Sunday, April 10, 2011

Topical Corticosteroid Potency Chart

Not all topical corticosteroids are created equally!
I saw a patient 2 days ago, with poorly-controlled allergic eczema, who commented the "creams were all the same.  None of them work!"  Hence my reply above.  After we determined which topical steroids she had used, I noted that she used products in the classes of 5, 6, and 7 - the lower end of potency.  To get relief, I stressed: general skin care (no tanning!, less soaps, more unscented oil-based lotions), avoiding irritants (perfumes, no scratching), routine use of a stronger topical steroid (class 4) + antihistamines to reduce itching.  I think this will help her.
Here is a good chart of many topical corticosteroids currently available.  Note: the greater the oil content, the greater the potency usually.  Watch the concentration (%) carefully also.  The exact rules are more complex and will be discussed in a later blog entry by The Allergy Dude.

Addendum: (4/23/11).  The Allergy Dude apologizes, but he tried for 3 hours yesterday night to make the best chart of topical steroids available on the entire internet.  However, the ghosts in the machine kept messing up the chart and have won.  So I would like to make some points.
1.  Lotions contain alcohol and are drying.  Creams are a mixture of water and oil and the most preferred.  Ointments are oil-based.  Potency increases as more oil is used, because the oil helps the medicine penetrate into the deeper skin where it has more effect.
2.  Foam, mousse, and shampoos are usually used on the scalp.
3.  Solutions and gels are like lotions.
4.  The table above is not complete.  There are other steroids that are: available in outside of the U.S. or simply not listed.
5.  Class 1 are up to 600x more potent than Class 7.
6.  After much digging, the FDA has defined topical dosage forms.

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