. Palms and soles
  3. Pearls
    1. Once daily dosing is as effective as bid-tid dosing
      1. Green (2005) Br J Dermatol 152:130
    2. Adjunctive measures: Occlusion
      1. Increases potency of steroid 10 fold
      2. Apply shower cap, plastic bag, or vinyl suit
      3. Use for stubborn areas
    3. Vehicle
      1. Ointments
        1. More potent than creams
        2. More greasy than creams
          1. Avoid on oozing lesions, or intertriginous folds
          2. Avoid in moist or hot environment
      2. Creams
        1. Preservatives may result in Contact Dermatitis
      3. Lotions
        1. Least potent, and least hydrating of vehicles
    4. Quantity to prescribe (10 day supply for bid dosing)
      1. Face and neck: 30 grams for adult (15 g for child)
      2. Hand: 15 grams for adult (7.5 g for child)
      3. Arm: 30 grams for adult (15 g for child)
      4. Leg: 60 grams for adult (30 g for child)
      5. Body: 300 grams for adult (150 g for child)
    5. References
      1. Buys (2007) Am Fam Physician 75:523
  4. Adverse Effects of Topical Steroids
    1. Percutaneous absorption with systemic steroid effects
    2. Skin atrophy
    3. Rebound papular dermatitis after medium-high potency
      1. Avoid high potency steroid on genital or face
    4. Striae formation
    5. Petechiae
    6. Telangiectasia
    7. Acne Vulgaris
  5. Example: Low cost, generic steroids
    1. Level 1: Clobetasol Propionate 0.05% ointment
    2. Level 2: Betamethasone dipropionate 0.05% ointment
    3. Level 3: Betamethasone dipropionate 0.05% cream
    4. Level 4: Triamcinolone acetonide 0.1% ointment
    5. Level 5: Triamcinolone acetonide 0.1% ointment
    6. Level 6: Fluocinolone acetonide 0.01% cream
    7. Level 7: Hydrocortisone 1% cream
  6. Level 1: Ultra-High Potency
    1. Halobetasol propionate (Ultravate)
      1. Preparations: 0.05% cream and ointment
    2. Clobetasol propionate (Temovate)
      1. Preparations: 0.05% cream and ointment
    3. Betamethasone dipropionate augmented (Diprolene)
      1. Preparations: 0.05% cream and ointment
    4. Diflorasone diacetate (Psorcon) 0.05% ointment
  7. Level 2: Very High Potency
    1. Halcinonide (Halog) 0.1% cream
    2. Amcinonide (Cyclocort) 0.1% ointment
    3. Betamethasone dipropionate augmented (Diprolene AF)
      1. Preparation: 0.05% cream
    4. Betamethasone dipropionate (Diprosone)
      1. Preparation: 0.05% ointment
    5. Mometasone furoate (Elocon) 0.1% ointment
    6. Diflorasone diacetate (Florone) 0.05% ointment
    7. Fluocinonide (Lidex) 0.05% cream, gel, and ointment
    8. Diflorasone diacetate (Maxiflor) 0.05% ointment
    9. Desoximetasone (Topicort) 0.25% cream and ointment
  8. Level 3: High Potency
    1. Halcinonide (Halog)
      1. Preparations: 0.1% ointment, Emollient, cream
    2. Triamcinolone acetonide (Aristocort A)
      1. Preparations: 0.1% ointment
    3. Amcinonide (Cyclocort) 0.1% cream and lotion
    4. Betamethasone dipropionate (Diprosone) 0.05% cream
    5. Diflorasone diacetate (Florone) 0.05% cream
    6. Fluocinonide (Lidex-E) 0.05% cream
    7. Diflorasone diacetate (Maxiflor) 0.05% cream
    8. Mometasone furoate (Elocon) 0.1% cream
  9. Level 4: Medium-High Potency
    1. Hydrocortisone valerate (Westcort) 0.2% ointment
    2. Triamcinolone acetonide (Kenalog)
      1. Preparations: 0.1% cream and ointment
    3. Flurandrenolide (Cordran) 0.05% ointment
    4. Flucinolone acetonide (Synalar) 0.025% ointment
  10. Level 5: Medium Potency
    1. Hydrocortisone valerate (Westcort) 0.2% cream
    2. Triamcinolone acetonide (Kenalog) 0.1% lotion
    3. Flurandrenolide (Cordran) 0.05% cream
    4. Betamethasone dipropionate (Diprosone) 0.05% lotion
    5. Betamethasone valerate (Valisone): 0.1% cream
    6. Hydrocortisone butyrate (Locoid) 0.1% cream
    7. Flucinolone acetonide (Synalar) 0.025% cream
  11. Level 6: Low Potency
    1. Alclometasone dipropionate (Aclovate)
      1. Preparations: 0.05% ointment and cream
    2. Betamethasone valerate (Valisone) 0.05% lotion
    3. Fluocinolone acetonide (Synalar)
      1. Preparations: 0.01% solution and cream
    4. Desonide (Tridesilon) 0.05% cream
  12. Level 7: Lowest Potency
    1. Hydrocortisone 1%, 2.5%
    2. Dexamethasone
    3. Flumethasone
    4. Prednisolone
    5. Methylprednisolone
  13. References
    1. Kaplan (2001) CMEA Medicine Lecture, San Diego

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