Topical Corticosteroids by Potency

(I—MOST POTENT, VII—LEAST POTENT)
Brand
Generic Name
Size
Fluorinated?
I - up to 600X more potent than hydrocortisone


Temovate cr, ot 0.05%
Clobetasol propionate
15, 30, 45 g
Y
Diprolene ot, cr 0.05%
Betamethasone dipropionate
15, 50 g
Y
Psorcon ot 0.05%
Diflorasone diacetate
15, 30, 60 g
Y
Ultravate cr, ot 0.05%
Halobetasol dipropionate
15, 45 g
Y




II - 100-150X more potent than hydrocortisone


Cyclocort ot 0.1%
Amcinonide
15, 30, 60 g
Y
Diprosone ot 0.05%
Betamethasone dipropionate------
15, 50 g
Y
Elocon ot 0.1%
Mometasone furoate
15, 45 g
N
Florone ot 0.05%
Diflorasone diacetate
15, 30, 60 g
Y
Halog cr, ot, sl 0.1%
Halcinonide
cr, ot: 15, 30, 60, 240 g
Y


sl: 20, 60 mL

Lidex cr, gl, ot, sl 0.05%------
Fluocinonide
15, 30, 60, 120 g
Y


sl: 20, 60 mL

Maxiflor ot 0.05%
Diflorasone diacetate
15, 30, 60 g
Y
Maxivate cr, ot 0.05%
Betamethasone dipropionate
15, 45 g
Y
Topicort cr, ot 0.25%
Desoximetasone
15, 60 g
Y
Topicort gl 0.05%
Desoximetasone
15, 60 g
Y




III - 2-25X more potent than hydrocortisone


Aristocort A ot 0.1%
Triamcinolone acetonide
15, 60 g
Y
Cutivate ot 0.005%
Fluticasone propionate
15, 30, 60 g
Y
Cyclocort cr, lt 0.1%
Amcinonide
cr: 15, 30, 60 g
Y


lt: 20, 60 mL

Diprosone cr 0.05%
Betamethasone dipropionate
15, 45 g
Y
Florone cr 0.05%
Diflorasone diacetate
15, 30, 60 g
Y
Lidex-E cr 0.05%
Fluocinonide
15, 30, 60, 120 g
Y
Maxiflor cr 0.05%
Diflorasone diacetate
15, 30, 60 g
Y
Maxivate lt 0.05%
Betamethasone dipropionate
60 mL
Y
Valisone ot 0.1%
Betamethasone valerate
14, 45 g
Y
ot 0.1%
Halcinonide






IV



Aristocort ot 0.1%
Triamcinolone acetonide
15, 60 g
Y
Cordran ot 0.05%
Flurandrenolide
15, 30, 60, 225 g
Y
Elocon cr, lt 0.1%
Mometasone furoate
cr: 15, 45 g
N


lt: 30, 60 mL

Kenalog cr, ot 0.1%
Triamcinolone acetonide
15, 60, 80, 240 g
Y
Kenalog aerosol 0.2%
Triamcinolone acetonide
63 mL
Y
Dermatop cr, ot 0.1%
Prednicarbate
15, 60 g
N
Synalar ot 0.025%
Fluocinolone acetonide
20, 60 g
Y
Topicort LP cr 0.05%
Desoximetasone
15, 60 g
Y
Westcort ot 0.2%
Hydrocortisone valerate
ot: 15, 45, 60 g
N
Cloderm cr 0.1%
Clocortolone pivalate
45, 90 g
Y




V



Cordran cr 0.05%
Flurandrenolide
15, 30, 60 g
Y
Cutivate cr 0.05%
Fluticasone propionate
15, 30, 60 g
Y
cr 0.025%
Fluticasone acetonide

Y
Kenalog lt 0.1%
Triamcinolone acetonide
15, 60 mL
Y
Kenalog ot 0.025%
Triamcinolone acetonide
15, 60, 80, 240 g
Y
Locoid cr, ot 0.1%
Hydrocortisone butyrate
15, 45 g
N
Synalar cr 0.025%
Fluocinolone acetonide
15, 60 g
Y
Tridesilon ot 0.05%
Desonide
15, 60 g
N
Valisone cr 0.1%
Betamethasone valerate
cr: 15, 45, 110, 430 g
Y
Westcort cr 0.2%
Hydrocortisone valerate
15, 45, 60, 120 g
N




