Medium and Low Potency Topical Corticosteroids
Medium potency topical corticosteroids (TCS) include agents like fluticasone propionate 0.05% and mometasone, while low potency TCS include hydrocortisone and similar weaker preparations. 1
Classification System
TCS are grouped into seven potency classes, ranging from Class I (very high potency) to Class VII (very low potency). 1 This classification system helps guide appropriate selection based on:
- Anatomic location of treatment
- Duration of therapy needed
- Patient age and skin characteristics
- Disease severity
Medium Potency TCS
Medium potency corticosteroids can be utilized for longer courses due to a more favorable adverse event profile compared to high or very high potency agents. 1
Clinical Applications
- Safe for extended use on trunk and extremities in chronic atopic dermatitis 1
- Preferred for maintenance therapy: Twice-weekly application of medium potency TCS (such as fluticasone or mometasone) to previously affected skin areas for up to 16 weeks helps prevent relapses in moderate to severe atopic dermatitis 1
- Reduced risk of skin atrophy compared to higher potency agents, making them suitable for longer treatment courses 1
Evidence for Maintenance Therapy
A randomized trial of 117 adult atopic dermatitis patients demonstrated that intermittent fluticasone propionate 0.05% cream (a medium potency TCS) used twice weekly made patients 7.0 times less likely to experience disease relapse (95% CI: 3.0-16.7; P < .001) compared to vehicle. 1
Low Potency TCS
Low potency topical corticosteroids are the safest option for prolonged use, particularly in vulnerable populations and sensitive anatomic areas. 1
Clinical Applications
- Preferred for infants and young children due to increased risk of adrenal suppression with more potent agents 1
- Safe for sensitive skin areas including face, neck, and intertriginous zones where higher potency agents risk atrophy 1
- No specified time limit for use, unlike higher potency agents 2
- Can be combined with medium potency TCS in a stepped approach for chronic disease management 1
Key Clinical Considerations
Anatomic Site Selection
Lower potency agents should be used on thin and sensitive skin areas (face, neck, genitals, and body folds) to avoid skin atrophy. 1 The risk of adverse effects increases with application to areas of thinner skin. 2
Pediatric Use
Children should be treated with less potent TCS than adults because they have an increased risk of adrenal suppression from potent TCS. 1 When prescribing for children, lower potencies and shorter durations should be used. 2
Duration Guidelines
- Medium potency TCS: Can be used for up to 12 weeks 2
- Low potency TCS: No specified time limit 2
- High/very high potency TCS: Limited to 2-4 weeks due to adverse effect risk 1, 3
Common Pitfalls to Avoid
Undertreatment due to steroid phobia is a significant clinical problem. 1 Patients and parents often have unfounded fears about topical corticosteroids that lead to poor adherence. Clear education about the differences between potency classes and appropriate use is essential. 1
Prolonged use of high potency TCS on sensitive areas when medium or low potency agents would suffice increases the risk of skin atrophy, striae, and systemic absorption. 1, 2 The basic principle is to use the least potent preparation required to keep the condition under control. 1