Topical Steroids

Low Potency:

Class 7
  • Hydrocortisone acetate 0.5% – 1%

Class 6

  • Desonide 0.05%
  • Fluocinolone 0.01% cream

Medium Potency:

Class 5
  • Hydrocortisone valerate 0.2% cream or butyrate 0.1% cream / ointment
  • Traimcinolone 0.1% cream / lotion
  • Fluocinolone 0.025% cream
Class 4
  • Hydrocortisone valerate 0.2% ointment
  • Fluocinolone 0.025% ointment

High Potency:

Class 3
  • Betamethasone 0.05% cream
  • Traimcinolone acetonide 0.5% cream
Class 2
  • Fluocinonide 0.05%
Class 1
  • Clobetasol 0.05%

Notes:

  1. Class 1 and 2 (high potency) should not be used on the face, body folds or groin due to potential for thinning of the skin.
  2. Trunk or extremities – triamcinolone 0.1% cream is commonly used.
  3. Face and body folds – lower potency hydrocortisone or desonide arecommonly used.
  4. Palms and sole – limited use of high potency (fluocinonide or clobetasol) may be used.
  5. Pediatric absorption is greater than in adulthood, therefore low potency should be used first.
  6. Ointments are thick and oily and can stain garments, but aid in medication absorption. An occlusive dressing helps the effect and protects garments.
  7. Creams are better tolerated on the face but contain alcohol and may sting if skin is broken.
  8. Lotions are water based and better for covering large body surfaces.
  9. 70kg adult requires 30gm tube to cover entire body.

References:

  1. Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-40.
  2. Up-To-Date, General principles of dermatologic therapy and topical corticosteroid use, Goldstein et al, accessed 05/18

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