What are examples of high potency steroid creams?

Examples of High Potency Topical Steroid Creams

High potency topical corticosteroids include clobetasol propionate 0.05%, betamethasone dipropionate 0.05%, fluocinonide 0.05%, and halobetasol propionate 0.05%, which are classified as Class I (super-high potency) or Class II (high potency) agents. 1, 2

Classification of Topical Corticosteroids

Topical corticosteroids are classified into 7 categories based on their vasoconstrictive activity:

• Class I (Super-high/Ultra-high potency):

  • Clobetasol propionate 0.05% (cream, ointment, gel, foam) 2
  • Halobetasol propionate 0.05% 3

• Class II (High potency):

  • Betamethasone dipropionate 0.05% (optimized formulation) 3, 4
  • Fluocinonide 0.05% 3, 1

Clinical Applications of High Potency Steroids

High potency steroids are particularly useful for:

• Psoriasis: Classes 1-2 (high to super-high potency) are recommended for plaque psoriasis not involving intertriginous areas 3, 1

• Severe Atopic Dermatitis: High potency steroids are useful for treating severe disease and flares 3

• Lichen Planus and Lichenoid Diseases: High-potency topical steroids like clobetasol 0.05% or fluocinonide 0.05% are recommended for all grades 3

• Immunotherapy-related Skin Reactions: High-potency topical steroids are recommended for psoriasiform diseases related to immunotherapy 3

Proper Usage Guidelines

• Application frequency: Apply a thin layer to affected areas twice daily and rub in gently 2

• Duration limitations:

  • Super-high potency (Class I) steroids should be limited to 2 consecutive weeks 2
  • Amounts greater than 50g per week should not be used for Class I steroids 2

• Anatomical considerations:

  • Lower potency corticosteroids should be used on the face, intertriginous areas, and areas susceptible to steroid atrophy 1
  • High potency steroids are most appropriate for thick-skinned areas like palms, soles, and extensor surfaces 3, 1

Efficacy Considerations

• High potency steroids demonstrate superior efficacy compared to lower potency agents:
  • In psoriasis, betamethasone dipropionate showed 94.1% good or excellent clinical response versus 12.5% in control groups 3
  • Clobetasol propionate has been shown to be more effective than Class II steroids in psoriasis treatment 5
  • High potency steroids can prolong remission rates, making intermittent treatment schedules feasible 5

Important Precautions

• Potential side effects:

  • Local cutaneous effects: skin atrophy, telangiectasia, striae, purpura, contact dermatitis, rosacea 3
  • Systemic effects with prolonged use: hypothalamic-pituitary-adrenal axis suppression 3, 2

• Risk factors for adverse effects:

  • Higher potency TCS use
  • Occlusion
  • Use on thinner and intertriginous skin
  • Older patient age
  • Long-term continuous use 3

• Monitoring recommendations:

  • Regular skin checks for all patients receiving long-term therapy to assess for atrophy 3
  • Assessment of growth in children using topical corticosteroids long-term 3

High potency topical steroids remain essential therapeutic agents for various dermatological conditions, but their potency necessitates careful patient education regarding proper application and potential side effects 6.