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Corticosteroids (Topical) 7 Group Classification

Original Topical Corticosteroid Reference
Group 1: Highest potency (Super potent) Group 2: High potency
Group 3: High/medium potency Group 4: Medium potency
Group 5: Medium/low potency Group 6: Low (Mild) potency
Group 7: Lowest Potency --®

Background

Corticosteroid strength has been classified according to the vasoconstrictor assay, which is based on the extent to which the compound induces cutaneous vasoconstriction ("blanching effect") in normal human subjects
Product Potency:

* Relative potency of a product depends on the characteristics and concentration of the drug and the vehicle.
* Generally, ointments and gels are more potent than creams or lotions; however, some products have been formulated to yield comparable potency.

Product Selection:

* Selection of a specific corticosteroid, strength, and vehicle depends on the nature, location, and extent of the skin condition, patient’s age, and anticipated duration of treatment.
* Use the least potent corticosteroid that would be effective.
* Low potency agents are preferred for the face, intertriginous areas (e.g., groin, axilla), large areas, and children, to reduce the potential for side effects.
* Reserve higher potency agents for areas and conditions resistant to treatment with milder agents.

Adverse Reactions:

* Systemic absorption of topical corticosteroids has produced reversible HPA axis suppression, Cushing’s syndrome, hyperglycemia, and glycosuria.
* Conditions that augment systemic absorption include application of more potent steroids, use over large surface areas, prolonged use, addition of occlusive dressings, and patient’s age.
* Perform appropriate clinical and laboratory tests if a topical corticosteroid is used for long periods or over large areas of the body.

With chronic conditions, gradual discontinuation of therapy may reduce the chance of rebound.

Mechanisms:
Topical corticosteroids have anti-inflammatory, antipruritic and vasoconstrictive properties.

The mechanism of the anti-inflammatory activity of the topical steroids, in general, is unclear. However, corticosteroids are thought to act by the induction of phospholipase A2 inhibitory proteins, collectively called lipocortins. It is postulated that these proteins control the biosynthesis of potent mediators of inflammation such as prostaglandins and leukotrienes by inhibiting the release of their common precursor arachidonic acid. Arachidonic acid is released from membrane phospholipids by phospholipase A2.

Pharmacokinetics: The extent of percutaneous absorption of topical corticosteroids is determined by many factors including the vehicle and the integrity of the epidermal barrier. Occlusive dressings with hydrocortisone for up to 24 hours have not been demonstrated to increase penetration; however, occlusion of hydrocortisone for 96 hours markedly enhances penetration. Topical corticosteroids can be absorbed from normal intact skin. Inflammation and/or other disease processes in the skin may increase percutaneous absorption
Please see package insert for additional information and possible updates. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.    [  Read the disclaimer    |   <<Back     ]

 Group 1: Highest potency (Super potent)   top of page

Group 1: Highest potency

Augmented betamethasone dipropionate:
Apply qd-bid [0.05% gel]
Apply qd-bid [0.05% lotion]
Apply qd-bid [0.05% ointment]

Clobetasol propionate:
Apply bid [0.05% cream]
Apply bid [0.05% foam]
Apply bid [0.05% gel]
Apply bid [0.05% lotion]
Apply bid [0.05% ointment]
Apply bid [0.05% Shampoo]
Apply bid [0.05% Solution]
Apply bid [0.05% Spray]

Fluocinonide:
Apply qd-bid [0.1% cream]

Flurandrenolide:
Apply bid [tape]

Halobetasol propionate:
Apply qd-bid [0.05% cream]
Apply qd-bid [0.05% ointment]

 Group 2: High potency   top of page

Group 2: High potency 

Amcinonide:
Apply bid-tid [0.1% ointment]

Augmented betamethasone dipropionate:
Apply qd-bid [0.05% cream]

Betamethasone dipropionate:
Apply qd-bid [0.05% ointment]

Desoximetasone:
Apply bid [0.25% cream]
Apply bid [0.05% gel]
Apply bid [0.25% ointment]

Diflorasone diacetate:
Apply qd-tid [0.05% ointment]

Fluocinonide:
Apply bid-qid [0.05% cream]

