Topical Steroid Strengths

Find out more about the seven different strength categories.

Hydrocortisone ointment
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Topical steroids are medical treatments that are applied directly to the 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.

The Forms They Take

Topical steroids can come in different forms, including ointments, creams, gels, lotions, solutions, sprays, and powders. A steroid cream (the form that is prescribed most often) is a mixture of water and oils and usually contains a preservative.

A steroid ointment is made of oils and little to no water, and it does not usually contain a preservative. A steroid gel is made with water and propylene glycol. A steroid solution or lotion contains alcohol, water, and other chemicals. Topical steroids tend to be applied in a thin layer and massaged into the skin anywhere from one to four times a day.

How They Help

Topical steroids help by reducing inflammation in the skin. For example, if a person who has eczema experiences a flare-up, he or she may apply a cream that decreases skin irritation and makes the skin feel less itchy. This treatment helps the person stop scratching the area and allows the 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 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. The ointments tend to be the most powerful. 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% Class I steroid is much more potent than a 3% Class VII steroid.

Why Potency Matters

Why are different strengths critical? Babies absorb topical steroids faster than adults, so they may require a low-potency steroid. Areas of the body where skin touches skin (think: armpits, rectal area, etc), as well as sensitive areas (like the skin on the eyelids) tend to absorb topical steroids more rapidly, so those regions of the body usually require a low-potency steroid, too. However, thick, rough skin on the palms of the hands and the soles of the 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

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

Topical Steroid Class I

  • Clobetasol diproprionate 0.05% (Temovate)
  • Betamethasone diproprionate 0.25% (Diprolene)
  • Halbetasol proprionate 0.05% (Ultravate)
  • Diflorasone diacetate 0.05% (Psorcon)

Topical Steroid Class II

  • Fluocinonide 0.05% (Lidex)
  • Halcinonide 0.05% (Halog)
  • Amcinonide 0.05% (Cyclocort)
  • Desoximetasone 0.25% (Topicort)

Topical Steroid Class III

  • Triamcinalone acetonide 0.5% (Kenalog, Aristocort cream)
  • Mometasone furoate 0.1% (Elocon ointment)
  • Fluticasone proprionate 0.005% (Cutivate)
  • Betamethasone diproprionate 0.05% (Diprosone)

Topical Steroid Class IV

  • Fluocinolone acetonide 0.01-0.2% (Synalar, Synemol, Fluonid)
  • Hydrocortisone valerate 0.2% (Westcort)
  • Hydrocortisone butyrate 0.1% (Locoid)
  • Flurandrenolide 0.05% (Cordran)
  • Triamcinalone acetonide 0.1% (Kenalog, Aristocort A ointment)
  • Mometasone furoate 0.1% (Elocon cream, lotion)

Topical Steroid Class V

  • Triamcinalone acetonide 0.1% (Kenalog, Aristocort cream, lotion)
  • Fluticasone propionate 0.05% (Cutivate cream)
  • Desonide 0.05% (Tridesilon, DesOwen ointment)
  • Fluocinolone acetonide 0.025% (Synalar, Synemol cream)
  • Hydrocortisone valerate 0.2% (Westcort cream)

Topical Steroid Class VI

  • Prednicarbate 0.05% (Aclovate cream, ointment)
  • Triamcinalone acetonide 0.025% (Aristocort A cream, Kenalog lotion)
  • Fluocinolone acetonide 0.01% (Capex shampoo, Dermasmooth)
  • Desonide 0.05% (DesOwen cream, lotion)

Topical Steroid Class VII

  • Hydrocortisone 2.5% (Hytone cream, lotion, ointment)
  • Hydrocortisone 1% (Many over-the-counter brands)

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