SNAP Comparison of Topical Steroids

PL Detail-Document #280908
−This PL Detail-Document gives subscribers

additional insight related to the Recommendations published in−
PHARMACIST’S LETTER / PRESCRIBER’S LETTER
September 2012
Comparison of Topical Corticosteroids

Potency of topical steroids is based on their skin vasoconstricting ability and ranked on a scale of I-VII.1,2 Typically, drugs that rank I are classified as very high
potency; II is considered high potency; III, IV, and V are medium potency; and VI and VII are low potency.2,5 Classification can vary depending on the source,
however, especially in the medium and high range. Furthermore, similar vasoconstricting ability does not indicate therapeutic equivalence.1,3 The following chart
compares topical corticosteroids available in the U.S. for treatment of dermatologic conditions based on potency, dose, dosage forms and sizes, and cost. Additional
information pertinent to prescribing is provided.
*Propylene glycol is added to optimize drug absorption in the “augmented” formulations.
Drug Adult Dosage Form and Sizesb AWP ($) for Selected Commentsc,e
Dosea Products
(Brand is listed if generic is
unavailable)
Very High Potencyd • It is recommended that patients
Augmented* QD to BID 0.05% Lotion (30, 60 mL) 30 mL lotion 57.23 on very high potency steroids
betamethasone 0.05% Oint (15, 45, 50 gm) 60 mL lotion 112.77 not be discontinued abruptly;
dipropionate 0.05% Gel (15, 50 gm) 15 gm oint 30 but instead switch to a lower
(Diprolene) 45 gm oint 127.71 potency agent.3,7
Generics available 50 gm oint 73
Clobetasol propionate QD 0.05% Cream 15 gm cream (emollient) • Treatment duration for very
(Shampoo) (15, 30, 45, 60 gm) 27.50 high potency steroids should
(Clobex, Olux, Olux-E, generally not exceed 2 to 4
Temovate, Temovate E) 0.05% Cream (emollient base) 30 gm cream (emollient) weeks of continuous use
Generics available BID (15, 30, 60 gm) 42.35 because of the potential for
0.05% Foam (50, 100 gm) 60 gm cream (emollient) 69 systemic side effects.3,e
0.05% Gel (15, 30, 60 gm) 15 gm cream 24.71
0.05% Lotion (60 mL, 120 mL) 30 gm cream 35.86 • Total dose should generally
0.05% Oint (15, 30, 45, 60 gm) 45 gm cream 50.21 not exceed 50 grams per week
0.05% Scalp application 60 gm cream 64.17 because of the potential for
(25, 50 mL) 15 gm gel 27.75 adrenal suppression.3,e
0.05% Shampoo (118 mL) 30 gm gel 40.69
Continued… 0.05% Spray (60, 125 mL) 60 gm gel 74.16
Continued…
More. . .
Copyright © 2012 by Therapeutic Research Center
P.O. Box 8190, Stockton, CA 95208 ~ Phone: 209-472-2240 ~ Fax: 209-472-2249
www.pharmacistsletter.com ~ www.prescribersletter.com ~ www.pharmacytechniciansletter.com
(PL Detail-Document #280908: Page 2 of 12)
Dosea Products
unavailable)
Very High Potency, continued • Occlusive dressings can be
Clobetasol propionate, 15 gm oint 24.71 used with caution with
continued 30 gm oint 35.86 diflorasone diacetate and
45 gm oint 50.21 fluocinonide, but should be
60 gm oint 64.17 avoided with other very high
25 mL scalp application potency agents, per FDA-
20.55 approved labeling.
50 mL scalp application
39.60 • Clobestasol may cause HPA
axis suppression at doses as
118 mL shampoo 385.29 low as 2 gm daily.
60 mL spray (Clobex)
332.56 • Lower potency agents are
125 mL spray (Clobex) preferred for the face, groin,
598.25 armpits, or skinfolds due to
60 mL lotion 288.96 susceptibility to local side
120 mL lotion 528.56 effects and systemic
50 gm foam 169.86 absorption.1
100 gm foam 313.14
Diflorasone diacetate QD to TID 0.05% Oint (15, 30, 60 gm) 15 gm oint 37.56 • Symptoms of adrenal
30 gm oint 51.86 suppression include weakness,
Generic available weight loss, hypotension, and
60 gm oint 100.16
gastrointestinal distress.
Fluocinonide QD to BID 0.1% Cream (30, 60, 120 gm) 30 gm cream 220.43
(Vanos) 60 gm cream 379.80
120 gm cream 721.62
Halobetasol propionate QD to BID 0.05% Cream (15, 50 gm) 15 gm cream 31.49

