Ten Things You Must Know About Topical Corticosteroids

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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If ever you should be angry at the cost of a medication, here it is. Many itchy rashes and chronic skin conditions like eczema and psoriasis are treated with a topical corticosteroid. These are a huge money making business and they will put a dent in your pocketbook.

Here is what do you need to know, and how can you save money on your topical steroid.

1. It’s about the skin: Skin disorders are the number one reason folks in the U.S. visit the doctor. Surprising isn’t it?

2. Why such a rip off? Generic topical steroids have risen in price over the past few years. This is because three companies, which were recently acquired by Sandoz, make most generic creams and ointments in the U.S. They can set the market price. Not fair, right?

3. Strength: There are low, medium and high potency steroids and your doctor will make a decision about which one you need based on you have going on.

4. The form matters: The base, whether a cream, gel or ointment determines the rate at which the active ingredient is absorbed through the skin. The same exact medication will be stronger in an ointment than a cream. Know this.

5. Creams are the base most often prescribed because they may be used in nearly any area.

6. Creases: Creams are white and somewhat greasy, they are good for creases (groin, rectal area and under arms), and have a DRYING effect, which is good if you have a wet oozing rash.

7. Ointments are greasy with little or no water so they are best for lubrication. Ointments are good for drier skin rashes and most importantly have GREATER penetration of medicine than creams and therefore are MORE potent (stronger).

8. Gels contain water and alcohol so they have a drying effect. They are good for wet, oozing rashes like poison oak or ivy.

9. Saving Dough: Common topical steroids like fluocinolone and triamcinolone have differences in price between creams and ointments. You can’t just switch, because one is stronger than the other, but make sure your doctor knows why they want you to have an ointment or cream, for example.

10. Size matters: The larger sizes (30-gram or 60-gram tubes) are often the best buy. If you have a chronic skin issue like eczema, psoriasis, or seborrheic dermatitis, ask about having the larger size prescribed. For example, the 80-gram tube of triamcinolone is quite cheap and will save you over the smaller tubes.

Lather up.

Dr. O.

Other generic topical corticosteroids with price differences between forms (cream, ointment, gel) include amcinonide, betamethasone dipropionate, clobetasol, desoximetasone, diflorasone, fluocinonide, mometasone, and nystatin/triamcinolone

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