High Potency Topical Corticosteroids
High potency topical corticosteroids are Class 2 and Class 3 agents in the 7-tier classification system, which includes medications like betamethasone dipropionate 0.05% and fluticasone propionate 0.05%. 1
Classification System
Topical corticosteroids are classified into 7 categories based on their vasoconstriction potency:
- Class 1 (Ultra-high/Super-high potency): Clobetasol propionate 0.05% 2, 3
- Class 2 (High potency): Betamethasone dipropionate 0.05% 4
- Class 3-5 (Moderate to high potency): Fluticasone propionate 0.05%, mometasone furoate 0.1% 1, 5
- Class 6-7 (Low potency): Hydrocortisone 1
The American Academy of Dermatology specifically recommends Class 2 and Class 3-5 corticosteroids as high to moderate potency agents for initial therapy in adults with plaque psoriasis. 1
Clinical Applications
High potency corticosteroids are recommended for areas with thick, chronic plaques that require more aggressive treatment. 6
The American Academy of Dermatology guidelines specify that:
- Class 1,2, and 3-5 topical corticosteroids can be used for up to 4 weeks for plaque psoriasis not involving intertriginous areas 1
- These agents are appropriate for localized disease and can serve as adjunctive therapy with systemic treatments 1
Critical Safety Considerations
Avoid using high potency corticosteroids on the face, intertriginous areas, and genitals due to significantly increased risk of skin atrophy. 6
Key safety points include:
- Lower potency agents should be used on areas susceptible to steroid atrophy, such as the face and forearms 1
- Treatment duration beyond 4 weeks requires careful physician supervision 1
- Medium potency steroids have a lower risk of skin atrophy compared to high potency options, making them preferable for longer treatment courses 5
Distinguishing High from Ultra-High Potency
Ultra-high potency (Class 1) agents like clobetasol propionate are distinct from high potency steroids and carry greater risks. 2
Clobetasol propionate is classified as "super-high potency" and:
- Should not be used beyond 2 consecutive weeks 2
- Has total dosage limits of 50g per week due to HPA axis suppression risk 2
- Is not recommended for pediatric patients under 12 years 2
- Demonstrates efficacy rates of 58-92% in clinical trials 1
In contrast, high potency steroids (Class 2-3) can be used for up to 4 weeks initially and up to 12 weeks under supervision. 1