Commonly Used Corticosteroids in Medical Practice
Systemic Corticosteroids
Short-Acting Agents
- Hydrocortisone and cortisone are the least potent systemic corticosteroids and are naturally occurring glucocorticoids that possess both anti-inflammatory and salt-retaining properties, making them suitable for replacement therapy in adrenocortical deficiency states 1, 2, 3.
Intermediate-Acting Agents
- Prednisone and prednisolone are intermediate-acting corticosteroids that are four to five times more potent than hydrocortisone and are primarily used for their anti-inflammatory effects across multiple organ systems 4, 3.
- Methylprednisolone is another intermediate-acting agent with similar potency to prednisone, approximately four to five times more potent than hydrocortisone 4.
- Triamcinolone acetonide is commonly used in both systemic (intramuscular injection) and intralesional forms, particularly for dermatologic conditions 5, 6.
Long-Acting Agents
- Dexamethasone is a long-acting systemic corticosteroid with potency approximately 25 times greater than hydrocortisone, and it almost completely lacks sodium-retaining properties, making it suitable for conditions requiring potent anti-inflammatory effects without fluid retention 4, 2.
- Betamethasone is a derivative of prednisolone with a 16β-methyl group that enhances anti-inflammatory action while reducing sodium and water retention properties 1.
Topical Corticosteroids
Superpotent Topical Agents
- Clobetasol propionate (0.05%) is a superpotent topical corticosteroid recommended as first-line treatment for conditions like bullous pemphigoid and alopecia areata 7, 5.
- Desoximetasone (0.25%) is another potent topical corticosteroid used in dermatologic conditions 5.
Route-Specific Formulations
Injectable Forms
- Triamcinolone acetonide is available as a suspension for intramuscular injection and for intralesional use at concentrations of 5-10 mg/mL 5, 6.
- Dexamethasone sodium phosphate injection provides rapid onset but short duration of action 2.
- Hydrocortisone acetate (25 mg/mL) is used for intralesional injections 5.
Oral Forms
- Prednisone and prednisolone are available as tablets or oral solutions for enteral administration 5, 3.
Important Clinical Considerations
The choice of corticosteroid depends on the clinical indication, desired duration of action, and route of administration. Short-acting agents like hydrocortisone are preferred for replacement therapy, while intermediate-acting agents like prednisone are most commonly used for anti-inflammatory purposes 4. Long-acting agents like dexamethasone are reserved for situations requiring maximal anti-inflammatory potency, such as brain metastases with cerebral edema 5.
For dermatologic conditions, topical superpotent corticosteroids like clobetasol propionate should be prioritized over systemic agents to minimize systemic side effects while maintaining efficacy 7, 5.