Table of contents
- 1. Topical Corticosteroids
- 1.1. Dermatological Bases
- 1.2. Topical Steroids
- 1.3. Percutaneous Absorption
- 1.4. Topical Steroid Quantity
- 1.5. Steroid Sparing
- 1.6. Potency Ratings
- 1.7. Conditions & Indications
- 1.8.
- 1.9. Side Effects
- 2. Notes
Taken from AAFP Steroids
Topical Corticosteroids
Table references: "Psoriases enabler for family practice - fall 2010" Dr. R. Gary Sibbald 2010
Dermatological Bases
Lotion | Powder in water |
Cream | Oil in continuous water phase |
Ointment | Water in continuous oil phase |
Paste | Powder in continuous oil base |
Gel | Powder in lattice structure (DO NOT COMPOUND) |
Topical Steroids
Relative Potency | Region | Examples |
---|---|---|
X1 | Face, folds | Hydrocortisone 1% |
X3 | Resistant, Kids | Hydroval, Desonide |
X6 | Hands, feet | Betamethasone 0.1% valerate Cyclocort, Nerisone, Elocom |
X9 | Palms, soles | Lyderm, Tiamol, Topicort Diprosone cream, Diprolene ointment Betamethasone dipropionate |
X12 | Resistant palms, soles | Clobex, Dermovate |
Percutaneous Absorption
Forearm | 1.00 |
Plantar | 0.14 |
Palm | 0.83 |
Back | 1.70 |
Scalp | 3.50 |
Forehead | 6.00 |
Cheeks | 13.0 |
Scrotum | 42.00 |
Topical Steroid Quantity
1X Application
| Area | BID x7 days |
---|---|---|
1g or a finger tip unit | 1 hand | 15 g |
2g | Head, Face, Genital area | 30 g |
3g | Arm, front or back of trunk | 45 g |
4g | Leg | 60 g |
30-60 g | Whole Body | 500-1000g |
Steroid Sparing
- Tazarotene (Tazorac) 0.05, 0.1% cream/gel 30g (both) 60g (cream), 100g (gel)
- Increased differentiation of skin
- 23% pruritis (decrease with topical steroids alternating treatment)
- 16% erythema (decrease with topical steroids alternating treatment)
- Not with pregnancy
- Increased susceptibility to sunlight.
- Coal Tar
- Antiproliferative, Keratolytic
- Combined or alternated with topical steroids
- More refined; less effective
20% LCD (Lysyl carboxyl detergents) = 4% crude coal tar - May aggravate acne or cause folliculitis.
Potency Ratings
Medication | ||||
---|---|---|---|---|
Potency (group) | Generic | Brand | Dosage vehicle | Available sizes |
Ultra high (Class I) | Augmented betamethasone dipropionate 0.05% | Diprolene* | G,† O | 15, 45, 50 g |
Clobetasol propionate 0.05% | Clobex | L, Sh | 59, 118 mL (L); 118 mL (Sh) | |
Olux* | F | 50, 100 g | ||
Temovate* | C, G, O | 15, 30, 45 g (C, O); 15, 30, 60 g (G) | ||
Temovate E* | C | 15, 30, 60 g | ||
Diflorasone diacetate 0.05% | Apexicon* | O | 15, 30, 60 g | |
Fluocinonide 0.1% | Vanos | C | 30, 60 g | |
Flurandrenolide 4 mcg per m2 | Cordran | T | 24” × 3” and 80” × 3” rolls | |
Halobetasol propionate 0.05% | Ultravate* | C, O | 15, 50 g | |
High (Class II) | Amcinonide 0.1% | — | O | 15, 30, 60 g |
Augmented betamethasone dipropionate 0.05% | Diprolene* | L | 30, 60 mL | |
Diprolene AF* | C | 15, 50 g | ||
Betamethasone dipropionate 0.05% | Diprosone*‡ | O | 15, 45 g | |
Desoximetasone | Topicort 0.25%* | C, O | 15, 60 g | |
Topicort 0.05%* | G | 15, 60 g | ||
Diflorasone diacetate 0.05% | Apexicon E* | C | 15, 30, 60 g | |
Fluocinonide 0.05% | Lidex* | C,† G,† O | 15, 30, 60 g | |
