Topical Steroids (Steroid Creams and Ointments) - a basic guide

imageSteroid creams or ointments, also called topical steroids, are frequently used to treat all types of skin inflammation in both children and adults. The most common conditions treated with steroid creams by allergists include eczema or atopic dermatitis, and contact dermatitis.

Topical steroids are most commonly prescribed in several forms including creams, ointments, and lotions. Steroid creams are the most commonly prescribed for most skin inflammation, but ointments are substituted when the skin requires additional moisture and better penetration of the steroid into the skin. Lotions are typically thinner and are used to cover more extensive areas of the body and hairy areas.

It is important to understand a general approach to the use of topical steroids. The first principle to understand is that not all steroid creams are equal. In fact, they vary widely in their potency, but their labeling can be quite misleading. For example, Diprolene® 0.05% is much, much more potent than Hytone® 2.5%, even though one would think that a 2.5% cream would be stronger than a 0.05% cream. As can be seen by the list below, many topical steroids are available in a wide variety of different strengths and potencies.  Your physician will prescribe the appropriate potency of cream or ointment based on the degree of inflammation, whether it is acute or chronic, the location on the body of the rash, and the extent of the skin area that needs to be treated.

In general, one should use the least potent steroid cream necessary to reduce and control the skin inflammation. If the area to be treated is highly inflamed, a potent steroid cream is usually prescribed initially to accelerate the healing process. High potency steroids are to be avoided on the face and genital areas where the skin is particularly thin. High potency steroid creams should be used for only a few days, maximally a week or two. Once the inflammation shows significant improvement, physicians will commonly transition to one of the weaker topical steroids which can be used for control on a more long term bases. The more high potency creams and ointments are generally applied only once or twice a day, while the weaker creams such as hydrocortisone cream 1%, which can be bought without a prescription, can be applied four times a day.

Steroid creams and ointments should be applied thinly and sparingly, but the area to be treated should be coated completely. If the lesion to be treated is highly inflamed or is oozing or weeping, then covering with a bandage may increase the penetration of the medication and augment healing.

Topical steroids are generally very safe for repeated and long-term use. But, it is important to remember that depending on the potency of the cream, the extent of skin area treated, and the duration of treatment, the steroid can be absorbed in significant amounts to cause local or systemic steroid side effects. Local effects include thinning of the skin, local changes in pigmentation, or the development of telangectasias, or tiny blood vessels visible in the skin. It is therefore critical that these medications be used under the guidance of a physician experienced in the use of these medications.

TOPICAL STEROIDS (list is not inclusive)

Super-high Potency

Betamethasone Dipropionate Gel & Ointment USP (Augmented 0.05%) - Diprolene®
Clobetasol Propionate Cream, Ointment, Solution, Emollient & Gel USP 0.05% - Temovate®
Diflorasone Diacetate Ointment USP 0.05% - Psorcon®
Halobetasol Propionate Cream/Ointment 0.05% - Ultravate®

High Potency

Betamethasone Dipropionate Ointment USP 0.1% - Diprosone®
Desoximetasone Cream & Ointment USP 0.25%, Gel 0.05% - Topicort®
Amcinonide Cream and Ointment USP 0.1% - Cyclocort®
Diflorasone Diacetate Cream & Ointment USP 0.05% - Florone®
Fluocinonide Cream, Ointment, Gel & Solution USP 0.05% - Lidex®
Halcinonide Cream 0.1% - Halog®

Medium Potency III

Betamethasone Valerate Ointment USP 0.01% - Valisone®
Diflorasone Diacetate Cream USP 0.05% - Florone®, Maxiflor®
Mometasone Furoate Ointment USP 0.1% - Elocon®
Amcinonide Lotion 0.1% - Cyclocort®

Medium Potency IV

Fluocinolone Acetonide Cream USP 0.2% - Synalar® HP
Fluocinolone Acetonide Ointment USP 0.025% - Synalar®
Desoximetasone Cream USP 0.05% - Topicort® LP
Flurandrenolide Ointment USP 0.05% - Cordran®
Triamcinolone Acetonide Ointment USP 0.1% - Aristocort®, Kenalog®

Medium Potency V

Betamethasone Dipropionate Lotion USP 0.05% - Diprosone®
Flurandrenolide Cream USP 0.05% - Cordran®
Hydrocortisone Butyrate Cream USP 0.1% - Locoid®
Hydrocortisone Valerate Cream USP 0.2% - Westcort®
Betamethasone Valerate Cream USP 0.1% - Valisone®
Fluocinolone Acetonide Cream USP 0.025% - Synalar®
Prednicarbate Emollient Cream USP 0.1% - Dermatop®
Triamcinolone Acetonide Cream/Lotion USP 0.1% - Kenalog®

Low Potency VI

Alclometasone Dipropionate Cream/Ointment USP 0.05% - Aclovate®
Desonide Lotion USP 0.05% - DesOwen®
Fluocinolone Acetonide Cream & Topical Solution USP 0.01% - Synalar®
Triamcinolone Acetonide Cream USP 0.1%  - Aristocort®
Desonide Cream USP 0.05% - Tridesilon®
Betamethasone Valerate Lotion USP 0.1% - Valisone®

Low Potency III

Hydrocortisone Cream, Ointment & Lotion USP 1% & 2.5% - Cortaid or Hytone®

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