Topical & Injectable Corticosteroids (by potency class)

Also known as: clobetasol, halobetasol, betamethasone valerate, desoximetasone, fluocinolone, desonide, hydrocortisone, triamcinolone (intralesional), dexamethasone

Dermatology

In plain English

Corticosteroids are anti-inflammatory medicines used to calm eczema, psoriasis, allergic rashes, and other itchy or inflamed skin conditions. They come in strengths from very mild (hydrocortisone) to super-potent (clobetasol, halobetasol), and the right strength depends on the body area and the problem. They work well for short courses; using strong steroids for too long or on delicate skin (face, folds) can thin the skin and cause other side effects, so they should be used as directed. Triamcinolone can be injected directly into stubborn lesions (e.g., keloids, cysts).

The science

Topical corticosteroids bind the glucocorticoid receptor to suppress inflammatory gene transcription (cytokines, phospholipase A2) and are ranked into 7 US potency classes by the vasoconstrictor assay, from class I superpotent (clobetasol 0.05%, halobetasol 0.05%, augmented betamethasone, desoximetasone 0.25%) to class VII least potent (hydrocortisone, dexamethasone). Potency, vehicle, occlusion, and application site determine both efficacy and adverse-effect risk; intralesional triamcinolone delivers durable local anti-inflammatory effect for hypertrophic scars, keloids, and alopecia areata.

References

• Gabros S et al., Topical Corticosteroids, StatPearls (NCBI Bookshelf) 2024
• Ference JD & Last AR, Topical corticosteroids: choice and application, Am Fam Physician 2021
• Coondoo A et al., side-effects of topical steroids, Indian Dermatol Online J 2014