From the Guidelines
There are seven classes of topical corticosteroids, ranging from Class I (very high potency) to Class VII (very low potency), as classified based on their potency and vasoconstrictor activity, which correlates with anti-inflammatory effect. These classes are used to guide the selection of appropriate topical corticosteroids for various skin conditions, including atopic dermatitis and psoriasis, with the goal of maximizing therapeutic efficacy while minimizing potential side effects 1. The classification system helps clinicians consider factors such as the condition being treated, body location, patient age, and treatment duration when choosing a topical corticosteroid.
- Key factors influencing the choice of topical corticosteroid class include:
- Condition severity: More potent steroids are typically used for severe conditions or thick-skinned areas.
- Body location: Less potent options are preferred for sensitive areas like the face, genitals, or for use in children.
- Patient age: Pediatric patients may require lower potency steroids due to increased risk of systemic absorption and side effects.
- Treatment duration: Prolonged use of higher potency steroids carries greater risk of local and systemic adverse effects, including skin thinning, striae, and hypothalamic-pituitary-adrenal axis suppression. The most recent and highest quality study, published in 2023, supports the use of this classification system to guide the management of atopic dermatitis with topical therapies 1.
From the FDA Drug Label
The corticosteroids are a class of compounds comprising steroid hormones secreted by the adrenal cortex and their synthetic analogs. The topical corticosteroids constitute a class of primarily synthetic steroids used as anti-inflammatory and antipruritic agents.
The classes of topical corticosteroids (steroids) are not explicitly listed in the provided drug labels. However, the labels mention that corticosteroids are a class of compounds, and topical corticosteroids are a class of primarily synthetic steroids.
From the Research
Classification of Topical Corticosteroids
Topical corticosteroids are classified based on their strength and the risk of adverse effects. The classes of topical corticosteroids are:
- Super-high-potency corticosteroids
- High-potency corticosteroids
- Medium-potency corticosteroids
- Low-potency corticosteroids 4 Alternatively, they can also be classified into four potencies:
- Mild
- Moderate
- Potent
- Very potent 5
Potency Classification
The potency of topical corticosteroids can be classified into seven classes, ranging from class 1 (superpotent) to class 7 (least potent) 6
Factors Affecting Potency
The potency of topical corticosteroids is affected by several factors, including:
- Duration of treatment
- Frequency of application
- Skin location
- Total surface area treated 4
Adverse Effects
The risk of adverse effects increases with:
- Prolonged use
- Large area of application
- Higher potency
- Occlusion
- Application to areas of thinner skin, such as the face and genitals 4