(Ultravate) 0.05% Oint (15, 50 gm) 50 gm cream 75.72
Generics available 15 gm oint 31.59
50 gm oint 75.99
More. . .
Dosea Products
unavailable)
High Potencyd
Amcinonide BID to TID 0.1% Cream (15, 30, 60 gm) 15 gm cream 26 • Occlusive dressings should
Generics available 0.1% Lotion (60 mL) 30 gm cream 38.88 be avoided with
0.1% Oint (60 gm) 60 gm cream 66.50 betamethasone dipropionate,
60 mL lotion 162.86 but can be used with caution
60 gm oint 194.40 with other high potency
Augmented* BID 0.05% Cream (15, 50 gm) 15 gm cream 36.43 agents, per FDA-approved
betamethasone 50 gm cream 81.65 labeling.
dipropionate (Diprolene
• Lower potency agents are
AF) Generics available
preferred for the face, groin,
Betamethasone QD to BID 0.05% Oint (15, 45 gm) 15 gm oint 50.45 armpits, or skinfolds due to
dipropionate 45 gm oint 87.01 susceptibility to local side
effects and systemic
Desoximetasone BID 0.25% Cream (15, 60, 100 gm) 15 gm cream 57.63 absorption.1
(Topicort) 0.05% Gel (15, 60 gm) 60 gm cream 197.03
Generics available 0.25% Oint (15, 60, 100 gm) 100 gm cream 224.95
15 gm gel 87.57
60 gm gel 280.20
15 gm oint 92.39
60 gm oint 243.06
100 gm oint 314.82
Diflorasone diacetate BID 0.05% Cream (15, 30, 60 gm) 15 gm cream 70.51
Generics available 30 gm cream 141.03
60 gm cream 282.07
Fluocinonide BID to 0.05% Cream 15 gm cream 3.56

