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Topical Corticosteroids

See Also

  1. Topical Dermatologic Praparations
  2. Preparation Bases

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

Pearls

  1. Once daily dosing is as effective as bid-tid dosing
  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

Adverse Effects of Topical Steroids

  1. Percutaneous absorption
  2. Skin atrophy
  3. Rebound papular dermatitis after medium-high potency
    1. Avoid high potency steroid on genital or face
  4. Striae formation


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

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

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

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

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. Hydrocortisone butyrate (Locoid) 0.1% cream
  6. Flucinolone acetonide (Synalar) 0.025% cream

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

Level 7: Lowest Potency

  1. Hydrocortisone1%, 2.5%
  2. Dexamethasone
  3. Flumethasone
  4. Prednisolone
  5. Methyprednisolone

References

  1. Kaplan (2001) CMEA Medicine Lecture, San Diego

     

2003