What Does Topical Steroid (Corticosteroid) Potency Mean?
Key takeaways:
Topical corticosteroid (steroid) medications can treat a variety of inflammatory skin conditions, such as eczema, psoriasis, and vitiligo.
Topical corticosteroids come in a variety of potencies (strengths), ranging from low to high. High potency steroids, such as fluocinonide, are used for more severe skin conditions. Lower potency steroids, such as hydrocortisone, are used for mild skin conditions.
People usually don't experience many side effects with topical steroids, but they’re more likely to happen with incorrect or prolonged use.
Table of contents
Topical corticosteroids (steroids) are useful treatment options for many skin-related health conditions. Some of them are found over-the-counter (OTC) at your local pharmacy. Many others can be prescribed by your healthcare provider.
But there’s not a one-size-fits-all approach for these medications. Each topical corticosteroid is unique, coming in many different strengths and preparations. So if you or a loved one need to use a topical steroid for a period of time, it’s normal to have questions about what your best options are.
Here, we’ll run through what topical steroids are, what they’re used to treat, and how they’re grouped based on their potency (strength).
Topical steroid potency chart
Topical steroids are available in many preparations. The potency, or strength, of a topical steroid is the amount of medication needed to produce a desired health benefit.
Since there’s so many topical steroids available, there’s a potency grouping system in place that helps healthcare providers decide which medication would be best to relieve your symptoms. There are seven groups of topical corticosteroid potency, ranked from highest to lowest strength.
| Potency strength (class) | Medication name | Dosage forms |
|---|---|---|
| Super potent (Class 1) | Clobetasol propionate 0.05% | Cream, foam, gel, lotion, ointment, shampoo |
| Augmented betamethasone dipropionate 0.05% | Gel, ointment | |
| Diflorasone diacetate 0.05% | Ointment | |
| Fluocinonide 0.1% | Cream | |
| Halobetasol propionate 0.05% | Cream, ointment | |
| High (Class 2) | Amcinonide 0.1% | Ointment |
| Augmented betamethasone dipropionate 0.05% | Cream, lotion | |
| Betamethasone dipropionate 0.05% | Ointment | |
| Desoximetasone | Cream or ointment (0.25%), gel (0.05%) | |
| Diflorasone diacetate 0.05% | Cream | |
| Fluocinonide 0.05% | Cream, gel, ointment | |
| Halcinonide 0.1% | Cream, ointment, solution | |
| Medium (Class 3, 4, or 5) | Amcinonide 0.1% | Cream, lotion |
| Betamethasone dipropionate 0.05% | Cream | |
| Fluticasone propionate 0.005% | Ointment | |
| Triamcinolone acetonide 0.5% | Cream, ointment | |
| Betamethasone valerate 0.1% | Cream, foam, lotion | |
| Desoximetasone 0.05% | Cream | |
| Fluocinolone acetonide 0.025% | Cream, ointment | |
| Fluticasone propionate 0.05% | Cream | |
| Hydrocortisone butyrate 0.1% | Ointment | |
| Hydrocortisone probutate 0.1% | Cream | |
| Hydrocortisone valerate 0.2% | Cream, ointment | |
| Mometasone furoate 0.1% | Cream, lotion, ointment | |
| Triamcinolone acetonide 0.025% or 0.1% | Cream, lotion, ointment | |
| Low (Class 6) | Alclometasone dipropionate 0.05% | Cream, ointment |
| Desonide 0.05% | Cream, foam, gel, lotion, ointment | |
| Fluocinolone acetonide 0.01% | Cream | |
| Hydrocortisone butyrate 0.1% | Cream | |
| Least potent (Class 7) | Hydrocortisone 0.5% and 1% — available OTC Hydrocortisone 2.5% — prescription only |
Cream, lotion, ointment |
For a frame of reference for what these categories mean, it’s helpful to keep in mind that the most potent topical steroids are about 600 to 1,000 times stronger than the least potent topical steroids.
What are topical steroids used to treat?
Topical steroids have many uses. But they’re usually used to treat skin conditions related to excessive inflammation. They can calm down rashes, scaly patches of skin, and itching.
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Depending on the skin condition, a certain level of potency may be needed. Here are common steroid potency levels used to treat certain skin conditions.
