Comparison of representative topical corticosteroid preparations (classified according to the US system) Potency group* Corticosteroid Vehicle type/form Trade names (United States) Available strength(s), percent (except as noted) Super-high potency (group 1) dipropionate, augmented Clobetasol propionate Ointment, optimized Diprolene Lotion Diprolene Gel Diprolene Ointment Temovate Cream Temovate Cream, emollient base Temovate E Gel Temovate Lotion Clobex Foam aerosol Olux-E Foam aerosol (scalp) Olux Shampoo Clobex Solution (scalp) Temovate, Cormax Spray aerosol Clobex Diflucortolone valerate (not available in United States) Ointment, oily cream Nerisone Forte (United Kingdom, others) 0.3 Fluocinonide Cream Vanos Flurandrenolide Tape (roll) Cordran 4 mcg/cm 2 Halobetasol propionate Ointment Ultravate Cream Ultravate High potency (group 2) Lotion Ultravate Amcinonide Ointment Cyclocort, Amcort dipropionate Ointment Diprosone Cream, augmented formulation (AF) Diprolene AF Clobetasol propionate Cream Impoyz 0.025 Desoximetasone Ointment Topicort 0.25 Cream Topicort 0.25 Spray Topicort 0.25 Gel Topicort
Diflorasone diacetate Ointment ApexiCon, Florone Cream, emollient ApexiCon E Fluocinonide Ointment Lidex Gel Lidex Cream anhydrous Lidex Solution Lidex Halcinonide Ointment Halog High potency (group 3) Cream Halog Amcinonide Cream Cyclocort, Amcort Lotion Amcort dipropionate valerate Cream, hydrophilic emollient Diprosone Ointment Valisone Foam Luxiq 2 Desoximetasone Cream Topicort LP Diflorasone diacetate Cream Florone Diflucortolone valerate (not available in United States) Fluocinonide Cream, oily cream, ointment Cream aqueous emollient Nerisone (Canada, United Kingdom, others) Lidex-E Fluticasone propionate Ointment Cutivate 0.005 Mometasone furoate Ointment Elocon Medium potency (group 4) Triamcinolone dipropionate Ointment Kenalog 0.5 Cream Triderm, Aristocort HP 0.5 Spray Sernivo Clocortolone pivalate Cream Cloderm Fluocinolone Ointment Synalar 0.025 Flurandrenolide Ointment Cordran valerate Ointment Westcort 0.2 Mometasone furoate Cream Elocon Triamcinolone Lotion Elocon Solution Elocon Cream Kenalog Ointment Kenalog
Lower-mid potency (group 5) dipropionate valerate Aerosol spray Kenalog 0.2 mg per 2 second spray Lotion Diprosone Cream Beta-Val, Valisone Desonide Ointment DesOwen, Tridesilon Fluocinolone Gel Desonate Cream Synalar 0.025 Flurandrenolide Cream Cordran Lotion Cordran Fluticasone propionate butyrate Cream Cutivate Lotion Cutivate Ointment Locoid Cream Locoid, Locoid Lipocream Lotion, spray Cortizone 10 maximum Lotion Locoid Solution Locoid probutate valerate Cream Pandel Cream Westcort 0.2 Prednicarbate Cream, emollient Dermatop Ointment Dermatop Low potency (group 6) Triamcinolone Alclometasone dipropionate valerate Lotion Kenalog Ointment Kenalog 0.025 Ointment Aclovate Cream Aclovate Lotion Beta-Val, Valisone Desonide Cream DesOwen, Tridesilon Lotion DesOwen, LoKara Fluocinolone Foam Verdeso Cream Synalar 0.01 Solution Synalar 0.01 Shampoo Capex 0.01 Oil (scalp) Derma-Smoothe/FS Scalp 0.01
