What are the typical low and medium potency corticosteroids (corticosteroids) used to treat eczema?

Low and Medium Potency Corticosteroids for Eczema Treatment

Low potency corticosteroids include hydrocortisone (0.1-2.5%), desonide, and clobetasone butyrate 0.05%, while medium potency options include mometasone furoate 0.1%, triamcinolone acetonide 0.1%, and fluocinolone acetonide 0.025%. 1, 2

Classification of Topical Corticosteroids by Potency

Low Potency (Class 6-7)

• Hydrocortisone (0.1-2.5%)
• Desonide
• Dioderm (hydrocortisone 0.1%)
• Clobetasone butyrate 0.05% (Eumovate)
• Prednicarbate 0.1%
• Fluocinolone acetonide 0.01%

Medium Potency (Class 3-5)

• Mometasone furoate 0.1%
• Triamcinolone acetonide 0.1%
• Fluocinolone acetonide 0.025%
• Betamethasone valerate 0.1%
• Fluticasone propionate 0.05%
• Hydrocortisone butyrate 0.1%
• Hydrocortisone valerate 0.2%

Appropriate Use Based on Body Location

Low Potency

• Face
• Skin folds/intertriginous areas
• Genitals
• Areas with thin skin
• Children
• Long-term use

Medium Potency

• Trunk
• Extremities
• Areas with thicker skin
• Short-term treatment of moderate eczema

Clinical Application Guidelines

1. Potency Selection:

   • Choose the lowest effective potency for the affected area
   • Consider patient age (lower potency for children)
   • Consider treatment duration (lower potency for chronic use)

2. Application Frequency:

   • Once daily application of potent corticosteroids is as effective as twice daily application 3
   • Apply after bathing when skin is hydrated for better absorption

3. Treatment Duration:

   • Use for limited periods (typically 1-2 weeks)
   • Taper gradually rather than stopping abruptly
   • Consider weekend/proactive therapy for maintenance (applying twice weekly) 3

Safety Considerations

1. Side Effects:

   • Skin thinning (atrophy) is rare with appropriate use of low and medium potency steroids
   • Risk increases with potency, occlusion, and duration of use
   • Only 1% of patients experience abnormal skin thinning across studies 3

2. Monitoring:

   • Watch for signs of skin atrophy, telangiectasia, or striae
   • Consider reassessment after 2 weeks of treatment 2

3. Patient Education:

   • Most patients (83%) do not understand corticosteroid potency classifications 4
   • Clear explanation of potency differences is essential
   • Demonstrate proper application technique using fingertip unit measurement

Special Considerations

1. Combination Therapy:

   • Emollients should be used liberally alongside corticosteroids
   • Allow 15-30 minutes between emollient and corticosteroid application

2. Infection Management:

   • Consider combination corticosteroid-antimicrobial preparations if infection is present
   • Examples: Fucidin H (hydrocortisone 1% + fusidic acid 2%) for mild potency with antimicrobial 1

3. Long-term Safety:

   • Intermittent use of mild/moderate potency corticosteroids for up to 5 years shows minimal risk of skin thinning or growth abnormalities 5

By selecting the appropriate potency corticosteroid based on treatment location, patient age, and condition severity, you can effectively manage eczema while minimizing adverse effects.