Topical Corticosteroids Potency Selector
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
* 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.
* 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.
* 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.
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2] Hengge et al. Adverse effects of topical glucocorticosteroids. J Am
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3] Jacob SE, Steele T. Corticosteroid classes: a quick reference guide
including patch test substances and cross-reactivity. J Am Acad Dermatol.
4] Klaus Wolff, Lowell A. Goldsmith, Stephen I. Katz, Barbara A.
Gilchrest et al. Editors, Fitzpatrick’s Dermatology in General Medicine,
7th Edition, New York: McGraw-Hill; 2007.
5] Ong PY, Boguniewicz M. Atopic Dermatitis. Prim Care Clin Office Pract.