Class 6 Topical Corticosteroids
Class 6 topical corticosteroids are low-potency agents that include medications such as desonide 0.05% cream and alclometasone dipropionate 0.05% cream, with efficacy rates of 41%-83% and a favorable safety profile suitable for sensitive skin areas and prolonged use. 1
Potency Classification System
- Topical corticosteroids are classified into 7 categories based on their vasoconstrictor activity, with Class 1 being ultra-high potency and Classes 6-7 representing low potency agents 1
- Class 6 specifically falls within the low-potency range, positioned just above Class 7 (the lowest potency, which includes hydrocortisone 1-2.5%) 1
- The classification system is based on skin blanching assays that correlate with clinical potency 2
Clinical Applications
Class 6 corticosteroids are particularly appropriate for:
- Facial dermatoses - Low potency agents are recommended for the face due to increased risk of skin atrophy in this area 3
- Intertriginous areas - These sensitive sites (skin folds, groin, axillae) require lower potency formulations to minimize adverse effects 3
- Genital skin conditions - The thin skin in genital areas necessitates low-potency agents 4
- Pediatric patients - Infants and young children should be treated with less potent topical corticosteroids due to increased risk of systemic absorption and adrenal suppression 3, 4
Duration and Frequency of Use
- Unlike ultra-high potency (Class 1) steroids which are limited to 2-4 weeks of continuous use, Class 6 corticosteroids have no specified time limit for use due to their favorable safety profile 1, 4
- Typical application is once or twice daily 4
- These agents can be used for longer treatment courses compared to higher potency steroids 3
Safety Profile
Key advantages of Class 6 steroids:
- Lower risk of local cutaneous side effects including skin atrophy, telangiectasia, striae, and purpura compared to higher potency agents 3, 4
- Minimal risk of hypothalamic-pituitary-adrenal axis suppression 3
- Safer for use in steroid-sensitive anatomical sites 3
Important Clinical Caveats
- While Class 6 steroids are safer, they have lower efficacy (41%-83%) compared to ultra-high potency agents (58%-92%) 1
- For thick, chronic plaques or severe inflammatory conditions, Class 6 agents may be insufficient and higher potency steroids may be required initially 1
- Patient confusion about steroid potency is common - only 17% of patients correctly understand the potency classification system, so clear labeling and education is essential 5
- When treating moderate-to-severe conditions, consider starting with medium-to-high potency agents and transitioning to Class 6 for maintenance therapy 3