Very High Potency Topical Corticosteroids

Augemented Betamethasone dipropionate (Diprolene®)

Clobetasol propionate (Clobevate®)

Fluocinonide (Vanos®)

Halobetasol propionate (Ultravate®)

Clinical Pearls:

• Do not DC abruptly (switch to lower potency)
• Do not use >2 wks
• Total dose should not exceed >50 g or 50 mL due to risk of adrenal suppression
• Avoid occlusive dressings
• Avoid use on face, groin, armpits, or skin folds due to striae and atrophy
• Symptoms of adrenal suppression include weakness, weight loss, hypotension, and GI distress

Augmented Betamethasone dipropionate

Diprolene®

Formulations: 0.05% Ointment & Lotion

Dose: Apply 1 to 2 times daily 

Clobetasol propionate

Clobevate®, Clobex®, Cormax®, Embeline®, Embeline® E, Olux®, Temovate®

Formulations: 0.05% Cream, Foam, Gel, Lotion, Ointment, Scalp application, Shampoo, Spray

Dose: Apply daily (shampoo) to twice daily

Clinical Pearls: May cause HPA axis suppression at doses low as 2g daily

Fluocinolide

Vanos®

Formulations: 0.1% cream

Dose: Apply 1 to 2 times daily

Clinical Pearls: Total dose should not exceed 60 grams per week due to risk of adrenal suppression

Halobetasol propionate

Ultravate®

Formulations: 0.05% Cream & Ointment

Dose: Apply 1 to 2 times daily

High Potency Topical Corticosteroids

Amcinonide (Cyclocort®)

Augmented Betamethasone diproprionate (Diprolene® AF)

Betamethasone diproprionate (Dirposone®)

Betamethasone valerate (Beta-Val®)

Desoximetasone (Topicort®)

Diflorasone diacetate (ApexiCon®)

Fluocinonide (Lidex®)

Halocinonide (Halog®)

Triamcinolone acetonide (Kenalog®)

Clinical Pearls:

• Use occlusive dressings with caution
• Avoid use on face or intertriginous areas due to striae

Amcinonide

Cyclocort®

Formulations: 0.1% Cream, Lotion, Ointment

Dose: Apply 2 to 3 times daily

Augmented Betamethasone diproprionate

Diprolene® AF

Formulations: 0.05% Cream

Dose: Apply twice daily

Clinical Pearls: Do not use occlusive dressings

Betamethasone diproprionate

Diprosone®

Formulations: 0.05% Cream & Ointment

Dose: Apply 1 to 2 times daily

Clinical Pearls: Do not use occlusive dressings

Betamethasone valerate

Beta-Val®

Formulations: 0.1% Ointment

Dose: Apply 1 to 3 times daily

Desoximetasone

Topicort®

Formulations: 0.25% Cream & Ointment; 0.05% Gel

Dose: Apply twice daily

Diflorasone diacetate

ApexiCon®, ApexiCon® E

Formulations: 0.05% Emollient Cream, Cream, Ointment

Dose: Cream: Apply 1 to 4 times daily, Emollient/Ointment: Apply 1 to 3 times daily

Fluocinonide

Lidex®, Lidex-E®

Formulations: 0.05% Cream, Cream (Emulsified base), Gel, Ointment, Solution

Dose: Apply 2 to 4 times daily

Halocinonide

Halog®

Formulations: 0.1% Cream & Ointment

Dose: Apply 2 to 3 times daily

Triamcinolone acetonide

Kenalog®

Formulations: 0.5% Cream & Ointment

Dose: Apply 2 to 4 times daily

Medium Potency Topical Corticosteroids

Betamethasone diproprionate (Diprosone®)

Betamethasone valerate (Beta-Val®)

Clocortolone pivalate (Cloderm®)

Desoximetasome (Topicort® LP)

Fluocinolone acetonide (Synalar®)

Flurandrenolide (Cordran®)

Fluticasone proprionate (Cutivate®)

Hydrocortisone butyrate (Locoid®)

Hydrocortisone valerate (Westcort®)

Mometasone furoate (Elocon®)

Predncarbate (Dermatop®)

Triamcinolone acetonide (Kenalog®)

Clinical Pearls:

• Non-fluorinated products should generally be chosen for use on the face, axillae, and groin