Fluocinonide:
Apply bid-qid [0.05% cream]
Apply bid-qid [0.05% gel]
Apply bid-qid [0.05% ointment]
Apply bid-qid [0.05% solution]

Halcinonide:
Apply bid-tid [0.1% cream]
Apply bid-tid [0.1% ointment]
Apply bid-tid [0.1% solution]

Mometasone furoate:
Apply qd [0.1% ointment]

Triamcinolone acetonide:
Apply bid-qid [0.5% ointment]

 Group 3: High/medium potency   top of page

Group 3: High/medium potency

Amcinonide:
Apply bid-tid [0.1% cream]
Apply bid-tid [0.1% lotion]

Betamethasone dipropionate:
Apply qd-bid [0.05% cream]

Betamethasone valerate:
Apply qd-tid [0.1% ointment]

Diflorasone diacetate:
Apply qd-tid [0.05% cream]

Fluocinonide:
Apply bid-qid [0.05% emollient cream]

Fluticasone propionate:
Apply qd-bid [0.005% ointment]

Triamcinolone acetonide:
Apply bid-qid [0.5% cream]

 Group 4: Medium potency   top of page

Group 4: Medium potency

Betamethasone valerate:
Apply qd-bid [0.12% foam]

Clocortolone pivalate:
Apply bid-tid [0.1% cream]

Desoximetasone:
Apply bid [0.05% emollient cream]

Fluocinolone acetonide:
Apply bid-qid [0.025% ointment]

Flurandrenolide:
Apply bid-tid [0.05% ointment]

Hydrocortisone valerate:
Apply bid-qid [0.2% ointment]

Mometasone furoate:
Apply qd [0.1% cream]
Apply qd [0.1% lotion]

Prednicarbate:
Apply bid [0.1% ointment]

Triamcinolone acetonide:
Apply bid-qid [0.1% ointment]

 Group 5: Medium/low potency   top of page

Group 5: Medium/low potency

Betamethasone dipropionate:
Apply qd-bid [0.05% lotion]

Betamethasone valerate:
Apply qd-bid [0.1% cream]
Apply qd-bid [0.1% lotion]

Desonide:
Apply bid-qid [0.05% ointment]

Fluocinolone acetonide:
Apply bid-qid [0.025% cream]

Flurandrenolide:
Apply bid-tid [0.05% cream]
Apply bid-tid [0.05% lotion]
Apply bid-tid [0.025% ointment]

Fluticasone propionate:
Apply qd-bid [0.05% cream]

Hydrocortisone butyrate:
Apply bid-qid [0.1% cream]
Apply bid-qid [0.1% lipocream]
Apply bid-qid [0.1% ointment]
Apply bid-qid [0.1% solution]

Hydrocortisone valerate:
Apply bid-qid [0.2% cream]

Prednicarbate:
Apply bid-qid [0.1% cream]

Triamcinolone acetonide:
Apply bid-qid [0.1% cream]
Apply bid-qid [0.1% lotion]
Apply bid-qid [0.025% ointment]

 Group 6: Low (Mild) potency   top of page

Group 6: Low Potency 

Alclometasone dipropionate:
Apply bid-tid [0.05% cream]
Apply bid-tid [0.05% ointment]

Desonide:
Apply bid-tid [0.05% cream]
Apply bid [0.05% foam]
Apply bid [0.05% gel]
Apply bid-tid [0.05% lotion]

Fluocinolone acetonide:
Apply qd [0.01% shampoo]
Apply tid-qid [0.01% solution]

Flurandrenolide:
Apply bid-tid [0.025% cream]

Triamcinolone acetonide:
Apply bid-qid [0.025% cream]
Apply bid-qid [0.025% lotion]

 Group 7: Lowest Potency   top of page

Group 7: Lowest Potency 

Hydrocortisone:
Apply bid-qid [0.5 % cream]
Apply bid-qid [0.5 % ointment]

Apply bid-qid [1.0 % cream]
Apply bid-qid [1.0 % lotion]
Apply bid-qid [1.0 % ointment]

Apply bid-qid [2.5 % cream]
Apply bid-qid [2.5 % lotion]
Apply bid-qid [2.5 % ointment]

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
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