Generics available QID (15, 30, 60, 120 gm) 30 gm cream 4.62
0.05% Gel (15, 30, 60 gm) 60 gm cream 6.90
Continued… 0.05% Oint (15, 30, 60 gm) 120 gm cream 43.74
0.05% Solution (20, 60 mL) 15 gm gel 18.83
More. . .
Dosea Products
unavailable)
High Potency, continued
Fluocinonide, continued 30 gm gel 38.90
60 gm gel 38.68
15 gm oint 6.54
30 gm oint 9.51
60 gm oint 13.02
20 mL sol 47.98
60 mL sol 14.70
Halcinonide BID to TID 0.1% Cream (30, 60, 216 gm) 30 gm cream 124.51
(Halog) 0.1% Oint (30, 60 gm) 60 gm cream 211.73
216 gm cream 582.26
30 gm oint 124.51
60 gm oint 211.73
Triamcinolone acetonide BID to 0.5% Oint (15 gm) 15 gm oint 10.10
Generics available QID
Medium Potencyd
Betamethasone QD to BID 0.05% Cream (15, 45, 50 gm) 15 gm cream 35.64
dipropionate (cream) 0.05% Lotion (60 mL) 45 gm cream 71.28 • Medium or low potency
Generics available 50 gm cream 85.34 agents are preferable when a
BID 60 mL lotion 45 large body surface area needs
(lotion) to be treated.1
Betamethasone valerate QD to TID 0.1% Cream (15, 45 gm) 15 gm cream 14.26 • Medium potency agents are
(Luxiq) 0.1% Oint (15, 45 gm) 45 gm cream 29.11 generally well tolerated when
Generics available BID 0.12% Foam (50, 100 gm) 15 gm oint 20.89 used for three months or less
(Luxiq) 0.1% Lotion (60 mL) 45 gm oint 42.66 on nonfacial,
50 gm foam (Luxiq) 223.07 nonintertriginous areas.1
100 gm foam (Luxiq)
415.19
60 mL lotion 72 Continued…
More. . .
Dosea Products
unavailable)
Medium Potency, continued • Occlusive dressings should be
Clocortolone pivalate TID 0.1% Cream 30 gm cream 141.66 avoided with betamethasone
(Cloderm) (30, 45, 75, 90 gm) 45 gm cream 212.48 dipropionate and fluticasone
75 gm cream 354.14 propionate 0.05% cream per
90 gm cream 424.97 FDA-approved labeling.
Desoximetasone BID 0.05% Cream (15, 60, 100 gm) 15 gm cream 62.43
(Topicort LP) 60 gm cream 231.49
Fluocinolone acetonide TID to QID 0.025% Cream (15, 60 gm) 15 gm cream 33.77
Generics available 0.025% Oint (15, 60 gm) 60 gm cream 101.27
15 gm oint 33.77
60 gm oint 101.27
Fluocinonide (emulsified BID to 0.05% Cream (15, 30, 60 gm) 15 gm cream 19.90
base) QID 30 gm cream 27.50
Flurandrenolide BID to TID 0.05% Cream (15, 30, 60 gm) 15 gm cream 108
(Cordran, Cordran SP) 0.05% Lotion (15, 60 , 120 mL) 30 gm cream 186
60 gm cream 358.80
15 mL lotion 108
60 mL lotion 358.80
120 mL lotion 690
QD to BID 4 mcg/cm2 tape 7.5 cm x 60 cm 123.35

(7.5 cm x 60 cm tape, 7.5 cm x 200 cm 264.67
7.5 cm x 200 cm tape)
More. . .
Dosea Products
unavailable)
Medium Potency, continued
Fluticasone propionate QD to BID 0.05% Cream (15, 30, 60 gm) 15 gm cream 22.18
(Cutivate) 30 gm cream 34.18
BID 0.005% Oint (15, 30, 60 gm) 15 gm oint 22.25
30 gm oint 34.30
60 gm oint 54.10
QD 0.05% Lotion (60, 120 mL) 60 mL (Cutivate) 126.72

120 mL (Cutivate) 779.70
Hydrocortisone butyrate BID to TID 0.1% Cream (15, 45 gm) 15 gm cream 19.69
(Locoid, Lipocream (15, 45, 60 gm) 45 gm cream 42.25
Locoid Lipocream) BID 0.1% Oint (15, 45 gm) 15 gm cream
Generics available (lotion) 0.1% Sol (20, 60 mL) (Locoid Lipocream) 85.76
0.1% Lotion (60, 120 mL) 45 gm cream
(Locoid Lipocream) 244.94
60 gm cream
(Locoid Lipocream) 326.59
59 mL lotion (Locoid)
237.06; 118 mL lotion
(Locoid) 466.20
15 gm oint 10.52
45 gm oint 22.38
20 mL sol 9.80
60 mL sol 14.88
Hydrocortisone valerate BID to TID 0.2% Cream (15, 45, 60 gm) 15 gm cream 15.25
(Westcort) 0.2% Oint (15, 45, 60 gm) 45 gm cream 32.15
15 gm oint 74.61
45 gm oint 150.42
60 gm oint 180.93
More. . .
Dosea Products
unavailable)
Mometasone furoate QD 0.1% Cream (15, 45 gm) 15 gm cream 26.75
(Elocon) 0.1% Oint (15, 45 gm) 45 gm cream 49
Generics available 0.1% Lotion (solution) 30 mL lotion 28.95
(30, 60 mL) 60 mL lotion 55.45
15 gm oint 23.90
45 gm oint 43.77
Prednicarbate BID 0.1% Cream (15, 60 gm) 15 gm cream 23.08

