Basics of Topical Corticosteroids

Topical corticosteroids have been used extensively for over 50 years to treat various inflammatory skin conditions. Without a doubt, they remain one of the most valuable currently available treatments, and if used properly, can control symptoms and restore patients’ quality of life.

The vehicle (type of base in which the medication is contained) and type of corticosteroid influences the strength of the topical medication more than the percentage of medication dissolved in the vehicle. Given the same percentage and type of topical corticosteroid, the following list generally represents the strengths of the medication, from highest to lowest:

  • Ointment (highest)
  • Creams
  • Lotions  (lowest)

 

Ointments are greasy, but have the lowest risk of burning and stinging with application. Solutions, gels and sprays are newer, often more complex formulations, some stronger and some weaker than lotions or creams containing the same medication.

Topical corticosteroids come in various strengths, ranging from “super potent” (Class I) to weaker, “least potent” (Class 7). The chart to the right lists some brand-name choices. Many topical steroids have generic versions. While often more expensive, your doctor may prescribe a branded product if they want you to receive the corticosteroid in a particular formulation for a variety of reasons. You should discuss with your doctor if a generic formulation may be available and would be right for you. The list is not comprehensive, and the strength class listing may vary for some products based on the different tests used to define this.

The majority of topical corticosteroid products have been approved by the Federal Drug Administration (FDA) for adults only because studies are always performed in adults first, and performing studies in children is more challenging.

Topical corticosteroids, like many other medications, are often used for indications and ages that have not been specifically studied. This is referred to as “off-label” use.

The following chart lists the topical corticosteroids that have been approved by the FDA for use with children. FDA approval is awarded based on studies with children in a specific range of ages. These medications are commonly used in younger children.

Generic Name
Age Group
Clobetasol propionate 0.05% foam > 12 years
Fluocinonide 0.1% cream > 12 years
Mometasone 0.1% cream/ointment > 2 years
Fluticasone 0.05% lotion/cream > 1 year
Alclometasone 0.05% cream/ointment > 1 year
Prednicarbate 0.1% cream/ointment > 1 year
Fluocinolone acetonide 0.01% in peanut oil > 3 months
Desonide 0.05% hydrogel > 3 months
Hydrocortisone butyrate 0.1% cream > 3 months
Generic Name
Examples of Branded Products
CLASS 1 – SUPER POTENT
0.05% clobetasol propionate Clobex® Lotion/Spray/Shampoo,
Olux®E Foam, Temovate E® Emollient/
Cream/Ointment Gel/Scalp
0.05% halobetasol propionate Ultravate® Cream
0.1%  fluocinonide Vanos® Cream
CLASS 2 – POTENT
0.05% diflorasone diacetate ApexiCon® E Cream
0.05% halobetasol propionate Elocon® Ointment
0.1%  fluocinonide Halog® Ointment
0.25% desoximetasone Topicort® Cream/Ointment
CLASS 3 – UPPER MID-STRENGTH
0.05%  fluocinonide Lidex-E® Cream
0.05%  desoximetasone Topicort® LP Cream
CLASS 4 – MID-STRENGTH
0.1%   clocortolone pivalate Cloderm® Cream
0.1%   mometasone furoate Elocon® Cream
0.1%   triamcinolone acetonide Aristocort® A Cream, Kenalog® Ointment
0.1%   betamethasone valerate Valisone Ointment
0.025% fluocinolone acetonide Synalar® Ointment
CLASS 5 – LOWER MID-STRENGTH
0.1%   clocortolone pivalate Cloderm® Cream
0.1%   mometasone furoate Elocon® Cream
0.1%   triamcinolone acetonide Aristocort® A Cream, Kenalog® Ointment
0.1%   betamethasone valerate Valisone Ointment
0.025% fluocinolone acetonide Synalar® Ointment
CLASS 6 – MILD
0.05% alclometasone dipropionate Aclovate® Cream/Ointment
0.05% desonide

Verdeso™ Foam, Desonate Gel™

0.025% triamcinolone acetonide Aristocort® A Cream, Kenalog® Ointment
0.1%   hydrocortisone butyrate Locoid Cream/Ointment
0.01% fluocinolone acetonide Derma-Smoothe/FS® Oil
CLASS 7 – LEAST POTENT
2%/2.5% hydrocortisone Nutracort® Lotion, Synacort® Cream
0.5- 1% hydrocortisone Cortaid® Cream/Spray/Ointment and
many other over-the-counter products