Key takeaways:
With several levels of potency and various formulations, the options of topical corticosteroids at the point of prescribing are many.
Best practices for prescribing topical steroids can help maximize effectiveness while minimizing side effects. It’s important to consider potency level, formulation, and body site when prescribing.
Due to local and systemic side effects of topical steroids, consider newer nonsteroidal options, such as Zoryve (roflumilast) or Opzelura (ruxolitinib), for patients with chronic skin conditions.
Topical corticosteroids are useful treatment options for many skin-related health conditions. Several options exist, in terms of strength and formulations, and many clinicians have go-to over-the-counter and prescription favorites. But for those who don’t commonly prescribe topical steroids, it can be hard to remember what’s what.
Here, we’ll run through different forms of topical steroids, provide a convenient strength chart, and discuss some best practices.
Topical corticosteroid potency chart
There are seven classes of topical corticosteroid potency, ranked from highest to lowest strength.
| Class (Potency) | Medication name | Available forms |
|---|---|---|
| Class 1 (Super potent) |
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 | |
| Class 2 (High) |
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 | |
| Class 3 (Medium-to-high) |
Amcinonide 0.1% | Cream, lotion |
| Betamethasone dipropionate 0.05% | Cream | |
| Fluticasone propionate 0.005% | Ointment | |
| Triamcinolone acetonide 0.5% | Cream, ointment | |
| Class 4 and 5 (Medium) |
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 | |
| Class 6 (Low) |
Alclometasone dipropionate 0.05% | Cream, ointment |
| Desonide 0.05% | Cream, foam, gel, lotion, ointment | |
| Fluocinolone acetonide 0.01% | Cream | |
| Hydrocortisone butyrate 0.1% | Cream | |
| Class 7 (Least potent) |
Hydrocortisone 0.5% and 1% — available OTC Hydrocortisone 2.5% — prescription only |
Cream, lotion, ointment |
Practical tips for patients using topical steroids
There are no universal guidelines for topical steroid use, but these best practices can help maximize effectiveness while minimizing side effects for your patients:
Match potency to body site and severity. Use low potency on sensitive areas, such as the face, genitals, and skin folds. Higher potency steroids are generally better for thicker skin (such as the palms and soles of feet) and more severe flares.
Once daily may be enough. For stronger steroids, applying them once daily may work just as well as twice daily.
Give clear instructions. Tell patients exactly where to apply the medication, how often to use it, and how long to continue treatment.
Use steroid-sparing agents. Nonsteroidal topical medications can be used as adjuncts or alternatives for many common skin conditions (more on this below).
Encourage regular moisturization. For atopic dermatitis and similar conditions, good moisturizers are a key part of treatment and should be used at least daily.
Different steroid forms
Many steroids come in semi-solid and liquid forms. Each one can be useful, depending on which area of the body is being treated, and for which condition.
Ointments
Ointments are the thickest formulation. They create a barrier on the skin to lock in moisture, which makes them an excellent choice for very dry skin. Ointments also enhance drug penetration, so they are generally more potent than creams or lotions of the same strength.
Drawbacks: Ointments have a thick, greasy consistency that can be uncomfortable, and some patients find them hard to tolerate for regular use. They can stain fabrics and other materials, and they’re harder to wash off.
Creams
Creams are smoother and less greasy. They spread easily, absorb quickly, and are suitable for most body areas. They’re one of the most commonly used vehicles for topical steroids.
Drawbacks: Creams can include preservatives or other ingredients that can cause skin reactions. It’s important to review both the active and inactive ingredients when choosing a topical steroid cream.
Lotions
Lotions are usually at least 50% water. They have a thinner consistency than creams, which makes it easy to spread them over large areas. Lotions are also good for hairy areas because they won’t cause clumping.
Drawbacks: Because lotions are lightweight, they may not provide hydration for as long as ointments or creams.
Gels
Gels are easier to apply and wash off when needed, and they don’t leave a greasy residue. They also work well for hair-bearing areas, like the scalp or beard.
Drawbacks: Gels may contain alcohol, which can sting or irritate inflamed skin. Gels are not occlusive and provide little to no hydration.
Side effects of topical steroids
Topical steroids are generally thought of as safe in short courses, but they are associated with many local and systemic adverse events. These are more likely the greater the steroid potency, amount, duration, and frequency of use.
Possible local side effects of topical steroids include:
Skin atrophy
Striae
Telangiectasias
Perioral dermatitis
Acne
Rosacea
Contact dermatitis
Poor wound healing
Possible systemic effects of topical steroids include:
Disruption of various hormonal loops
Ophthalmic effects
Negative effects on bone density
Hyperglycemia
Due to secondary effects of systemic absorption, an expert consensus panel recently issued a “strong call to action for clinicians” to consider newer, nonsteroidal therapies for patients with chronic inflammatory skin conditions. Examples of nonsteroidal alternatives include:
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 $12 with a free GoodRx discount.
The bottom line
Topical corticosteroids come in a variety of potencies and forms, which can make it hard to narrow it down when it comes to prescribing. Due to potential local and systemic side effects, it’s best to minimize length of exposure when possible and use newer nonsteroidal alternatives. Patients for whom cost is an issue can use a free GoodRx coupon to save on their prescription.
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References
Barnes, T. M., et al. (2021). Vehicles for drug delivery and cosmetic moisturizers: Review and comparison. Pharmaceutics.
Burshtein, J., et al. (2025). Risks of topical corticosteroid therapy and role for advanced targeted topical treatments for inflammatory skin diseases: An expert consensus panel. Dermatology Online Journal.
DiRuggiero, D., et al. (2025). Beyond skin deep: The systemic impact of topical corticosteroids in dermatology Journal of Clinical Aesthetic Dermatology.
Gabros, S., et al. (2023). Topical corticosteroids. StatPearls.
Moncayo-Hida, J. (2024). A look at current guidelines for topical steroid use for atopic dermatitis. National Eczema Association.
Sidbury, R., et al. (2023). Guidelines of care for the management of atopic dermatitis in adults with topical therapies. Journal of the American Academy of Dermatology.
Stacy, S. K., et al. (2021). Topical corticosteroids: Choice and application. American Family Physician.
Yilong Tan, S., et al. (2021). Steroid phobia: Is there a basis? A review of topical steroid safety, addiction and withdrawal. Clinical Drug Investigation.