(Dermatop) 0.1% Oint (15, 60 gm) 60 gm cream 56.76
Generics available 15 gm oint 30
60 gm oint 73.79
Triamcinolone acetonide BID to 0.025% Cream 15 gm cream 4.45

(Kenalog) QID (15, 80, 454 gm) 80 gm cream 10.11
Generics available 0.025% Lotion (60 mL) 454 gm cream 22.73
TID to QID 0.025% Oint (15, 80, 454 gm) 60 mL lotion 37.79
(Spray) 15 gm oint 6.12
80 gm oint 11.15
BID to TID 454 gm oint 31.51
(0.1% 0.1% Cream 15 gm cream 5.58
lotion) (15, 30, 80, 454 gm) 30 gm cream 9.65
0.1% Lotion (60 mL) 80 gm cream 12.68
0.1% Oint (15, 80, 454 gm) 454 gm cream 30
0.147% Spray (63, 100 gm) 60 mL lotion 42.42
15 gm oint 5.57
80 gm oint 12.68
454 gm oint 30
63 gm spray (Kenalog)
195.88
100 gm spray (Kenalog)
Continued… 310.92
More. . .
Dosea Products
unavailable)
Triamcinolone acetonide, BID to 0.5% Cream (15 gm) 15 gm cream 11.10
continued QID
Low Potencyd
Alclometasone BID to TID 0.05% Cream (15, 45, 60 gm) 15 gm cream 19.05 • Hydrocortisone is available
dipropionate 0.05% Oint (15, 45, 60 gm) 45 gm cream 39.72 by prescription and OTC.
(Aclovate) 60 gm cream 50.30 The 2.5% strength is
Generics available 15 gm oint 20 prescription. Some 1%
45 gm oint 39.70 formulations are prescription
60 gm oint 50.32 while others are OTC.
• Consider low potency agents
for children, pregnant
women, the elderly, and
patients with large areas to be
Desonide BID to TID 0.05% Cream (15, 60 gm) 15 gm cream 12.10
treated.1
(Desonate, DesOwen, 0.05% Foam (50, 100 gm) 60 gm cream 27.81
BID 0.05% Lotion (60, 118 mL) 50 gm foam (Verdeso) • Low potency agents are
Verdeso)
(Foam, 0.05% Oint (15, 60 gm) 194.92 preferred for the face, groin,
Generics available
Gel) 0.05% Gel (60 gm) armpits, or skinfolds due to
100 gm foam (Verdeso)
susceptibility to local side
364.25
effects and systemic
60 gm gel (Desonate)
absorption.1
383.10
60 mL lotion 146.06
118 mL lotion 216.25
15 gm oint 15.45
60 gm oint 40.15
More. . .
Dosea Products
unavailable)
Low Potency, continued
Fluocinolone acetonide QD 0.01% Cream (15, 60 gm) 15 gm cream 44.57
(Capex, Derma- (Shampoo) 0.01% Shampoo (120 mL) 60 gm cream 133.67
Smoothe/FS) 0.01% Sol (60 mL) 120 mL shampoo (Capex)
Generics available TID to QID 0.01% Oil (118 mL) 375.88
(Cream,
Solution) 60 mL sol 90
118 mL oil 31.47
TID (Oil)
Hydrocortisone up to QID 0.5% Cream (28, 56 gm) 56 gm cream 4.49 (retail

OTC 0.5% Oint (38.3 gm) price)
Generics available
(AWP not available)
Hydrocortisone up to QID 1% Cream (28, 56, 454 gm) 28 gm cream 3.49 (retail
(Cortaid, Cortizone-10) 1% Oint (28, 454 gm) price)
Generics available 56 gm cream 6.49 (retail
Some products OTC price)
454 gm cream 40 (retail
price)
(AWP not available)
Hydrocortisone, continued BID to 2.5% Cream

