What are examples of topical moderate potency steroids for inflammatory skin conditions?

Topical Moderate Potency Steroids for Inflammatory Skin Conditions

Moderate potency topical corticosteroids (class 3-5) are recommended for inflammatory skin conditions when treating areas not involving the face, intertriginous areas, or areas susceptible to steroid atrophy. 1

Examples of Moderate Potency Topical Steroids

• Class 3-4 (Medium Potency):
  • Fluocinolone acetonide 0.025% cream 1
  • Fluticasone propionate 0.05% cream/ointment 1
  • Flurandrenolide 0.05% cream/ointment 1
  • Hydrocortisone butyrate 0.1% cream/ointment 1
  • Hydrocortisone valerate 0.2% cream 1
  • Prednicarbate 0.1% cream 1
  • Triamcinolone acetonide 0.025% cream/ointment 1
  • Triamcinolone acetonide 0.1% lotion 1
  • Fluocinolone acetonide 0.01% oil (for scalp) 2

Clinical Applications

Indications

• Plaque psoriasis (not involving intertriginous areas) 1
• Atopic dermatitis (moderate cases) 1
• Scalp psoriasis 1
• Inflammatory skin conditions (moderate severity) 3

Duration of Treatment

• Moderate potency corticosteroids can be used for up to 4 weeks for plaque psoriasis 1
• For maintenance therapy, intermittent use (2 times/week) can help reduce disease flares and relapse 1
• No specified time limit for low-potency topical corticosteroid use, but medium potency should generally be limited to 12 weeks 3

Application Guidelines

• Frequency: Apply once or twice daily for most conditions 3
• Quantity: Use the fingertip unit method - one fingertip unit covers approximately 2% body surface area on an adult 3
• Location considerations:
  • Avoid use on face, intertriginous areas, and areas susceptible to steroid atrophy 1
  • For thicker, chronic plaques, higher potency corticosteroids may be required 1
  • For sensitive areas, lower potency corticosteroids are recommended 1

Potential Adverse Effects

• Local effects: Skin atrophy, striae, telangiectasias, purpura 3
• Systemic effects: Risk increases with:
  • Prolonged use
  • Large area of application
  • Higher potency
  • Occlusion
  • Application to areas of thinner skin 3, 4
• HPA axis suppression: Can occur with extensive use, especially under occlusion 4

Special Considerations

• Children: Lower potencies and shorter durations should be used 3, 5
• Pregnancy/Lactation: Topical corticosteroids can work safely and effectively 3
• Formulation selection:
  • Ointments generally provide greater efficacy than creams for dry, scaly conditions 6
  • Creams are preferred for moist or weeping lesions 6
  • Lotions, solutions, and foams are useful for scalp application 3
  • Patient preference should be considered for adherence 1

Monitoring

• Regular follow-up is recommended to assess efficacy and monitor for adverse effects 4
• For prolonged use, consider evaluating for evidence of HPA axis suppression 4
• Reassess after 2-4 weeks to determine if continued treatment is necessary 1

Remember that choosing the appropriate potency of topical corticosteroid depends on the severity of the condition, location of application, patient age, and duration of treatment needed 1.