Topical Steroid Strengths

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.

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.

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.

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)