Brand Names and Strengths of Topical Corticosteroids
Topical corticosteroids are classified into 7 potency categories ranging from ultra-high potency (class 1) to low potency (classes 6 and 7), with specific brand names available for each strength level. 1, 2
Ultra-High Potency (Class 1) Corticosteroids
- Dermovate (clobetasol propionate 0.05%) - available as cream, ointment 3, 4
- Nerisone Forte (diflucortolone valerate 0.3%) 3
- Temovate (clobetasol propionate 0.05%) 4
- Ultravate (halobetasol propionate 0.05%) 1
High Potency (Class 2) Corticosteroids
- Betnovate (betamethasone valerate 0.1%) - available as cream, ointment 3, 5
- Elocon (mometasone furoate 0.1%) 3
- Diprolene (betamethasone dipropionate 0.05%) 2
- Topicort (desoximetasone 0.25%) 2
Upper Mid-Strength (Class 3) Corticosteroids
- Cutivate (fluticasone propionate 0.005%) 2
- Lidex (fluocinonide 0.05%) 2
- Aristocort (triamcinolone acetonide 0.5%) 2
Mid-Strength (Class 4) Corticosteroids
- Eumovate (clobetasone butyrate 0.05%) 3, 6
- Betnovate-RD (betamethasone valerate 0.025%) 3
- Synalar (fluocinolone acetonide 0.025%) 2
- Kenalog (triamcinolone acetonide 0.1%) 2
Lower Mid-Strength (Class 5) Corticosteroids
- Locoid (hydrocortisone butyrate 0.1%) 2
- Westcort (hydrocortisone valerate 0.2%) 2
- Dermatop (prednicarbate 0.1%) 2
Low Potency (Classes 6-7) Corticosteroids
- Hydrocortisone (1% or 0.5%) - available as cream, ointment 3, 7
- Derm-Aid (hydrocortisone 0.1%) 3
- Hytone (hydrocortisone 1%, 2.5%) 2
Combination Products
- Betnovate-C (betamethasone valerate 0.1% + clioquinol 3%) 3
- Fucibet (betamethasone valerate 0.1% + fusidic acid 2%) 3
- Daktacort (hydrocortisone 1% + miconazole nitrate 2%) 3
- Canesten HC (hydrocortisone 1% + clotrimazole 1%) 3
- Trimovate (clobetasone 0.05% + oxytetracycline 3% + nystatin 100,000 units/g) 3
- Dermovate-NN (clobetasol propionate 0.05% + neomycin sulphate 0.5% + nystatin 100,000 units/g) 3
Selection Considerations
Potency Selection
- Ultra-high potency (Class 1): For thick, chronic plaques of psoriasis 1, 2
- High potency (Class 2): For moderate to severe plaque psoriasis 1, 2
- Mid-potency (Classes 3-5): For moderate psoriasis and as initial therapy for most adults 2
- Low potency (Classes 6-7): For face, intertriginous areas, and children 2, 7
Vehicle Formulations
- Ointments: Most potent, best for dry, scaly lesions 8
- Creams: Less greasy, cosmetically acceptable, less potent than ointments 8
- Lotions/Solutions: For scalp and hairy areas 8
- Gels/Foams: For scalp and hairy areas 8
- Tapes: Can significantly increase potency (e.g., flurandrenolide 0.1% functions as class 5 as cream but class 1 as tape) 9
Application Guidelines
- For scalp application: 15-30g for a two-week period 3, 6
- For face and neck: 15-30g for a two-week period 3
- For trunk: 100g for a two-week period 3
- For extremities: 30-60g for arms, 100g for legs for a two-week period 3
Important Considerations
- Efficacy rates vary from 41% to 92%, with higher potency corticosteroids generally showing greater efficacy 1
- Risk of adverse effects increases with prolonged use, higher potency, occlusion, and application to areas with thinner skin 8, 10
- Limit duration of ultra-high potency corticosteroids to 2-4 weeks 1, 8
- Intermittent treatment is recommended for long-term management to minimize side effects 1
- Consider rotational or combination strategies with non-steroidal agents to maintain efficacy while reducing side effects 9
- Occlusive dressings substantially increase percutaneous absorption and potency 4, 5
- Significant off-label use occurs with over-the-counter topical steroids 11
Prescription Requirements
- Ultra-high and high potency corticosteroids require prescription 11
- Low potency corticosteroids (hydrocortisone 1%) and some mid-potency (clobetasone) are available over-the-counter in some countries 11
When selecting a topical corticosteroid, consider the condition being treated, affected body area, patient age, and treatment duration to optimize efficacy while minimizing potential adverse effects 8.