TOPICAL CORTICOSTEROIDS - The Dermatologist

Structural Class Class A: Class B: Class C: Class D1: Class D2:Hydrocortisone Type Triamcinolone Acetonide Type Betamethasone Type Betamethasone Dipropionate Type Methylprednisolone Aceponate TypeCLASS 7: LEAST POTENTHydrocortisoneHydrocortisone acetateMethylprednisolone,prednisoloneTixocortol pivalateCLASS 6: LOW POTENTDesonide 0.05% C, FFluocinolone acetonide 0.01% C, STriamcinolone acetonide 0.025% CTriamcinolone diacetate 0.025% CAlclometasone dipropionate 0.05% C, OBetamethasone valerate 0.1% CCLASS 5: LOWER MID-STRENGTHCLASS 4: MID-STRENGTHCLASS 3: UPPER MID-STRENGTHCLASS 2: HIGH POTENTCLASS 1: SUPERPOTENTADDITIONAL INFORMATIONSTRUCTURECROSS-REACTIONSPATCH TEST SUBSTANCEOral: CloprednolFludrocortisone acetateMethylprednisolone,prednisoloneNo substitutions in theD ring, except C21 –short-chain estersCross-reacts with D2Tixocortol-21-pivalateDesonide 0.05% OFluocinolone acetonide 0.025% CTriamcinolone acetonide0.1% C, 0.025% O, LTriamcinolone diacetate 0.1% CAmcinonide 0.1% CFluocinolone acetonide 0.01%, 0.025% OHalcinonide 0.025% CTriamcinolone acetonide 0.1% OTriamcinolone diacetate 0.1% OAmcinonide 0.1% LFluocinonide 0.05%Triamcinolone acetonide 0.1% C, OTriamcinolone diacetate 0.1% C, OAmcinonide 0.1% O, L, CBudesonide 0.025% CFluocinonide 0.05% C, O, G, SHalcinonide 0.1% C, O, SOral: BudesonideTriamcinoloneC16,17 – cis-diol or – ketalBudesonide specificallycross-reacts with D2BudesonideTriamcinolone acetonideLEGEND: C=Cream, G=Gel, L=Lotion, O=Ointment, S=Solution, F=FoamReferences1. Jacob SE, Steele T. Corticosteroid classes: a quick reference. J Am Acad Dermatol. 2006;54:723-7.2. De Groot AC, Weyland JW, Nater JP. Unwanted effects of cosmetics and drugs used in dermatology. Third Ed. Amsterdam: Elsevier; 1994.3. De Groot AC. Patch testing: concentrations and vehicles for 3700 chemicals. Second Ed. New York: Elsevier; 1994. p.307.Clocortolone pivalate 0.1% CDesoximetasone 0.05% CDesoximetasone 0.25% C, 0.05% GOral: BetamethasoneDexamethasoneC16 – methyl substitutionBetamethasone dipropionate 0.05% LBetamethasone valerate C, LFluticasone propionate 0.05% CBetamethasonevalerate 0.12% FClobetasone butyrate 0.05%Mometasone furoate 0.1% C, LBetamethasone dipropionate 0.05% CBetamethasone valerate 0.1% OClobetasone butyrate 0.05%Diflorasone diacetate 0.05% CFluticasone propionate 0.005% OMometasone furoate 0.1% OBetamethasone dipropionate 0.05% O, CBetamethasone valerate 0.1%Diflorasone diacetate 0.05%Betamethasone dipropionate0.05% G, O, LClobetasol propionate0.05% C, O, G, S, FDiflorasone diacetate0.05% OOral/IM: BetamethasoneC16 – methyl substitutionC17/C21 – long-chain esterClobetasol-17-propionateHydrocortisone buteprate 0.1% C, O, SHydrocortisone butyrate 0.1% C, O, SHydrocortisone valerate 0.2% CPrednicarbate 0.1% CHydrocortisone valerate 0.2% OOral/IV: HydrocortisoneC16 – no methyl substitutionC16 – no halogenationC17 – long-chain esterC21 – possible side chainCross-reacts with Class A andbudesonideHydrocortisone-17-butyrateVerdeso is a trademark, and OLUX, Luxiq, the foam icon, the interlocking “C” logo, and Connetics are registered trademarks of Connetics Corporation.4. Scheuer E, Warshaw E. Allergy to Corticosteroids: Update and Review of Epidemiology, Clinical Characteristics, andStructural Cross Reactivity. Am J Contact Dermat 2003; 14(4):179-187.5. Sasaki. Corticosteroid sensitivity and cross-sensitivity. Contact Dermatitis. 1990;23:306-15.6. Fisher AA, editor. Reactions to topical steroids. Contact Dermatitis. Third Ed. Philadelphia: Lea and Febiger; 1986. p.203-10.Adapted from Jacob SE, Steele T. Corticosteroid classes: a quick reference guide including patch test substances and cross-reactivity. J Am Acad Dermatol. 2006;54:723-727.