Betamethasone diproprionate

Diprosone®

Formulations: 0.05% Lotion

Dose: Apply 2 times daily

Betamethasone valerate

Beta-Val®, Luxiq®

Formulations: 0.1% Cream, Lotion; 0.12% Foam

Dose: Apply 1 to 3 times daily; Luxiq: Apply twice daily

Clocortolone pivalate

Cloderm®

Formulations: 0.1% Cream

Dose: Apply 3 times daily

Desoximetasone

Topicort® LP

Formulations: 0.05% Cream

Dose: Apply 2 times daily

Fluocinolone acetonide

Synalar®

Formulations: 0.025% Cream & Ointment

Dose: Apply 3 to 4 times daily

Flurandrenolide

Cordran®, Cordran® SP

Formulations: 0.05% Cream & Lotion, 4 mcg/cm2 tape

Dose: Cream/Lotion: Apply 2 to 3 times daily; Tape: Apply 1 to 2 times daily

Clinical Pearls: Stripping of the epidermis and purpura has been reported with use of Cordran® tape

Fluticasone proprionate

Cutivate®

Formulations: 0.05% Cream

Dose: Apply 1 to 2 times daily

Hydrocotrisone butyrate

Locoid®, Locoid® Lipocream

Formulations: 0.1% Cream, Ointment, Solution

Dose: Appy 2 to 3 times daily

Hydrocortisone valerate

Westcort®

Formulations: 0.2% Cream & Ointment 

Dose: Apply 2 to 3 times daily

Mometasone furoate

Elocon®

Formulations: 0.1% Cream, Ointment, Lotion, Solution

Dose: Apply 1 time daily

Prednicarbate

Dermatop®

Formulations: 0.1% Cream & Ointment

Dose: Apply 2 times daily

Triamcinolone acetonide

Kenalog®

Formulations: 0.025% Cream, Lotion, Ointment; 0.1% Cream, Lotion, Ointment

Dose: Apply 2 to 4 times daily

Low Potency Topical Corticosteroids

Alclometasone diproprionate (Aclovate®)

Desonide (DesOwen®)

Fluocinolone acetonide (Capex®)

Hydrocortisone (Cortaid®)

Hydrocortisone acetate (Corticaine®)

Clinical Pearls:

• Low potency agents are recommended in children or in patients requiring large areas of the body to be covered
• Low potency steroids should be used on body sites that are most susceptible to steroid damage (ex. face, skin folds)

Alclometasone diproprionate

Aclovate®

Formulations: 0.05% Cream & Ointment

Dose: Apply 2 to 3 times daily

Desonide

DesOwen®, LoKara®, Tridesilon®, Verdeso®

Formulations: 0.05% Cream, Foam, Lotion, Ointment

Dose: Apply 2 to 4 times daily; Foam: Apply 2 times daily; Lotion: Apply 2 to 3 times daily

Fluocinolone acetonide

Capex®, Synalar®

Formulations: 0.01% Cream, Shampoo, Solution

Dose: Shampoo: Apply 1 time daily; Cream/Solution: Apply 3 to 4 times daily

Hydrocortisone

Cortaid®, Cortisone® 5, Corticaine®, Ala-Cort®, Cortizone-10®, Hytone®, Preparation-H®, Anusol-HC®

Formulations: 0.5% Cream & Ointment; 1% Cream, Lotion, Ointment; 2.5% Cream, Lotion, Ointment

Dose: Apply 2 to 4 times daily

Clinical Pearls: Hydrocortisone is available by prescription and OTC. The 2.5% strength is prescription; some 1% formulations are prescription while others are OTC.

Hydrocortisone acetate

Corticaine®, Lanacort® 10, U-cort®

Formulations: 0.5% Cream; 1% Cream & Ointment

Dose: Apply 2 to 4 times daily

Clinical Pearls: Hydrocortisone is available by prescription and OTC. The 2.5% strength is prescriptiom; some 1% formulations are prescription while others are OTC 

Other Topical Therapy

Coal Tar (Scytera®)

Anthralin (Dritho-Scalp®)

Calcipotriene (Dovonex®)

Tazarotene (Tazorac®)

Coal Tar

Scytera®, T/Gel® Shampoo

Anthralin

Calcipotriene

Tazarotene

Systemic Therapy

Methotrexate (Trexall®)

Acitretin (Soriatane®)

Cyclosporine (Neoral®)

Sulfsalazine (Azulfidine®)

Tacolimus (Prograf®)

Alefacept (Amevive®)

Efalizumab (Raptiva®)

Adalimumab (Humira®)

Mycophenolic mofetil (CellCept®)

Hydroxyurea (Hydrea®)

6-thioguanine

Infliximab (Remicade®)

Etanercept (Enbrel®)

Ustekinumab (Stelara®)

Methotrexate

Acitretin

Cyclosporine

Sulfsalazine

Tacrolimus

Alefacept

Efalizumab

Adalimumab

Mycophenolic mofetil

Hydroxyurea

6-thioguanine

Infliximab

Etanercept

Ustekinumab