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.

The Forms Topical Steroids Take

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.

How Topical Steroids Help

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.

Divisions 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).

There's a big difference in strength among topical steroids. Those in Class I are approximately 600 to 1,000 times stronger than those in Class VII. It's important to note that whatever percentage you see on a topical steroid's label is not referring to its strength. For instance, a 0.01 percent Class I steroid is much more potent than a 3 percent Class VII steroid.

Always discuss the risks and benefits of any topical steroid with your doctor before applying the treatment to make sure it's right for your condition.

Why Potency Matters

The appropriate strength for each person and situation depends on many factors. For example, babies absorb topical steroids faster than adults, so they may require a low-potency steroid. Areas of the body where your skin touches other skin (think: armpits, rectal area, etc.), as well as sensitive areas like the skin on your eyelids, tend to absorb topical steroids more rapidly, so those regions of the body also usually require a low-potency steroid. 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.

Keep in mind: The greater the potency of the steroid, in other words, the lower its class number, the more likely it is to cause side effects. 

Some of the more popular steroids in each class are listed below.

Topical Steroid Class I

These topical steroids are considered to have the highest potency:

• Clobetasol propionate 0.05% (Temovate)
• Halbetasol 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)
• Triamcinolone acetonide 0.5% (Kenalog 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)

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 0.01% (Synalar cream, solution, shampoo)
• Hydrocortisone butyrate 0.1% (Locoid cream, lotion, solution)

Topical Steroid Class VII

These topical steroids are considered 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)

Sources:

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.