Appendix B: Use of Topical and Intralesional Corticosteroids

Class 1—Superpotent

Betamethasone dipropionate^*

Diprolene ointment 0.05 percent

Diflorasone diacetate^**

Psorcon ointment, 0.05 percent

Clobetasol propionate

Temovate cream, gel, ointment, shampoo, spray, or foam, 0.05 percent; also as Cormax, Clobex, Clarelux, Olux

Halobetasol propionate^*

Ultravate cream/ointment, 0.05 percent

Class 2—Potent

Amcinonide

Cyclocort cream/ointment/lotion, 0.1 percent

Betamethasone dipropionate

Diprosone ointment, 0.05 percent

Desoximetasone

Topicort cream 0.25 percent, gel 0.05 percent, and ointment 0.25 percent

Diflorasone diacetate^**

Psorcon, ApexiCon ointment 0.05 percent

Fluocinonide

Lidex, Lidemol, Lyderm, Tiamol, Topactin, Topsyn, Vanos cream 0.05 percent, 0.1 percent/ointment/gel, 0.05 percent

Halcinonide

Halog cream/ointment/topical solution, 0.1 percent

Class 3—Upper mid-strength

Betamethasone valerate^*

Diprolene, Luxiq, Dermabet, Alphatrex, Diprolene AF, Diprolene Glycol, Diprosone, Valnac, BetaVal cream/lotion 0.05 percent or 0.1 percent, foam 0.12 percent

Diflorasone diacetate^**

Psorcon, ApexiCon, ApexiCon E cream 0.05 percent

Mometasone furoate

Elocon cream/lotion/ointment, 0.1 percent

Triamcinolone acetonide

Kenalog topical, Pediaderm, Triacet, Trianex cream, 0.5 percent

Class 4—Mid-strength

Desoximetasone

Topicort LP cream, 0.05 percent

Fluocinolone acetonide

Synalar-HP cream, 0.2 percent; Synalar ointment, 0.025 percent

Flurandrenolide

Cordran ointment, 0.05 percent

Triamcinolone acetonide

Aristocort, Kenalog ointments, 0.1 percent

Class 5—Lower mid-strength

Betamethasone dipropionate

Diprosone lotion, 0.05 percent

Betamethasone valerate

Valisone cream, 0.1 percent; Betatrex 0.1 percent

Fluocinolone acetonide

Synalar cream, 0.025 percent

Flurandrenolide

Cordran cream, 0.05 percent

Hydrocortisone butyrate

Locoid cream, 0.1 percent

Hydrocortisone valerate

Westcort cream, 0.2 percent

Prednicarbate

Dermatop cream/ointment, 0.1 percent

Triamcinolone acetonide

Kenalog cream/lotion, 0.1 percent

Class 6—Mild

Alclometasone dipropionate

Aclovate cream/ointment, 0.05 percent

Triamcinolone acetonide

Aristocort cream, 0.1 percent

Desonide

Desonate, DesOwen, Tridesilon, Verdeso cream/lotion/ointment 0.05 percent, foam 0.05 percent, gel, 0.05 percent, 0.05 percent

Fluocinolone acetonide

Synalar cream/solution, 0.01 percent; Capex shampoo, Dermasmooth, 0.01 percent

Betamethasone valerate

Valisone lotion, 0.1 percent

Class 7—Least potent

Hydrocortisone

Hyton, Cortate, Unicort, other OTC cream/lotion/foam

Skin atrophy

Most common adverse effect

Epidermal thinning may begin after only a few days

Dermal thinning usually takes several weeks to develop

Usually reversible within 2 months after stopping the corticosteroid

Telangiectasia

Most often occurs on the face, neck, and upper chest

Tends to decrease when steroid discontinued, but may be irreversible

Striae

Usually occur around flexures (groin, axillary, and inner thigh areas)

Usually permanent, but may fade with time

Purpura

Frequently occurs after minimal trauma

Attributed to loss of perivascular supporting tissue in the dermis

Hypopigmentation

Reversible upon discontinuing the corticosteroid

Acneform eruptions

Particularly common on the face, especially with the “potent” and “very potent” corticosteroids

Usually reversible

Fine hair growth

Reversible upon discontinuation of the corticosteroid

Infections

May worsen viral, bacterial, or fungal skin infections

May cause tinea incognito

Hypothalamic-pituitary-adrenal axis suppression

Rare with topicals

>30 g/wk of “very potent” ...