What are examples of moderate-potency topical corticosteroid ointments?

Moderate-Potency Topical Corticosteroid Ointment Examples

Moderate-potency topical corticosteroid ointments include triamcinolone acetonide 0.1% ointment (Class 4-5) and fluocinolone acetonide 0.025% ointment (Class 5), which are appropriate for treating inflammatory skin conditions on the trunk and extremities while carrying a lower risk of skin atrophy compared to high-potency agents. 1

Classification System

The American Academy of Dermatology uses a 7-class system to categorize topical corticosteroids by potency, with Class 1 being ultra-high potency and Classes 6-7 being low potency. 1 Moderate-potency agents fall into Classes 3-5 of this classification system. 1

Specific Moderate-Potency Ointment Examples

Class 4-5 Agents

• Triamcinolone acetonide 0.1% ointment is a well-established moderate-potency corticosteroid that has been studied extensively in pediatric populations without notable adrenal suppression when used for up to 6 weeks. 2
• Fluocinolone acetonide 0.01% topical oil is FDA-labeled as a "low to medium potency corticosteroid" specifically indicated for scalp psoriasis in adults. 3
• Hydrocortisone 17-butyrate 21-propionate cream (Class 5) achieved 41% excellent or good improvement versus 18% with vehicle in mild to moderate psoriasis over 3 weeks. 4

Class 3-4 Agents (Upper Moderate Range)

• Betamethasone valerate foam (Class 4) demonstrated 72% improvement versus 47% placebo in moderate to severe scalp psoriasis over 4 weeks. 4
• Fluticasone propionate 0.005% ointment (Class 3) showed 68-69% of patients achieving good, excellent, or clear skin versus 29-30% with vehicle over 4 weeks. 4

Clinical Application Guidelines

Anatomical Site Selection

• Use moderate-potency agents (Classes 3-5) for trunk and limbs where thicker skin requires adequate penetration but lower risk of atrophy is desired compared to high-potency steroids. 1
• Avoid using moderate-potency agents on the face, genitals, or intertriginous areas—these sensitive sites require only low-potency (Classes 5-7) corticosteroids due to increased absorption and atrophy risk. 1
• Do not use moderate-potency agents on thick, keratotic plaques (such as palmar or plantar psoriasis), as the thick stratum corneum limits penetration and requires ultra-high-potency (Class 1) agents for effectiveness. 1

Duration of Treatment

• Moderate-potency corticosteroids (Classes 3-5) can be used for up to 12 weeks under careful supervision, offering a more favorable safety profile than high-potency formulations. 1, 5
• This contrasts with Class 1 ultra-high-potency agents, which should be limited to 2-4 weeks of continuous use with a maximum of 50 grams weekly. 4, 1

Application Frequency

• Once-daily application of moderate-potency topical corticosteroids is as effective as twice-daily application for treating eczema flare-ups, based on pooled data from 15 trials with 1821 participants. 6
• This finding allows for simplified dosing regimens that may improve patient adherence. 6

Efficacy Data

Classes 3-4 moderate-potency corticosteroids demonstrate 68-72% efficacy rates in achieving clear or almost clear status in psoriasis trials. 1 This represents a middle ground between the 58-92% efficacy of ultra-high-potency agents and the 41-83% efficacy of low-potency agents. 1

Safety Profile

Local Adverse Effects

• Abnormal skin thinning occurred in only 1% of 2,266 participants across 22 trials, with only 2 cases reported with moderate (Class 4) potency corticosteroids. 1
• The risk of local cutaneous side effects (atrophy, telangiectasia, striae, purpura) increases with higher potency, prolonged duration, larger treatment areas, and application to sensitive sites. 4, 5

Systemic Absorption

• Medium-potency topical steroids can cause hypothalamic-pituitary-adrenal axis suppression, though this risk is lessened by intermittent or localized use. 4
• A 6-week study of triamcinolone acetonide 0.1% ointment applied four times daily in children with severe atopic eczema showed no notable adrenal suppression based on plasma and urinary cortisol measurements. 2

Special Populations

Pediatric Use

• Lower potencies and shorter durations should be used in children due to increased skin surface-to-body mass ratio and enhanced absorption risk. 4, 5
• Growth retardation is a potential concern with prolonged use in pediatric patients. 4

Geriatric Patients

• Thin, chronically sun-exposed skin on the forearms of older adults increases adverse effect risk, supporting the use of low- to medium-potency agents rather than high-potency steroids. 1

Common Pitfalls to Avoid

• Do not confuse apparent "tachyphylaxis" with true receptor down-regulation—a 12-week study found no evidence of receptor dysfunction with continuous use, and perceived loss of effectiveness is more likely due to poor patient adherence. 4, 1
• Do not use moderate-potency agents when low-potency would suffice for sensitive anatomical sites, as this unnecessarily increases atrophy risk. 1
• Do not use moderate-potency agents when high-potency is needed for thick plaques, as inadequate penetration will result in treatment failure. 1