Topical Medications

    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

    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
    SteroidAcne.png

    SteroidInfections.png

    SteroidInfections2.png

    PerioralDermatitis.png

     

     

    Notes

    • Mild Psoriasis:

      Olux-E foam 0.05% apply BID to affected areas x 3 weeks then PRN.

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