From the Guidelines
Topical corticosteroids are classified into 7 categories based on their skin vasoconstrictive activity, ranging in strength from ultra-high (class 1) to low (class 6 and 7) [ 1 ].
Classification of Topical Corticosteroids
- Class 1 (superpotent): includes medications such as halobetasol propionate and clobetasol foam, with efficacy rates ranging from 58% to 92% [ 1 ]
- Class 2 (potent): includes medications such as desoximetasone cream and halcinonide solution, with efficacy rates ranging from 68% to 74% [ 1 ]
- Class 3,4 (midstrength and upper midstrength): includes medications such as fluticasone propionate and betamethasone valerate foam, with efficacy rates ranging from 68% to 72% [ 1 ]
- Class 5,6,7 (least potent, midstrength, and lower midstrength): with efficacy rates ranging from 41% to 83% [ 1 ]
Key Points
- The choice of topical corticosteroid should be based on the disease severity, disease location, patient preference, and the age of the patient [ 1 ]
- Lower potency corticosteroids should be used on the face, intertriginous areas, and areas that are susceptible to steroid atrophy [ 1 ]
- In adults, corticosteroids in classes 2 through 5 (moderate to high potency) are generally recommended as initial therapy [ 1 ]
From the Research
Definition and Classification of Topical Corticosteroids
- Topical corticosteroids are one of the oldest and most useful treatments for dermatologic conditions 2
- They are classified by strength and the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions 3
- They are available in various formulations, including ointments, creams, lotions, gels, foams, oils, solutions, and shampoos 3
Indications for Topical Corticosteroids
- Topical corticosteroids are used to treat inflammatory skin conditions such as psoriasis and atopic dermatitis 3
- Evidence of effectiveness exists for select conditions, such as psoriasis, vitiligo, eczema, atopic dermatitis, phimosis, acute radiation dermatitis, and lichen sclerosus 2
- They can also be used to treat other skin conditions, including melasma, chronic idiopathic urticaria, and alopecia areata, although evidence is limited 2
Usage and Application of Topical Corticosteroids
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 3
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 3
- Topical corticosteroids are applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3
Safety and Side Effects of Topical Corticosteroids
- The risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 3
- Local and systemic side effects have been associated with the use of topical corticosteroids, including allergic contact dermatitis 4
- Judicious use with reinforced patient education can lower the risk of side effects and make topical corticosteroids a useful treatment for dermatologic conditions 4