Halcinonide 0.1% | Halog | C, O, So | 15, 30, 60, 240 g (C, O); 30, 60 mL (So) | |
Medium to high (Class III) | Amcinonide 0.1% | Cyclocort‡ | C | 4, 15, 30, 60 g |
Betamethasone dipropionate 0.05% | Betanate* | C | 15, 45 g | |
Fluticasone propionate 0.005% | Cutivate* | O | 15, 30, 60 g | |
Triamcinolone acetonide 0.5% | Cinalog*‡ | C, O | 15 g | |
Medium (IV and V) | Betamethasone valerate | Beta-Val 0.1%* | C, L | 14, 45 g (C); 60 mL (L) |
Luxiq 0.12% | F | 100 g | ||
Desoximetasone 0.05% | Topicort LP* | C | 15, 60 g | |
Fluocinolone acetonide 0.025% | Synalar*‡ | C, O | 15, 60 g | |
Fluticasone propionate 0.05% | Cutivate* | C | 15, 30, 60 g | |
Hydrocortisone butyrate 0.1% | Locoid* | O | 5, 10, 15, 30, 45 g | |
Hydrocortisone probutate 0.1% | Pandel | C | 15, 45, 80 g | |
Hydrocortisone valerate 0.2% | Westcort* | C, O | 14, 45, 60 g (C, O); 120 g (C) | |
Mometasone furoate 0.1% | Elocon* | C, L, O | 15, 45 g (C, O); 30, 60 mL (L) | |
Triamcinolone acetonide 0.025% | Kenalog*‡ | C, L, O | 15, 80, 454 g (C, O); 60 mL (L) | |
Triamcinolone acetonide 0.1% | Triderm* | C, L,† O† | 15, 80, 454 g (C, O); 15, 60 mL (L) | |
Low (Class VI) | Alclometasone dipropionate 0.05% | Aclovate* | C, O | 15, 45, 60 g |
Desonide 0.05% | Desonate | G | 15, 30, 60 g | |
Desowen* | C, O | 15, 60 g | ||
Lokara | L | 60, 120 mL | ||
Verdeso | F | 100 g | ||
Fluocinolone 0.01% | — | C | 15, 60 g | |
Hydrocortisone butyrate 0.1% | Locoid* | C | 5, 10, 15, 30, 45 g | |
Least potent (Class VII) | Hydrocortisone 1%, 2.5% | — | C, L, O | 20, 30, 120 g (C, O); 60, 120 mL (L) |
C = cream; F = foam; G = gel; L = lotion; O = ointment; Sh = shampoo; So = solution; T = tape.
*— Generic is available.
†— Brand not available in this formulation.
‡— Brand no longer available in the United States.
Information from reference 24.
Conditions & Indications
Indication | Condition |
---|---|
High-potency steroids (groups I to III) | Alopecia areata |
Atopic dermatitis (resistant) | |
Discoid lupus | |
Hyperkeratotic eczema | |
Lichen planus | |
Lichen sclerosus (skin) | |
Lichen simplex chronicus | |
Nummular eczema | |
Poison ivy (severe) | |
Psoriasis | |
Severe hand eczema | |
Medium-potency steroids groups IV and V) | Anal inflammation (severe) |
Asteatotic eczema | |
Atopic dermatitis | |
Lichen sclerosus (vulva) | |
Nummular eczema | |
Scabies (after scabicide) | |
Seborrheic dermatitis | |
Severe dermatitis | |
Severe intertrigo (short-term) | |
Stasis dermatitis | |
Low-potency steroids (groups VI and VII) | Dermatitis (diaper) |
Dermatitis (eyelids) | |
Dermatitis (face) | |
Intertrigo | |
Perianal inflammation |
- Weak
- Hydrocortisone (Cortate)
- Moderate
- Desonide (Tridesilon)
- Potent
- Betamethasone-17-valerate (Betnovate)
- Very Potent
- Halcinonide (Halog)
- Extremely Potent
- Clobetasol 17-propionate (Dermovate)
Side Effects
- Acne Related
- Perioral dermatitis
- Pustular Acne
- Rosacea
- Atrophy
- Telangiectasia, purpura
- Epidermal and dermal atrophy
- Striae
- Infection
Steroid Acne | Steroid Infections | Perioral Dermatitis |
---|---|---|
![]() | | ![]() |
Notes
- Mild Psoriasis:
Olux-E foam 0.05% apply BID to affected areas x 3 weeks then PRN.
Comments