What is the ranking of topical steroids by potency?

Topical Corticosteroid Potency Classification

Topical corticosteroids are classified into 7 categories based on their skin vasoconstrictive activity, ranging from ultra-high potency (class 1) to low potency (classes 6 and 7), with class 1 being the most potent and classes 6-7 being the least potent. 1

Potency Classification Chart

Class 1 (Ultra-high/Superpotent)

• Clobetasol propionate 0.05% (cream, ointment, foam, solution) 1, 2
• Betamethasone dipropionate 0.05% (optimized vehicle) 1
• Diflorasone diacetate 0.05% (ointment) 1
• Halobetasol propionate 0.05% (cream, ointment) 1

Class 2 (High/Potent)

• Amcinonide 0.1% (cream, ointment) 1
• Betamethasone dipropionate 0.05% (cream) 1
• Betamethasone valerate 0.1% (ointment) 1
• Diflorasone diacetate 0.05% (cream) 1
• Fluocinonide 0.05% (cream, gel, ointment) 1
• Fluticasone propionate 0.005% (ointment) 1
• Mometasone furoate 0.1% (ointment) 1
• Triamcinolone acetonide 0.5% (cream, ointment) 1

Class 3-4 (Medium/Mid-strength)

• Betamethasone valerate 0.1% (cream) 1
• Fluocinolone acetonide 0.025% (cream, ointment) 1
• Fluticasone propionate 0.05% (cream) 1
• Mometasone furoate 0.1% (cream) 1
• Triamcinolone acetonide 0.1% (cream, ointment) 1
• Hydrocortisone valerate 0.2% (cream) 1
• Flurandrenolide 0.05% (cream, ointment) 1

Class 5-7 (Low/Mild)

• Hydrocortisone 2.5% (cream, ointment) 1
• Hydrocortisone 1% (cream, ointment) 1
• Fluocinolone acetonide 0.01% (oil, solution) 1
• Triamcinolone acetonide 0.025% (cream) 1
• Triamcinolone acetonide 0.01% (cream) 1

Clinical Application Guidelines

• Potency Selection: Choose corticosteroid potency based on disease severity, location, patient age, and treatment goals 1

• Anatomical Considerations:

  • Face, intertriginous areas, genitals: Use lower potency (classes 5-7) due to increased risk of skin atrophy 1
  • Thick, chronic plaques: Consider ultra-high potency (class 1) corticosteroids 1
  • Trunk and extremities: Medium to high potency (classes 2-5) generally recommended as initial therapy 1

• Duration of Treatment:

  • Class 1 (ultra-high potency): Limited to 2-4 weeks of continuous use 1
  • Classes 2-5 (medium to high potency): Up to 4 weeks for plaque psoriasis 1
  • All classes: Up to 4 weeks for scalp psoriasis 1
  • Extended use (>12 weeks): Only under careful physician supervision 1

• Efficacy by Potency Class:

  • Class 1 (ultra-high potency): 58%-92% efficacy 1
  • Class 2 (high potency): 68%-74% efficacy 1
  • Classes 3-4 (medium potency): 68%-72% efficacy 1
  • Classes 5-7 (low potency): 41%-83% efficacy 1

Important Considerations and Precautions

• Application Method: Use the fingertip unit method for appropriate dosing - one fingertip unit covers approximately 2% body surface area 3, 4

• Common Adverse Effects: Skin atrophy, striae, telangiectasia, purpura, folliculitis, particularly in steroid-sensitive sites (face, intertriginous areas, forearms) 1, 5

• Risk Mitigation:

  • Gradual tapering after clinical response 1
  • For clobetasol and halobetasol, limit weekly use to 50g or less 1
  • Consider steroid-sparing agents for long-term management 1
  • Regular monitoring for adverse effects with prolonged use 1, 5

• Vehicle Selection: Consider the treatment area when selecting vehicle - ointments for dry, scaly conditions; creams for moist areas; solutions and foams for scalp 6, 4

Topical corticosteroids remain the cornerstone of treatment for many inflammatory skin conditions when used appropriately with consideration of potency, application site, and duration of treatment 1, 7.