What is the ranking of corticosteroids from high potency to low potency?

Topical Corticosteroid Potency Ranking

Topical corticosteroids are classified into seven potency groups, ranging from ultra-high potency (Class I) to low potency (Class VII), based on their vasoconstrictor assay results and clinical efficacy. 1, 2

Ultra-High Potency (Class I)

• Clobetasol propionate 0.05% (ointment, cream, gel, foam) 1, 3
• Halobetasol propionate 0.05% 1
• Betamethasone dipropionate 0.05% (optimized formulation) 4, 5

These are approximately 600-1000 times more potent than hydrocortisone 1% and should be limited to 2-4 weeks of continuous use due to significant risk of HPA axis suppression and cutaneous atrophy. 1, 3, 2

High Potency (Class II-III)

• Fluocinonide 0.05% 1
• Betamethasone dipropionate 0.05% (standard formulation) 1, 4
• Mometasone furoate 0.1% 5
• Fluticasone propionate 0.005% 1, 5

These agents are 50-100 times more potent than hydrocortisone 1% and represent the preferred choice for moderate-to-severe inflammatory dermatoses on the trunk and extremities. 1, 5, 2

Medium Potency (Class IV-V)

• Triamcinolone acetonide 0.1% 6
• Fluocinolone acetonide 0.025% 7, 6
• Hydrocortisone butyrate 0.1% 4, 5
• Betamethasone valerate 0.12% 1, 4, 6
• Prednicarbate 0.1% 5

These preparations are 2-25 times more potent than hydrocortisone 1% and can be used for extended periods (up to 12 weeks) with lower risk of adverse effects. 1, 2, 6

Low Potency (Class VI-VII)

• Desonide 0.05% 4
• Hydrocortisone 1% (base formulation) 8, 4, 6
• Hydrocortisone acetate 1% 6

These are the least potent topical corticosteroids with minimal systemic absorption risk and can be used on sensitive areas including the face, genitals, and intertriginous zones without time limitation. 1, 2

Critical Application Principles

Potency selection must account for both the severity of inflammation and the anatomical location, as facial and genital skin absorbs corticosteroids at rates 3-10 times higher than trunk skin. 1, 3, 2

Duration Limits by Potency Class

• Class I (ultra-high): Maximum 2-4 weeks continuous use, not exceeding 50g weekly for clobetasol propionate 1, 3, 2
• Class II-III (high): Up to 12 weeks with appropriate monitoring 1, 2
• Class IV-V (medium): Extended use acceptable with intermittent application 1, 2
• Class VI-VII (low): No specified time limit 2

Common Pitfalls to Avoid

• Never use ultra-high or high potency corticosteroids on the face, genitals, or intertriginous areas due to exponentially increased absorption and atrophy risk 1, 3, 2
• Avoid abrupt discontinuation of potent corticosteroids after prolonged use; taper by reducing frequency or transitioning to lower potency agents 1
• Do not exceed twice-daily application as increased frequency does not improve efficacy but substantially increases adverse effect risk 1, 9, 2

Vehicle Selection Impact

Ointments provide the highest potency for a given corticosteroid concentration due to enhanced penetration, followed by creams, then lotions and solutions. 9, 2