Potency | Skin condition |
Class 1 to 3 (High to medium strength) | • Alopecia |
Class 4 to 5 (Medium strength) | • Acute radiation dermatitis (skin inflammation after exposure to radiation) |
Class 6 to 7 (Low strength) | • Dermatitis (diaper rash, eyelids, face) |
Keep in mind: Your healthcare provider will evaluate your condition to find the best topical steroid for you. Choosing the right topical steroid will depend on factors such as your age, severity of your condition, and location on the body.
Why are there different steroid potencies and forms?
Different steroid potencies exist because some preparations are more useful in certain situations.
Differences between ointments, creams, and lotions
A topical steroid’s potency can be influenced by how it’s prepared — meaning what form the medication takes. Top options include ointments, creams, and lotions. Gels are also relatively common. The choice between dosage forms depends on your skin condition, skin type, and your personal preferences.
Ointments: Ointments are the thickest dosage forms. They create a barrier on the skin to lock in moisture, which makes them an excellent choice for very dry skin. And in general, steroid ointments are more potent than creams and lotions. Ointments, however, are the slowest to absorb. They often leave a heavy or greasy feeling that some people find uncomfortable. They also can rub off and stain your fabrics.
Creams: Creams have a smoother, less greasy texture. They’re easier to spread on your skin and absorb quickly. Creams work well as a daily moisturizer to keep your skin hydrated. On the other hand, creams often include preservatives which can cause skin reactions. It’s important to review both the active and inactive ingredients when choosing a topical steroid.
Lotions: Lotions have the thinnest texture. They have a liquid-like consistency which makes it easy to spread over large areas. Because lotions are lightweight, they may not provide hydration that is as long-lasting as ointments or creams. Lotions are also best for hairy areas because they won’t cause clumping.
Low vs. high potency topical steroids
Low potency steroids are the safest to use if you need to apply a topical steroid for a longer period of time or on large surface areas of your body. They’re also preferred in areas where the skin is thinner, like on your face.
More potent topical steroids are beneficial for more serious skin conditions and thicker areas of skin. If possible, you shouldn’t use high- and ultra-high potency steroids on the face, groin, or armpit. The skin is more thin in these areas.
Side effects of topical steroids
Topical steroids are generally safe. Most people don’t experience side effects from them. But if your topical steroid is too potent, there’s a higher chance of experiencing side effects.
Common side effects of topical steroids include:
Skin thinning
Rosacea (reddening skin)
Rashes around the mouth
Purplish spots or patches on the skin
Unlike oral steroids, topical steroids generally only work where you apply them on your skin. But some of the medication may still absorb through your skin and into your body. In these cases, side effects may affect other areas of your body. Although very rare, topical steroids have the potential to cause systemic side effects such as blood glucose (sugar) changes and weaker bones.
Side effects like these are also more likely to happen if you use a topical steroid for a long time. When possible, you shouldn’t use topical steroids of any potency for longer than 2 to 4 weeks. However, you may use them for longer than this if your healthcare provider has given you the go-ahead. They may just recommend eventually tapering off the medication to avoid topical steroid withdrawal.
Should you switch to a stronger or lower potency topical steroid?
You may need to switch to a more potent topical steroid — or a different treatment altogether — if your skin doesn’t show signs of improvement after applying your topical steroid for a recommended period of time.
And if you start to experience side effects from topical steroids, such as those listed above, you may need to switch to a less potent topical steroid or stop applying it altogether. You should speak with your healthcare provider if this occurs.
How to save on topical corticosteroids
There are many ways to save on topical corticosteroids. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs. You can find topical corticosteroid prices as low as $7 with a free GoodRx discount.
The bottom line
Topical corticosteroids (steroids) are medications that are applied directly to your skin. They treat a variety of skin conditions, such as psoriasis and eczema. They come in a variety of potencies, which refers to how strong or effective they are in treating a particular skin condition. The choice of potency depends on factors such as your skin condition, location on your body, and age. Speak with your healthcare provider to learn more about topical steroid potency.
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References
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Eichenfield, L. F., et al. (2014). Guidelines of care for the management of atopic dermatitis: Part 2: Management and treatment of atopic dermatitis with topical therapies. Journal of the American Academy of Dermatology.
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