Skin Health Topical Steroid Strengths The 7 Drug Classifications by Relative Potency By Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Heather L. Brannon, MD Medically reviewed by Medically reviewed by Casey Gallagher, MD on July 19, 2020 Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Review Board Casey Gallagher, MD on July 19, 2020 Print Table of Contents View All Table of Contents Formulations Mechanism of Action Classification by Strength Treatment Considerations Steroid Classes Topical steroids are medical treatments that are applied directly to your skin (as opposed to taking a pill by mouth) to provide relief for a wide variety of dermatological conditions, such as psoriasis, seborrhea, atopic dermatitis, and contact dermatitis. They can be prescribed or purchased over-the-counter, depending on their strength. Robert Brook / Getty Images Formulations Topical steroids are usually applied in a thin layer and massaged into your skin anywhere from one to four times a day. They can come in different forms including: Creams, the form that's prescribed most often, are a mixture of water and oils and usually contains a preservative. They're especially good for hairy and wet areas and are easily applied without a greasy feel.Ointments are made of oils and little to no water and don't usually contain a preservative. They're great for dry, scaly skin or areas with thick skin like the soles of your feet and the palms of your hands.Gels are made with water and propylene glycol and, like creams, they're easy to apply.Solutions, foams, and lotions usually contain oil, water, and other chemicals and are used on your scalp. Mechanism of Action Topical steroids help by reducing inflammation in your skin. For example, if you have eczema and you experience a flare-up, you can apply a cream that decreases your skin irritation and makes your skin feel less itchy. This treatment helps you stop scratching the area and allows your skin to heal. Classification by Strength Topical steroids are divided into seven classes based on how strong they are. The strongest steroids are in Class I and the weakest steroids are in Class VII. The strength of a topical steroid is determined by a standardized test that measures the extent to which it can cause your blood vessels to constrict in the upper dermis (the layer of skin that's just below the outer epidermis). Comparatively speaking, Class I topical steroids are between 600 and 1,000 times stronger than those in Class VII. It is important to note that the percentages listed on a product label do not reflect the product's strength. For instance, a 0.01 percent Class I topical steroid is far more potent than a 3 percent Class VII steroid. To this end, it is important to always speak with your doctor about the risks and benefits of using a topical steroid and to fully understand how to use the drug properly. Treatment Considerations The appropriate steroid strength depends on a variety of factors. For example, babies absorb topical steroids much faster than adults, so they may require a low-potency steroid. Areas of the body where skin touches skin (such as the armpits or under the breasts) or sensitive areas of skin such as the eyelids, also absorb topical steroids quickly and may only need a low-potency formulation. However, thick, rough skin on the palms of your hands and the soles of your feet usually absorb topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid. Consideration also needs to be made as to the risks a topical steroid may pose to a user. This would dictate how long the drug should be used and under what conditions. Common side effects of topical steroid use include skin thinning (atrophy), easy bruising, enlarged blood vessels (telangiectasis), localized thickening of hair (hypertrichosis), and stretch marks in the armpits or groin. Steroid Classes Keep in mind that the greater the potency of a topical steroid, the greater the risk of side effects. Topical Steroid Class I These topical steroids are considered to have the highest potency: Clobetasol propionate 0.05% (Temovate)Halobetasol propionate 0.05% (Ultravate cream, ointment, lotion)Diflorasone diacetate 0.05% (Psorcon ointment)Betamethasone dipropionate 0.25% (Diprolene ointment, gel) Topical Steroid Class II These topical steroids are considered highly potent: Fluocinonide 0.05% (Lidex cream, gel, ointment, solution)Halcinonide 0.1% (Halog cream, ointment, solution)Amcinonide 0.1% (Cyclocort ointment)Desoximetasone 0.25% (Topicort cream, ointment) Topical Steroid Class III These topical steroids are considered potent: Amcinonide 0.1% (Cyclocort cream, lotion)Mometasone furoate 0.1% (Elocon ointment)Fluticasone propionate 0.005% (Cutivate ointment)Betamethasone dipropionate 0.05% (Betanate cream)Triamcinolone acetonide 0.5% (Kenalog cream, ointment) Topical Steroid Class IV These topical steroids are considered moderately potent: Fluocinolone acetonide 0.025% (Synalar cream, ointment)Flurandrenolide 0.05% (Cordran cream, ointment, lotion)Triamcinolone acetonide 0.1% (Triderm cream, ointment, lotion)Mometasone furoate 0.1% (Elocon cream, lotion, solution)Fluticasone propionate 0.05% (Cutivate cream) Topical Steroid Class V These topical steroids are considered somewhat potent: Hydrocortisone valerate 0.2% (Westcort cream, ointment)Hydrocortisone butyrate 0.1% (Locoid ointment)Prednicarbate 0.1% (Dermatop cream, ointment)Hydrocortisone probutate 0.1% (Pandel cream) Topical Steroid Class VI These topical steroids are considered mild: Desonide 0.05% (LoKara lotion, Desonate gel, Desowen cream, ointment)Fluocinolone acetonide 0.025% (Synalar cream, solution, shampoo)Hydrocortisone butyrate 0.1% (Locoid cream, lotion, solution) Topical Steroid Class VII These topical steroids are considered the least potent: Hydrocortisone 2.5% (Hytone cream/lotion)Hydrocortisone 1% (Many over-the-counter brands of creams, ointments, lotions)Hydrocortisone acetate 0.5% and 1% (Anusol-HC, Proctocream-HC, Proctosol HC cream) Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Siegfried EC, Hebert AA. Diagnosis of Atopic Dermatitis: Mimics, Overlaps, and Complications. J Clin Med. 2015;4(5):884-917. doi:10.3390/jcm4050884 Gabros S, Zito PM. Topical Corticosteroids. StatPearls Publishing. Updated January 10, 2019. Uva L, Miguel D, Pinheiro C, et al. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. 2012;2012:561018. doi:10.1155/2012/561018 Humbert P, Guichard A. The topical corticosteroid classification called into question: towards a new approach. Exp Dermatol. 2015;24(5):393-5. doi:10.1111/exd.12677 Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-25. doi:10.4103/2229-5178.142483 Rathi SK, D'souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. 2012;57(4):251-9. doi:10.4103/0019-5154.97655 Additional Reading Gadbois N, Arensman K. Topical Corticosteroids. Pharmacy Times. Published September 2, 2017. Kwatra G, Mukhopadhyay S. Topical Corticosteroids: Pharmacology. In: A Treatise on Topical Corticosteroids Dermatology: Use, Misuse and Abuse. January 2018:11-22. doi:10.1007/978-981-10-4609-4_2.