Generics available QID (20, 28, 30, 454 gm) (AWP not available)
2.5% Oint (20, 28.3, 454 gm)
2.5% Lotion (60, 120 mL)
More. . .
Dosea Products
unavailable)
Low Potency, continued
Hydrocortisone acetate BID to 1% Cream (15, 20, 30 gm) 30 gm cream 3.20
U-cort QID 1% Oint (30 gm) 30 gm oint 3.99
Some available OTC
Generics available
a. Dosing interval per FDA-approved product labeling. Once or twice daily dosing is generally recommended.1,3,6,7 For psoriasis, some experts
start with BID dosing, then taper as the disease responds. Once daily dosing of medium to very high potency agents helps minimize side
effects.4 Even less frequent dosing (e.g., weekend only) may be appropriate for chronic conditions such as psoriasis or eczema once the
disease is under control.1,3,7
b. Fingertip units can be used to estimate the quantity of topical corticosteroid the patient will need. A fingertip unit is the amount squeezed
from the tube from the tip of the finger to the first joint. It’s approximately 500 mg. It will take three fingertip units to cover the scalp; 2.5
for the face and neck; one for the elbows, knees, or an entire hand; four for an arm (including entire hand) or the buttocks; 1.5 for both soles
or one foot (including toes); eight for a leg (including entire foot), back of trunk, or front of trunk; and 0.5 for the genitalia.
c. Patients may need more than one product for use on different body parts; for use for disease of varying severity; or for tapering.
d. Potency classification based on product labeling and references 2, 5, 6, and 8.
e. Treatment duration and maximum total dose per week may vary per individual product labeling.
Abbreviations: QD = once daily; BID = twice daily, TID = three time daily; QID = four times daily
U.S. product labeling used for the above chart: Aclovate (April 2011); Ala-Scalp (September 2011); amcinonide cream, ointment (February 2010
[Taro]); amcinonide lotion (November 2011 [Fougera]); ApexiCon E (October 2011); betamethasone dipropionate cream, lotion, ointment (October
2011 [Fougera]); betamethasone dipropionate gel, augmented (October 2003 [Taro]); betamethasone dipropionate ointment (February 2006
[Actavis]); betamethasone valerate cream, ointment, lotion (September 2011 [Fougera]); Capex (February 2007); clobetasol propionate gel, cream,
ointment (March 2010 [Taro]); clobetasol propionate emollient cream (September 2004 [Taro]); Clobex lotion (October 2005); Clobex shampoo
(November 2011); Clobex spray (January 2011); Cloderm (July 2007); Cordran lotion (July 2011); Cordran SP (February 2006); Cordran tape
(November 2011); Cortaid cream (November 2010); Cortaid ointment (October 2009); Cutivate lotion (October 2011); Derma-Smoothe/FS (March
2012); Dermatop cream (October 2011); Dermatop ointment (January 2011); Desonate (December 2009); DesOwen (June 2008); diflorasone
diacetate cream (February 2006 [Taro]); diflorasone diacetate ointment (February 2006 [Taro]); Diprolene lotion (August 2010); Diprolene ointment
(August 2010); Diprolene AF (August 2010); fluocinolone acetonide cream (October 2011 [Fougera]); fluocinolone acetonide ointment (October
2011 [Fougera]); fluocinolone acetonide solution (October 2011 [Fougera]); fluocinonide cream, emulsified base, gel, ointment (April 2010 [Taro]);
More. . .
fluocinonide solution (October 2011 [Taro]); fluticasone propionate cream (August 2011 [Fougera]); fluticasone propionate ointment (February 2012
[Fougera]); Halog (June 2009); hydrocortisone 0.5% cream (November 2011 [Fougera]); hydrocortisone 0.5% ointment (December 2011 [Fougera]);
hydrocortisone 2.5% lotion (November 2011 [Fougera]); hydrocortisone 2.5% cream, ointment (December 2011 [Fougera]); hydrocortisone butyrate
cream, ointment, solution (February 2010 [Taro]); hydrocortisone valerate (May 2011 [Taro]); Kenalog spray (August 2011); Locoid Lipocream