VI



Aclovate cr, ot 0.05%
Alclometasone dipropionate
15, 45 g
N
Aristocort cr 0.1%
Triamcinolone acetonide
15, 60 g
Y
Kenalog cr, lt 0.025%
Triamcinolone acetonide
cr: 15, 60, 80
Y


lt: 60 mL

Locoid sl 0.1%
Hydrocortisone butyrate
20, 60 mL
N
Locorten cr 0.03%
Flumetasone pivalate
15, 60 g
Y
Synalar cr, sl, oil 0.01%
Fluocinolone acetonide
cr: 15, 45, 60 g
Y


sl: 20, 60 mL

Tridesilon cr 0.05%
Desonide
15, 60 g
N
Valisone lt 0.1%
Betamethasone valerate
20, 60 mL
Y




VII



Hytone cr, ot, lt 1%
Hydrocortisone acetate or HCl
cr, ot: 30 g
N


lt: 120 mL

Hytone cr, ot, lt 2.5%
Hydrocortisone acetate or HCl
cr, ot: 30 g
N


lt: 60 mL





Cr, cream; gl, gel; lt, lotion; ot, ointment; sl, solution.


German Classification System
german steroid classification.png


Notes
  • Fluticasone and mometasone have long half-lives and may be best choice for QD dosing
  • Prolonged use of potent fluorinated topical steroids increase risk for skin atrophy, telangiectasias, acne, particularly on face, axilla, inguinal areas
  • A gram of topical cream or ointment should cover a 10 × 10-cm area
  • A 30-60 g tube will cover the entire body of an adult once
  • FDA approval of topical steroids for children:
topical_corticosteroids_table_02.jpg



Topical Corticosteroids by Structural Class

Structural class
Class A:
Hydrocortisone type
Class B:
Triamcinolone acetonide type
Class C:
Betamethasone type
Class D1:
Betamethasone dipropionate type
Class D2:
Methylprednisolone aceponate type
Cross-reactions
Cross-reacts with D2
Budesonide specifically cross-reacts with D2


Cross-reacts with class A and budesonide
Patch Test Substance
Tixocortol-21-pivalate
Budesonide Triamcinolone acetonide

Clobetasol-17-propionate
Hydrocortisone-
17-butyrate
Class 1
Superpotent



  • Betamethasone dipropionate (Diprolene 0.05% G, O, L)
  • Clobetasol propionate (Clobex Cormax, Dermovate, Temovate C, O, G, S Olux foam 0.05%)
  • Diflorasone diacetate (Psorcon 0.05% O)

Class 2
Potent

  • Amcinonide (Cyclocort 0.1% O, L, C)
  • Budesonide (Naricort 0.025% C)
  • Fluocinonide (Lidex 0.05% C, O, G, S)
  • Halcinonide
    (Halog 0.1% C, O, S)
  • Desoximetasone (Topicort 0.25% C, 0.05% G)
  • Betamethasone dipropionate (Diprosone, Maxivate 0.05% O, Diprolene AF 0.05% C)
  • Betamethasone valerate (Betnovate 0.1%)
  • Diflorasone diacetate (Florone, Maxiflor 0.05%)

Class 3 Upper mid-strength

  • Amcinonide (Cyclocort 0.1% L)
  • Fluocinonide (Lidex 0.05%)
  • Triamcinolone acetonide (Aristocort Kenalog 0.1% C, O)
  • Triamcinolone diacetate (Amcort, Aristocort 0.1% C, O)

  • Betamethasone dipropionate (Diprosone, Maxivate 0.05% C)
  • Betamethasone valerate (Betatrex, Valisone 0.1%, O, Luxiq foam 0.12%)
  • Clobetasone butyrate (Eumovate 0.05%)
  • Diflorasone diacetate (Florone, Maxiflor 0.05% C)
  • Fluticasone propionate (Cutivate 0.005% O)
  • Mometasone furoate
    (Elocon 0.1% O)

