Topical Steroids Potency
LOW STRENGTH:
Alclometasone dipropionate 0.05% (c, o), Clocortolone pivalate 0.1% (c), Fluocinolone acetonide 0.01% solution (s), Hydrocortisone base or acetate 0.25% to 2.5% (o, c), Triamcinolone acetonide 0.025% (c, l, o)
INTERMEDIATE STRENGTH:
Betamethasone dipropionate 0.05% (c), Desonide 0.05% (c, l, o), Desoximetasone 0.05% (c), Fluocinolone acetonide 0.025%, Flurandrenolide 0.025 to 0.5%, Fluticasone propionate 0.005% to 0.05% (o, c), Hydrocortisone butyrate 0.1%, Hydrocortisone valerate 0.2%, Mometasone furoate 0.1%, Triamcinolone acetonide 0.1% to 0.2% (c, o)
HIGH STRENGTH:
Amcinonide 0.1% (c, l, o), Betamethasone dipropionate augmented 0.05% (c, l), Desoximetasone 0.05% (o), Diflorasone diacetate 0.05% (o, c), Fluocinonide 0.05% (c, g, o, s), Halcinonide 0.1% (c, o), Triamcinolone acetonide 0.5% (c, o)
VERY HIGH STRENGTH:
Betamethasone dipropionate 0.05% (o, g), Clobetasol propionate 0.05% (c, g, o), Diflorasone diacetate 0.05% (o), Fluocinonide 0.1% (c), Flurandrenolide 0.05% (l), Halobetasol 0.05% (c, o)
#Topical #Steroids #Potency #Corticosteroids #Classification #dermatology
Topical Corticosteroid Potencies
High Potency:
Betamethasone dipropionate 0.05%
Clobestasol propionate 0.05%
Halobetasol propionate 0.05%
Desoximetasone 0.05%, 0.25%
Fluocinonide 0.05%
Medium Potency:
Betamethasone valerate 0.1%
Triamcinolone acetate 0.1%, 0.5%
Flurandrenolide 0.05%
Fluticasone propionate 0.05%
High Potency:
Desonide 0.05%
Hydrocortisone 0.5-2.5%
Topical Corticosteroids (TCS) are one of the most common dermatologic topical products used. It's important to note that each TCS is categorized into different potencies (strengths). For more severe skin conditions or for thick-skinned areas, you generally want to use a higher potency product. If using high-potency though, we generally do not want to use those for more than 2 weeks at a time to limit side effects. The lowest potency TCS is hydrocortisone, which is why it's available OTC.
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
#Topical #Corticosteroid #Potencies #Potency #Steroid #Pharmacology #Dermatology
Atopic Dermatitis - Topical Treatment Options
First Line: Topical Corticosteroids
- High Potency: Betamethasone dipropionate, clobetasol, halobetasol
- Medium Potency: Triamcinolone, Fluticasone
- Low Potency: Desonide, Hydrocortisone
Topical Calcineurin Inhibitors
- Elidel (pimecrolimus)
- Protopic (tacrolimus)
Phosphodiesterase-4 (PDE4) Inhibitor
- Eucrisa (crisaborol)
Atopic dermatitis is the most common form of eczema. It is a chronic condition in which patients can have times of remission and times of flare-ups. The first line therapy is non-pharmacologic, but many patients require at least the first line pharmacologic option which is topical corticosteroids (TCS). Remember that we have different strengths/potencies of the topical corticosteroids, and that long-term use of the higher potency products is not recommended. If patients using TCS products do not have good enough responses, we can use topical calcineurin inhibitors or the topical PDE4 inhibitor. If all topical products do not work and patient has moderate/severe atopic dermatitis, we can consider the use of the biologic agent Dupixent.
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
#Atopic #Dermatitis #Topical #Treatment #Medications #Pharmacology #Dermatology #Management
Atopic Dermatitis - Topical Treatment Options
First Line: Topical Corticosteroids
- High Potency: Betamethasone dipropionate, clobetasol, halobetasol
- Medium Potency: Triamcinolone, Fluticasone
- Low Potency: Desonide, Hydrocortisone
Topical Calcineurin Inhibitors
- Elidel (pimecrolimus)
- Protopic (tacrolimus)
Phosphodiesterase-4 (PDE4) Inhibitor
- Eucrisa (crisaborol)
Atopic Dermatitis is the most common form of eczema, which affects approximately 20% of children and 3% of adults. After non-pharmacologic options, first-line treatment is topical corticosteroids (TCS). Remember that all TCS are not equal, each has a different level of potency. Aside from TCS, topical calcineurin inhibitors (TCI) are available. Tacrolimus is used in more moderate/severe AD while pimecrolimus is used in mild/moderate AD. Lastly is the newest medication called crisaborole, which is a topical PDE4 inhibitor. You may have seen the commercial for this medication which emphasizes that it can be used on very different skin locations and is "steroid-free" since it's not a TCS.
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Although crisaborole is a PDE4 inhibitor, it is VERY different than roflumilast (see previous post).
Jarred Prudencio, PharmD - https://www.instagram.com/ambcarerx
#Atopic #Dermatitis #Topical #Treatment #Medications #Pharmacology #Dermatology #Management
Table 2: Relative potency of topical corticosteroids*
TC are divided into four groups according to their potency in keeping with the British National Formulary (BNF), while American system classifies them into seven classes, [23] with class I being the super potent or ultra potent and class VII represent the least potent [Table 2]. Although a thorough knowledge of drugs in each class may be ideal, practically a physician should become familiar with one or two agents in each category of potency to safely and effectively treat steroid-responsive skin conditions.
As a general rule, low potency steroids are the safest agents for long-term use, on large surface areas, on the face, or on areas with thinner skin and for children. More potent TC are helpful for severe disease and for thicker skin of palms and soles. High and ultra-high potency steroids should not be used on the face, groin, axillae, and under occlusion; except in rare situations and for short duration.
#Pharm #Derm #Topical #Corticosteroid #Steroids #Potency #Table
