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Corticosteroids - Topical
Corticosteroids are a class of medications used to control inflammation. They are similar to natural hormones produced by the body. When applied to the skin, they provide a very effective treatment for a variety of skin problems.
(Corticosteroids are different from the other "steroids," such as testosterone, used by athletes and body builders to build muscle mass)
Topical corticosteroids are categorized by their strength. Group 1 (I) corticosteroids are "super potent" and have the greatest risk of side effects if used for prolonged periods. Group 7 (VII) corticosteroids are "low potency" and include 1% hydrocortisone, which can be purchased without a prescription.
Corticosteroids are available in different formulations, including ointments, gels, creams, lotions, foams, or solutions.
The potency of the medication is determined by several factors including:
The active ingredient used
The formulation (cream, ointment or gel)
For instance, a medication with 2% concentration of hydrocortisone is more potent than a medication with 1% hydrocortisone. Similarly, 2% hydrocortisone ointment may be more potent than 2% hydrocortisone cream.
The potency of an ointment is often greater than other formulations because the ointment keeps the skin hydrated, helping the medication to penetrate to deeper layers. Creams, because they absorb more quickly, have greater cosmetic appeal for most people so are often used on the face. Foams and solutions are useful for penetrating hair-bearing areas, such as the scalp.
Examples of different corticosteroid strengths:
Group 1 (I) Superpotent
Clobetasol, 0.05% (Clobex, Temovate)
Clobetasol Foam 0.05% (Olux and Olux E)
Fluocinonide 0.1% (Vanos)
Halobetasol 0.05%, (Ultravate)
Group 2 (II) Potent
Desoximetasone, 0.05% (Topicort gel)
Desoximetasone, 0.25% (Topicort cream, ointment)
Diflorasone diacetate 0.05% (Psorcon cream)
Fluocinonide 0.05% (LIdex)
Halcinonide, 0.1% (Halog)
Group 3 (III) Upper Mid-Strength
Desoximetasone 0.05% (Topicort LP cream)
Fluocinonide 0.05% (Lidex-E cream)
Fluticasone propionate. 0.005% (Cutivate Ointment)
Group 4 (IV) Mid-Strength
Betamethasone valerate 0.12% (Luxiq foam)
Fluocinolone acetonide 0.025% (Synalar ointment)
Hydrocortisone valerate, 0.2% (Westcort ointment)
Mometasone furoate 0.1% (Elocon cream, lotion)
Triamcinalone acetonide 0.1% (Kenalog cream, ointment)
Group 5 (V) Lower Mid-Strength
Fluocinolone acetonide 0.025% (Synalar cream)
Fluticasone propionate 0.05% (Cutivate Cream)
Hydrocortisone valerate, 0.2% (Westcort cream)
Prednicarbate, 0.1% (Dermatop cream)
Group 6 (VI) Mild
Alclometasone dipropionate, 0.05% (Aclovate cream)
Desonide, 0.05% (DesOwen cream, lotion and ointment, LoKara lotion, and Verdeso Foam)
Fluocinolone acetonide 0.01% (Capex shampoo, Synalar cream and solution)
Group 7 (VII) Least Potent
Hyrocortisone 1%, or 2.5%
Some skin disorders, such as seborrheic dermatitis, are relatively sensitive to corticosteroids and usually respond well to less potent corticosteroids in Group 7 (VII) and 6 (IV).
Some more moderately resistant skin diseases, such as adult atopic dermatitis, nummular eczema, or allergic contact dermatitis may require slightly stronger corticosteroids in Group 5 (V) and 4 (IV).
Resistant skin diseases, such a plaque psoriasis and lichen planus may require treatment with the more potent corticosteroids in Group 2 (II) and 1 (I).
The corticosteroid recommended may also depend on the body part being treated. Because the skin on the elbows and knees is relatively thick, stronger formulations can be used more safely on those sites. Conversely, less potent steroids are usually recommended for the thinner skin of the face and genital area.
Prolonged use of corticosteroids can lead to side effects, including the thinning of skin (atrophy).
Due to increased risk of side effects associated with potent corticosteroids, the use of Group 1 and 2 formulations is generally not recommended for periods longer than two weeks.
Corticosteroids can also cause some skin conditions to worsen, including rosacea, fungal infections, and scabies. If used for longer than one month, they can create additional skin disorders including perioral dermatitis and "steroid acne." Speak to your doctor if your condition worsens while on treatment.
If your skin condition gets under control following the use of a corticosteroid, your doctor will recommend stopping its use, reducing the number of times it is applied each week, or taking a less potent formulation.