Mid to High Potency Topical Corticosteroids
Mometasone furoate 0.1% cream and fluticasone propionate 0.05% cream are effective mid-potency topical corticosteroids, while clobetasol propionate 0.05% cream/ointment is a highly effective high-potency option. 1, 2
Mid-Potency Options
- Mometasone furoate 0.1% cream - a medium-potency synthetic corticosteroid that can be applied once daily, making it convenient for patients 1, 2
- Fluticasone propionate 0.05% cream - recommended by the American Academy of Dermatology for inflammatory skin conditions 1
- Triamcinolone acetonide 0.1% cream/ointment - approximately 2 times more potent than hydrocortisone acetate 1% 3, 4
- Betamethasone valerate 0.1% cream - achieves effective skin concentrations comparable to oral prednisone 5
High-Potency Options
- Clobetasol propionate 0.05% cream/ointment - classified as a super-high potency corticosteroid, 5-6 times more potent than hydrocortisone 6, 3
- Betamethasone dipropionate 0.05% ointment - considered a high-potency option 7, 3
- Halcinonide 0.1% cream/ointment - comparable in potency to clobetasol propionate 3
Clinical Applications
- Mid-potency corticosteroids are recommended for initial therapy in adults with plaque psoriasis not involving intertriginous areas 7
- High-potency corticosteroids are recommended for areas with thick, chronic plaques 7
- For localized or mild disease, very potent topical steroids can be applied to lesional skin 7
- For moderate-to-severe disease, systemic corticosteroids with or without very potent topical steroids are recommended 7
Dosing Guidelines
- Mid-potency topical corticosteroids can be applied once or twice daily for up to 12 weeks 1, 8
- High-potency and super-high-potency corticosteroids should be limited to 2-4 weeks of continuous use 6
- For maintenance therapy in chronic conditions, twice weekly application (weekend-only therapy) can prevent relapses 1
Safety Considerations
- Avoid using high-potency corticosteroids on the face, intertriginous areas, and genitals due to increased risk of skin atrophy 7, 6
- Use lower potency corticosteroids on the face (e.g., hydrocortisone) to avoid skin atrophy 7
- Patients applying topical steroids to large surface areas should be monitored for HPA axis suppression 6
- Super-potent corticosteroids should not be used for more than 2 consecutive weeks, and amounts greater than 50g per week should be avoided 6
- Medium-potency corticosteroids have a lower risk of skin atrophy compared to high-potency options, making them suitable for longer courses of treatment 1
Special Considerations
- In children, lower potency corticosteroids should be used when possible, with monitoring for growth during long-term use 1
- For hand-foot skin reactions from anticancer agents, topical high-potency steroids applied twice daily are recommended 7
- For grade I acute graft-versus-host disease affecting only the skin, medium to high-potency topical steroids are recommended 7
When selecting between mid and high-potency options, consider the location of application, duration of treatment needed, and patient factors such as age and comorbidities. For most inflammatory conditions requiring medium to high potency treatment, mometasone furoate 0.1% cream provides an excellent balance of efficacy and safety with once-daily dosing 2.