Topical Corticosteroids

Topical Corticosteroids – Potency Comparison Table

General rule: Use the lowest effective potency for the shortest duration, especially on the face, groin, axillae, and in children.

Potency Class Potency Level Generic Name Common Brand Names Typical Indications Safe Use Areas Key Pharmacist Pearls
Class I Super-potent Clobetasol propionate 0.05% Dermovate®, Clobex® Severe psoriasis, lichen planus, discoid lupus Thick skin only (palms, soles) Limit to ≤2 weeks; high risk of skin atrophy and HPA axis suppression
Class II High Betamethasone dipropionate 0.05% (augmented) Diprolene® Severe eczema, psoriasis Trunk, extremities Avoid face/groin; occlusion ↑ absorption
Class III High Fluocinonide 0.05% Lidex® Chronic inflammatory dermatoses Trunk, extremities Use short courses
Class IV Medium–high Mometasone furoate 0.1% Elocon® Moderate eczema, dermatitis Trunk, limbs Once-daily dosing sufficient
Class V Medium Triamcinolone acetonide 0.1% Kenalog® Atopic dermatitis, contact dermatitis Trunk, limbs Avoid prolonged use on face
Class VI Low Desonide 0.05% Desowen® Mild eczema, facial dermatitis Face, intertriginous areas Safe for children short-term
Class VII Least potent Hydrocortisone 1–2.5% Cortate®, OTC hydrocortisone Mild inflammation, insect bites Face, groin, infants Lowest risk of adverse effects

Vehicle Strength Matters (High-Yield Tip)

Vehicle Relative Potency
Ointment Highest
Cream Moderate
Lotion Lower
Gel/Foam Variable (good for scalp)

Same steroid + different vehicle = different clinical effect

Safety & Counseling Pearls for Pharmacists

  • Fingertip unit (FTU): 1 FTU ≈ 0.5 g covers ~2 adult palm areas
  • Avoid occlusion unless directed (dramatically increases absorption)
  • Watch for local adverse effects:
  • Systemic effects possible with:
    • High potency
    • Large surface area
    • Prolonged use
  • For chronic disease, consider steroid-sparing agents (tacrolimus, pimecrolimus)
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