What is the grade of strong effect of corticosteroid (corticoid) in topical cream?

From the Guidelines

Corticosteroid creams, such as clobetasol propionate 0.05%, are classified as super-potent (Class I) and provide the strongest anti-inflammatory effect for severe skin conditions, as supported by the British Association of Dermatologists' guidelines 1. When considering the grade of strong effect of corticosteroid in topical cream, it is essential to evaluate the potency grades and their corresponding effects on skin conditions.

• The classification of corticosteroid creams ranges from super-potent (Class I) to least potent (Class VII), with Class I including clobetasol propionate 0.05% and betamethasone dipropionate 0.05% in optimized vehicle.
• The British Association of Dermatologists' guidelines recommend the use of topical corticosteroids, such as clobetasol propionate 0.05% cream, as first-line treatment for both localized and moderate disease, with a strength of recommendation A and level of evidence 1+ 1.
• The guidelines also highlight the benefits of topical clobetasol propionate 0.05% cream in extensive disease, including improved disease control, reduced adverse events, and lower mortality compared to oral prednisone 1.
• The choice of potency should be based on the severity of the condition, body location, and treatment duration, with higher potency steroids working faster but carrying greater risk of side effects like skin thinning, striae, and adrenal suppression when used long-term.
• Generally, the lowest effective potency should be used, especially on thin skin areas like the face, genitals, and skin folds, and high-potency steroids should be limited to short courses (typically 2-4 weeks) for acute flares.

From the FDA Drug Label

Studies performed with clobetasol propionate gel, cream and ointment indicate that they are in the super-high range of potency as compared with other topical corticosteroids. The grade of strong effect of corticosteroid (corticoid) in topical cream is super-high 2.

• The potency of clobetasol propionate cream is classified as super-high.
• This classification indicates a strong effect of the corticosteroid in the topical cream formulation.

From the Research

Classification of Topical Corticosteroids

• Topical corticosteroids are classified by strength and the risk of adverse effects 3
• The potency of topical corticosteroids can be ranked based on their antipsoriatic effect, with more potent corticosteroids showing a stronger effect 4

Potency of Specific Topical Corticosteroids

• Clobetasol propionate (0.05%) is considered a super-high-potency corticosteroid 4, 5, 6
• Betamethasone valerate (0.1%) and triamcinolone acetonide (0.1%) are considered high-potency corticosteroids 4, 5, 6
• Hydrocortisone acetate (1%) is considered a low-potency corticosteroid 6

Factors Affecting Potency

• Occlusion with a hydrocolloid dressing can increase the potency of topical corticosteroids 4
• The vehicle used for the topical corticosteroid can affect its potency and patient preference 5
• The concentration of corticosteroid in the skin, adjusted for relative potency, can be a predictor of clinical efficacy 7

Comparison of Topical and Oral Corticosteroids

• Topical corticosteroids can achieve greater effective drug levels in the superficial layers of skin than oral prednisone 7
• The apparently greater efficacy of oral corticosteroid therapy may be attributable to poor patient compliance with topical therapy or systemic alterations in immune function 7