What are examples of corticosteroids used to treat psoriasis?

Examples of Corticosteroids for Psoriasis

Topical corticosteroids are classified into 7 potency classes for psoriasis treatment, ranging from ultrahigh-potency (Class 1) agents like clobetasol propionate 0.05% and halobetasol propionate 0.05%, to low-potency (Class 6-7) agents like hydrocortisone, with selection based on disease severity, location, and patient age. 1

Ultrahigh-Potency Corticosteroids (Class 1)

These agents demonstrate the highest efficacy (58-92% improvement rates) and are reserved for thick, chronic plaques on non-sensitive areas 1:

• Clobetasol propionate 0.05% (ointment, cream, foam, solution) 1, 2
• Halobetasol propionate 0.05% 1

Maximum weekly use should not exceed 50g for clobetasol and halobetasol, with treatment duration limited to up to 4 weeks. 1, 3

High-Potency Corticosteroids (Class 2)

These agents show 68-74% efficacy rates and are appropriate for moderate to severe plaques 1:

• Amcinonide 0.1% 1
• Betamethasone dipropionate 0.05% 1
• Augmented betamethasone dipropionate 0.05% 1
• Desoximetasone 0.25% 1
• Diflorasone diacetate 0.05% 1
• Fluocinonide 0.05% 1
• Halcinonide 0.1% 1
• Mometasone furoate 0.1% 1

Medium-Potency Corticosteroids (Class 3-5)

These agents demonstrate 68-72% efficacy and are recommended as initial therapy for adults with psoriasis 1:

Class 3 agents: 1

• Betamethasone valerate 0.1%
• Fluticasone propionate 0.005%
• Triamcinolone acetonide 0.1% and 0.5%

Class 4 agents: 1

• Desoximetasone 0.05%
• Fluocinolone acetonide 0.025%
• Hydrocortisone valerate 0.2%
• Mometasone furoate 0.1%

Class 5 agents: 1

• Betamethasone valerate 0.1%
• Fluticasone propionate 0.05%
• Hydrocortisone butyrate 0.1%
• Prednicarbate 0.1%

Low-Potency Corticosteroids (Class 6-7)

These agents show more variable efficacy (41-83%) but are critical for sensitive areas 1:

• Fluocinolone acetonide 0.01% 1
• Triamcinolone acetonide 0.025% 1
• Hydrocortisone preparations (various strengths) 1

Location-Based Selection Algorithm

For thick plaques on trunk/extremities: Use Class 1 ultrahigh-potency corticosteroids for up to 4 weeks 1, 3

For face and intertriginous areas: Use only low-potency (Class 6-7) corticosteroids to minimize atrophy risk 1, 4

For scalp psoriasis: All potency classes (1-7) are appropriate for minimum 4 weeks for both initial and maintenance treatment 3

For areas susceptible to atrophy (forearms): Use lower potency agents to prevent telangiectasia, striae, and skin thinning 1

Critical Safety Considerations

Abrupt discontinuation of topical corticosteroids can trigger rebound flares and potentially worsen pustular psoriasis. 3, 4 Gradual tapering after clinical improvement (typically within 2 weeks for ultrahigh-potency agents) is essential 3.

Hypothalamic-pituitary-adrenal (HPA) axis suppression can occur with clobetasol at doses as low as 2g per day, particularly with large surface area application, prolonged use, or occlusive dressings. 2 This effect is typically transient and reversible upon discontinuation 2.

Common local adverse effects include skin atrophy, striae, folliculitis, telangiectasia, and purpura, with risk increasing beyond 4 weeks of continuous use. 1, 3, 4

Treatment Duration Framework

Standard duration: Up to 4 weeks for Class 1-5 corticosteroids on non-intertriginous areas 1, 3

Extended use: Beyond 4 weeks (up to 12 weeks) only under careful physician supervision with regular monitoring for adverse effects 3

Maintenance strategy: After initial improvement, transition to intermittent use (every-other-day or weekend-only application) rather than continuous therapy to minimize adverse effects 1, 5