Least potent (group 7) Triamcinolone (base, 2%) Oil (body) Derma-Smoothe/FS Body Cream Kenalog, Aristocort 0.01 0.025 Lotion Kenalog 0.025 Ointment Hytone 2.5 Cream Hytone, Nutracort 2.5 Lotion Hytone, Ala Scalp, Scalacort 2.5 or 2 Solution Texacort 2.5 (base, <2%) Ointment Cortaid, Hytone, Nutracort 1 Cream Cortaid, Hytone, Synacort 1 Lotion Aquanil HC, Sarnol- HC, Cortizone 10 1 Spray Cortaid 1 Solution Cortaid, Noble, Scalp relief 1 Ointment Cortaid 0.5 Cream Cortaid 0.5 acetate with pramoxine 1% combination Ointment Pramosone 1 or 2.5 Cream Lotion Pramosone, Analpram-HC Pramosone, Analpram-HC 1 or 2.5 1 or 2.5 Aerosol foam Epifoam 1 US: United States. * Listed by potency according to the US classification system: group 1 is the most potent, group 7 is the least potent. Other countries use a different classification system with only four or five groups. Inactive United States trade name for specific product; brand may be available outside United States. 48% refined peanut oil. Data from: 1. Lexicomp Online. Copyright 1978-2018 Lexicomp, Inc. All Rights Reserved. 2. Tadicherla S, Ross K, Shenefelt D. Topical corticosteroids in dermatology. Journal of Drugs in Dermatology 2009; 12:1093. 3. U.S. Food & Drug Administration Approved Drug Products with Therapeutic Equivalence (Orange Book). Available at: https://www.accessdata.fda.gov/scripts/cder/ob/default.cfm (Accessed on June 18, 2017). Graphic 62402 Version 46.0
GRAPHICS Management of atopic dermatitis
For examples of low-, medium-, and high-potency topical corticosteroids, please refer to the UpToDate table on topical corticosteroids. TCS: topical corticosteroid; TCI: topical calcineurin inhibitor. * Trigger/exacerbating factors: Irritants (soaps, detergents) Skin infections (Staphylococcus aureus, herpes simplex) Contact, inhalant, or food allergens Mild atopic dermatitis Areas of dry skin, infrequent itching (with or without small areas of redness); little impact on everyday activities, sleep, and psychosocial wellbeing. Moderate atopic dermatitis Areas of dry skin, frequent itching, redness (with or without excoriation and localized skin thickening); moderate impact on everyday activities and psychosocial wellbeing, frequently disturbed sleep. Severe atopic dermatitis Widespread areas of dry skin, incessant itching, redness (with or without excoriation, extensive skin thickening, bleeding, oozing, cracking, and alteration of pigmentation); severe limitation of everyday activities and psychosocial functioning, nightly loss of sleep. Crisaborole is approved for mild to moderate atopic dermatitis in adults and children >2 years. TCIs are approved for mild to moderate atopic dermatitis in adults and children >2 years. TCIs include tacrolimus and pimecrolimus. Dupilumab is approved for moderate to severe atopic dermatitis in adults whose disease is not adequately controlled with topical prescription therapies. Graphic 115549 Version 1.0
GRAPHICS Topical antifungal agents Azoles Drug Dose How supplied* Clotrimazole Twice per day Cream 1% Ointment 1% Solution 1% Econazole Once per day (twice per day for candidiasis) Cream 1% Foam 1% Efinaconazole Once per day Solution 10% Ketoconazole Once per day (shampoo is usually one use) Cream 2% Shampoo 2% (1% shampoo is available overthe-counter) Gel 2% Foam 2% Luliconazole Once per day Cream 1% Miconazole Twice per day Cream 2% Ointment 2% Solution 2% Lotion 2% Powder 2% Aerosol solution 2% Aerosol powder 2% Oxiconazole Once to twice per day Cream 1% Lotion 1% Sertaconazole Twice per day Cream 2% Sulconazole Once or twice per day Cream 1% Allylamines Solution 1% Naftifine Once per day (cream), twice per day (gel) Cream 1% Cream 2% Gel 1% Gel 2% Terbinafine Once to twice per day Cream 1% Benzylamine Gel 1% Spray solution 1% Butenafine Once per day (twice per day for tinea pedis) Cream 1% Polyene: Treats Candida infections only Nystatin Two to three times per day Cream 100,000 units/gram