Class 4 Mid-strength

  • Amcinonide (Cyclocort 0.1% C)
  • Fluocinolone acetonide (Derma-Smoothe 0.01%, Synalar 0.025% O)
  • Halcinonide (Halog 0.025%, C)
  • Triamcinolone acetonide (Aristocort, Kenalog, Triacet 0.1%, O)
  • Triamcinolone diacetate (Amcort, Aristocort 0.1%, O)
  • Clocortolone pivalate (Cloderm 0.1% C)
  • Desoximetasone (Topicort 0.05% emollient cream)
  • Clobetasone butyrate (Eumovate 0.05%)
  • Mometasone furoate (Elocon 0.1% C, L)
  • Hydrocortisone valerate (Westcort 0.2% O)
Class 5
Lower mid-strength

  • Desonide (DesOwen, Tridesilon 0.05% O)
  • Fluocinolone acetonide (Derma-Smoothe, Synalar 0.025% C)
  • Triamcinolone acetonide (Aristocort, Kenalog 0.1% C, Kenalog 0.025% O, L)
  • Triamcinolone diacetate (Amcort, Aristocort 0.1% C)

  • Betamethasone dipropionate (Diprosone, Maxivate 0.05% L)
  • Betamethasone valerate (Betatrex, Valisone C, L)
  • Fluticasone propionate (Cutivate 0.05% C)
  • Hydrocortisone buteprate (Pandel 0.1% C, O, S)
  • Hydrocortisone butyrate (Locoid 0.1% C, O, S)
  • Hydrocortisone valerate (Westcort 0.2% C)
  • Prednicarbate (Dermatop 0.1% C)
Class 6
Mild

  • Desonide (DesOwen,
    Tridesilon 0.05% C)
  • Fluocinolone acetonide
    (Derma-Smoothe, Synalar
    0.01% C, Sol)
  • Triamcinolone acetonide
    (Aristocort, Kenalog 0.025% C)
  • Triamcinolone diacetate
    (Amcort, Aristocort 0.025% C)

  • Alclometasone dipropionate
    (Aclovate 0.05% C, O)
  • Betamethasone valerate (Valisone 0.1% C)

Class 7
Least potent
  • Hydrocortisone (Bactine, Caldecort, Corticaine, Delacort, Dermolate, Hytone, Prepcort, Resicort)
  • Hydrocortisone acetate (Cortaid, Cortef Feminine or Rectal Itch Cream, Gynecort, Lanacort, Wellcortin)
  • Tixocortol pivalate (Pivalone)






Topical Calcineurin Inhibitors (TCIs)

  • Pimecrolimus 1% (Elidel) cream BID, 30, 60, 100 g
  • Tacrolimus 0.03% (Protopic) oint BID, 30, 60 g
  • Tacrolimus 0.1% (Protopic) oint BID, 30, 60, 100 g


TCI Malignancy Risk

  • AAAAI/ACAAI Joint Task Force: “None of the information provided for the cases of lymphoma associated with the use of topical pimecrolimus or tacrolimus in AD indicate or suggest a causal relationship.”
  • FDA guidance regarding risk of malignancy with topical calcineurin inhibitors:
    • Use only as 2nd line in patients unresponsive/intolerant of other treatments
    • Avoid in children <2 years old; clinical studies have found higher rates of URIs in children <2 who were treated with pimecrolimus (Elidel).
    • Use for short periods of time and with minimum amount necessary; avoid continuous use.
    • Avoid in immunocompromised patients


Topical Anti-MRSA

  • Bactroban (mupirocin 2%) topical ointment, TID up to 12 days for impetigo, 15, 22, 30g
    • Bactroban nasal (mupirocin calcium 2%) ointment indicated for treatment of nasal MRSA carriers, 0.5 g intranasal BID x 5 days, supplied as 10-pack of 1 g tubes
  • Altabax (retapamulin 1%) topical ointment, BID x 5 days for impetigo, 5, 10, 15g


References