(October 2009); Locoid lotion (July 2008); Luxiq (November 2009); mometasone furoate cream (December 2011 [Fougera]); mometasone furoate
lotion (December 2011 [Fougera]); mometasone furoate ointment (January 2012 [Fougera]); Olux (March 2011); Olux-E (June 2011); Temovate scalp
application (October 2008); Topicort cream, gel (September 2011); Topicort ointment (October 2010); triamcinolone acetonide cream (September
2011 [Fougera]); triamcinolone acetonide lotion (October 2011 [Fougera]); triamcinolone acetonide 0.025% and 0.1% ointment (October 2011
[Fougera]); triamcinolone acetonide cream (August 2009 [Perrigo]); triamcinolone acetonide ointment (August 2009 [Perrigo]); U-cort (October
2010); Ultravate (March 2012); Vanos (March 2012); Verdeso (August 2011)
Users of this PL Detail-Document are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making
clinical judgments based on the content of this document. Our editors have researched the information with input from experts, government agencies, and national
organizations. Information and internet links in this article were current as of the date of publication.
More. . .
Project Leader in preparation of this PL Detail- 5. Fougera. Knowledge center: steroid potency
Document: Melanie Cupp, Pharm.D., BCPS comparison.
http://www.fougera.com/knowledge_center/steroidpot
ency.asp. (Accessed August 12, 2012).
References 6. Herrier SN. Dermatotherapy and drug-induced skin
1. Drake LA, Dinehart SM, Farmer ER, et al. disorders. In: Aldredge BK, Corelli RL, Ernst ME, et
Guidelines of care for the use of topical al, editors. Koda-Kimble and Young’s Applied
glucocorticoids. J Am Acad Dermatol 1996;35:615- Therapeutics: the clinical use of drugs. 10th ed.
9. Philadelphia, PA: Lippincott Williams & Wilkins;
2. National Psoriasis Foundation. Topical steroids 2012. p. 925-43.
potency chart. 7. Haber RM. Topical management of recalcitrant
http://www.psoriasis.org/Page.aspx?pid=469. psoriasis and eczema. Skin Therapy Lett FP
(Accessed August 11, 2012). 2010;6(3):1-4.
3. Menter A, Korman NJ, Elmets CA, et al. Guidelines 8. eCPS [Internet]. Ottawa (ON): Canadian
of care for the management of psoriasis and psoriatic Pharmacists Association; c2012. Corticosteroids:
arthritis. J Am Acad Dermatol 2009;60:643-59. topical. CPhA monograph (November 2011).
4. Shear N, Vender R, Thomas R, Kuehl BL. Eczema http://www.e-therapeutics.ca. (Accessed August 13,
treatment. Skin Therapy Lett. Last modified June 2012).
27, 2012.
http://www.skintherapyletter.com/treat/eczema/index.
html. (Accessed August 11, 2012).
Cite this document as follows: PL Detail-Document, Comparison of Topical Corticosteroids. Pharmacist’s

Letter/Prescriber’s Letter. September 2012.
Evidence and Recommendations You Can Trust…

3120 West March Lane, P.O. Box 8190, Stockton, CA 95208 ~ TEL (209) 472-2240 ~ FAX (209) 472-2249
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SNAP Comparison of Topical Steroids

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−This PL Detail-Document gives subscribers

Comparison of Topical Corticosteroids

Halobetasol propionate QD to BID 0.05% Cream (15, 50 gm) 15 gm cream 31.49

Fluocinonide BID to 0.05% Cream 15 gm cream 3.56

QD to BID 4 mcg/cm2 tape 7.5 cm x 60 cm 123.35

QD 0.05% Lotion (60, 120 mL) 60 mL (Cutivate) 126.72

Prednicarbate BID 0.1% Cream (15, 60 gm) 15 gm cream 23.08

Triamcinolone acetonide BID to 0.025% Cream 15 gm cream 4.45

Hydrocortisone up to QID 0.5% Cream (28, 56 gm) 56 gm cream 4.49 (retail

(AWP not available)

Hydrocortisone, continued BID to 2.5% Cream

Cite this document as follows: PL Detail-Document, Comparison of Topical Corticosteroids. Pharmacist’s

Evidence and Recommendations You Can Trust…

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