Topical Steroids are classified into 7 classes based on potency. The most potent are in class 1 and the least potent are in class 7. A list of the most commonly prescribed steroids is provided below. A few notes to keep in mind when prescribing these medications:
- Class 1 and 2 (high potency) should not be used on the face, body folds or groin due to potential for thinning of the skin.
- Pediatric absorption is greater than in adulthood, therefore low potency should be used first.
- A 70kg adult requires 30gm tube to cover entire body.
Location
- Trunk or extremities – triamcinolone 0.1% cream is commonly used.
- Face and body folds – lower potency hydrocortisone or desonide are commonly used.
- Palms and soles – limited use of high potency (fluocinonide or clobetasol) steroids is acceptable.
Formulation
- Ointments are thick and oily and can stain garments, but aid in medication absorption. An occlusive dressing helps the effect and protects garments.
- Creams are better tolerated on the face but contain alcohol and may sting if skin is broken.
- Lotions are water based and better for covering large body surfaces.
Low Potency
Class 7
- Hydrocortisone acetate 0.5% – 1%
Class 6
- Desonide 0.05%
- Fluocinolone 0.01% cream
Medium Potency
Class 5
- Hydrocortisone valerate 0.2% cream or butyrate 0.1% cream / ointment
- Traimcinolone 0.1% cream / lotion
- Fluocinolone 0.025% cream
Class 4
- Hydrocortisone valerate 0.2% ointment
- Fluocinolone 0.025% ointment
High Potency
Class 3
- Betamethasone 0.05% cream
- Traimcinolone acetonide 0.5% cream
Class 2
- Fluocinonide 0.05%
Class 1
- Clobetasol 0.05%
Further Reading
Childhood Rashes That Present To The ED Part I: Viral And Bacterial Issues Date Release: Mar 2007 This article discusses specific common dermatologic entities within the broad categories of infectious disease, eczematous disorders, inflammatory disease, and neoplastic disease.
Childhood Rashes That Present To The ED Part II: Fungal, G Annulare, Kawasaki Disease, Insect Related, And Molluscum Date Release: Apr 2007 This month’s issue continues the review of skin related infections by discussing mycotic causes, Lyme disease, pediculosis, and warts.
Evidence-Based Management Of Skin And Soft-Tissue Infections In Pediatric Patients In The Emergency Department Date Release: Feb 2015 This issue of Pediatric Emergency Medicine Practice will focus on the management of children with skin and soft-tissue infections, based on the current literature.
References
Last Updated on January 25, 2023
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