Topical drugs for pediculosis capitis Pediculicide* Mechanism of action Age group Regimen Precautions/side effects Pyrethrins and piperonyl butoxide Neurotoxin 2 years Leave on hair for 10 minutes, then rinse; repeat on day 9 Skin irritation Permethrin (1%) Neurotoxin 2 months Leave on hair for 10 minutes, then rinse; repeat on day 9 Skin irritation; pyrethrins may induce breathing difficulties in patients with ragweed allergy; avoid permethrin in patients with chrysanthemum allergy Malathion Neurotoxin 6 years; contraindicated in children under 2 years; safety has not been established in children 2 to 6 years Leave on hair for 8 to 12 hours, then wash with a non-medicated shampoo; a single application may be effective; repeat in 7 to 9 days if live lice are seen Malodorous, flammable, skin irritation, theoretical risk for respiratory depression if ingested Benzyl alcohol Asphyxiation 6 months Leave on hair for 10 minutes, then rinse; repeat after 7 days Spinosad Neurotoxin 6 months Leave on hair for 10 minutes, then rinse; repeat in 7 days if live lice remain Ivermectin Neurotoxin 6 months Leave on hair for 10 minutes, then rinse Skin and eye irritation, transient skin numbness Skin irritation Skin or eye irritation * There is wide variation in the cost of topical pediculicides. In general, pyrethrins and permethrin are the least expensive agents. Current United States pricing information is available in the Lexicomp Drug Information content provided in UpToDate. Graphic 105474 Version 3.0
Other Ointment 100,000 units/gram Powder 100,000 units/gram Ciclopirox Twice per day Cream 0.77% Gel 0.77% Suspension 0.77% Shampoo 1% Solution 8% Tolnaftate Twice per day Cream 1% Powder 1% Aerosol: Liquid 1% Powder 1% Solution 1% * Preparations available in United States and some other countries. Azoles have activity against dermatophytes, tinea versicolor, and Candida. Sulconazole, oxiconazole, and luliconazole may be less effective for Candida infection than other azoles. Available in over-the-counter (nonprescription) preparations in the United States and some other countries. Indicated for onychomycosis. Can treat Candida in addition to dermatophytes and tinea versicolor but may be less effective than azoles and ciclopirox for Candida infection. Treats dermatophytes, tinea versicolor, and Candida. Does not treat Candida; less effective than other options for dermatophytes. Prepared with data from: US Food & Drug Administration (FDA) approved product information. US National Library of Medicine. (Available online at: http://dailymed.nlm.nih.gov/dailymed/about.cfm). Graphic 76148 Version 11.0
GRAPHICS Acne medications Medications Dose Partial list of preparations Select adverse effects Topical retinoids Tretinoin Once daily, at bedtime Standard vehicles - Creams: 0.025%, 0.0375%, %, % Gels: 0.01%, 0.025% Optimized vehicles - Microsphere gels: 0.04%, 0.08%, % Local skin irritation, dryness, and flaking; sun sensitivity NOTE: Micronized gel tretinoin % (Atralin) contains soluble fish proteins, use with caution in patients with known sensitivity or allergy to fish Polyolprepolymer-2 cream: 0.025% Polyolprepolymer-2 gel: 0.025% Gel (micronized): % Adapalene Once daily, at bedtime Cream: % Gels: %, 0.3% Local skin irritation, dryness, and flaking; sun sensitivity Lotion: % Tazarotene Once daily, at bedtime Creams: %, % Gels: %, % Foam: % Contraindicated in pregnancy; local skin irritation, dryness, and flaking; sun sensitivity Isotretinoin (not available in United States) Once daily, at bedtime or twice per day Gel: % Contraindicated in pregnancy and lactation; local skin irritation, dryness and flaking; sun sensitivity Topical antimicrobials* (BPO) Twice daily Multiple (prescription and nonprescription) 2.5 to 10% gels, lotions, creams, pads, masks, cleansers Local skin irritation; may bleach Clindamycin Twice daily Once daily (foam) 1% gel, lotion, pledget, solution, foam Rare risk of pseudomembranous colitis; usually prescribed with BPO to decrease resistance Erythromycin Twice daily 2% gel, solution, pledget Usually prescribed with BPO to decrease resistance Dapsone Topical combination products Twice daily (5% gel) Once daily (7.5% gel) 5% gel, 7.5% gel Yellow-orange skin discoloration when applied at the same time as BPO 5%/Clindamycin 1% 5%/Clindamycin 1.2% 2.5%/Clindamycin 1.2% 3.75%/Clindamycin 1.2% 5%/Erythromycin 3% Clindamycin 1.2%/Tretinoin 0.025% Twice daily Gel Local skin irritation; may bleach Once daily Gel Local skin irritation; may bleach Once daily Gel Local skin irritation; may bleach Once daily Gel Local skin irritation; may bleach Twice daily Gel Local skin irritation; may bleach Once daily, at bedtime Gel Local skin irritation
2.5%/Adapalene % 2.5%/Adapalene 0.3% Once daily Gel Local skin irritation; may bleach Once daily Gel Local skin irritation; may bleach Azelaic acid Twice daily 20% cream, 15% gel Local skin irritation Salicylic acid Once to three times daily Multiple (non-prescription) 0.5 to 2% creams, gels, pads, cleansers, solutions, soaps, pledget, foam Local skin irritation; potential for salicylate absorption Oral antibiotics Tetracycline 500 mg twice daily Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children Doxycycline 50 to 100 mg twice daily or 100 mg once daily or Delayed release formulation: 100 mg every 12 hours for one day, then 100 mg per day Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children Minocycline Subantimicrobial dosing: 20 mg twice daily or Delayed release formulation given as 40 mg once daily 50 mg one to three times daily or Extended release formulation: 1 mg/kg/day (round to nearest available strength) Dizziness, drug-induced lupus, skin discoloration; contraindicated in pregnancy and young children Erythromycin 500 mg twice daily (base) Gastrointestinal distress Trimethoprimsulfamethoxazole Azithromycin Hormonal agents 160 mg/800 mg once to twice daily Intermittent dosing due to long drug half-life; optimum regimen unknown Stevens-Johnson syndrome, toxic epidermal necrolysis Gastrointestinal distress Combination oral contraceptives (estrogen/progestin) Once daily Nausea, breast tenderness, weight gain, thromboembolic events Spironolactone 25 to 200 mg/day in one or two equally divided doses; doses of 50 to 100 mg/day may be as effective as higher doses and reduce side effects Contraindicated in pregnancy; menstrual irregularity, breast tenderness, minor gastrointestinal symptoms, orthostatic hypotension, hyperkalemia, dizziness, headaches, fatigue Oral retinoid Oral isotretinoin 0.5 mg/kg/day, increasing to 1 mg/kg/day in one or two equally divided doses; total dose 120 to 150 mg/kg over 20 weeks Teratogenicity (absolutely contraindicated in pregnancy), mucocutaneous effects, hypertriglyceridemia, others %: percent; BPO: (topical). * Topical sulfacetamide (eg, gels, creams, lotions, other) with and without sulfur are also available but not typically used and have limited data; refer to topic. Usual oral dose for adult or adolescent. BPO may be prescribed with oral antibiotics to reduce resistance.
For additional information refer to topic review of hormonal therapy for acne vulgaris. For additional information refer to topic review of oral isotretinoin therapy for acne vulgaris. Graphic 55642 Version 13.0