Potency
Ranking of Some Commonly Used
Topical Corticosteroids1*
Class |
|
Generic name |
| Temovate® Cream, 0.05% Temovate® Ointment, 0.05% Temovate® Gel, 0.05% Temovate® E, 0.05% Diprolene® Cream, 0.05% Diprolene® Ointment, 0.05% Diprolene® AF Cream, 0.05% Psorcon® Ointment, 0.05% Ultravate® Cream, 0.05% Ultravate® Ointment, 0.05% Temovate® Cream or Ointment is more potent than Diprolene® Cream or Ointment and Psorcon® Ointment |
clobetasol propionate clobetasol propionate clobetasol propionate clobetasol propionate betamethasone dipropionate betamethasone dipropionate betamethasone dipropionate diflorasone diacetate halobetasol propionate halobetasol propionate |
|
| Cyclocort® Cream, 0.1% Cyclocort® Ointment, 0.1% Cyclocort® Lotion, 0.1% Diprosone® Ointment, 0.05% Florone® ointment 0.05% Halog® Cream®, 0.1% Halog® Ointment Lidex® Cream, 0.05% Lidex® Ointment, 0.05% Lidex-E® Cream, 0.05% Maxiflor® Ointment, 0.05% Maxivate® , Ointment 0.05% Topicort® Cream, 0.25% Topicort® Gel, 0.05% Topicort® Ointment, 0.25% |
amcinonide amcinonide amcinonide betamethasone dipropionate diflorasone diacetate halcinonide halcinonide fluocinonide fluocinonide fluocinonide diflorasone diacetate betamethasone dipropionate desoximetasone desoximetasone desoximetasone |
|
| Aristocort A® Cream 0.5% Cutivate® Ointment, 0.05% Diprosone® Cream, 0.05% Elocon® Ointment 0.1% Florone® Cream, 0.05% Maxiflor® Cream, 0.05% Maxivate® Cream, 0.05% Uticort gel®, 0.025% Valisone® Ointment, 0.1% |
triamcinolone acetonide fluticasone propionate betamethasone dipropionate mometasone furoate diflorasone diacetate diflorasone diacetate betamethasone dipropionate betamethasone benzoate betamethasone valerate |
|
| Aristocort® Ointment, 0.1% Cordran® Ointment, 0.05% Elocon® Cream, 0.1% Kenalog® Ointment, 0.1% Synalar® Ointment, 0.025% Topicort LP® Cream, 0.05% |
triamcinolone acetonide flurandrenolide mometasone furoate triamcinolone acetonide fluocinolone acetonide desoximetasone |
|
| Aristocort® Cream, 0.1% Cordran® Cream, 0.05% Cutivate® Cream, 0.05% Dermatop® Emollient cream, 0.05% Diprosone® Lotion, 0.05% Kenalog® Cream, 0.1% Kenalog® Lotion, 0.1% Locoid® Cream, 0.1% Synalar® Cream, 0.025% Valisone® Cream, 0.1% Valisone® Lotion, 0.1% Uticort® Cream 0.025% Westcort® Cream, 0.2% Westcort® Ointment, 0.2% |
triamcinolone acetonide flurandrenolide fluticasone propionate prednicarbate betamethasone dipropionate triamcinolone acetonide triamcinolone acetonide hydrocortisone butyrate fluocinolone acetonide betamethasone valerate betamethasone valerate betamethasone benzoate hydrocortisone valerate hydrocortisone valerate |
|
| Aclovate® Cream, 0.05% Aclovate® Ointment, 0.05% Synalar® Solution, 0.01% Tridesilon® Cream, 0.05% |
alclometasone dipropionate alclometasone dipropionate fluocinolone acetonide desonide |
|
| Low Potency |
Numerous preparations exist | dexamethasone flumethalone hydrocortisone methylprednisolone prednisolone |
Adapted from Stoughton.1
Group I is the superpotent category; potency descends with each group, to group VII, which is least potent (II, III, potent steroids; IV, V, midstrength steroids; VI, VII, mild steroids). There is no significant difference between agents within groups II through VII; the compounds are simply arranged alphabetically. However, within group I, Temovate® Cream or Ointment is more potent than Diprolene Cream or Ointment and Psorcon Ointment.
Intravaginal steroids have been used for lichen planus as a first line of treatment if vaginal involvement is present.
Cort-Dome vaginal suppositories are used in the following manner:
1/2 of a Cort-Dome suppository per vagina twice daily for 2 months, then daily for 2 months, then maintenance treatment at 1 to 3 times per week. However, many patients do not experience significant long-term response to intravaginal steroids. The vaginal vault tends to continue to scar. To keep the vault open and prevent adhesions it often will be necessary to use vaginal dilators. The dilator may be lubricated with a hydrocortisone cream.
Walsh et al. developed a method to occlude topical medication on the vagina following surgical release of labial adhesions. An aggressive approach to increase delivery of topical medications included a vaginal (and oral) prosthesis, use of the vaginal moisturizer (Replens) as a vehicle for corticosteroids, and iontophoresis. Rapid response was obtained, and a less-intensive dosing schedule has resulted in remission of over 1 year.
Open areas of limited size can be healed with intralesional triamcinolone acetonide injections at a concentration of 3 mg/ml.
At times a stronger steroid may be required. Oral prednisone at a dose of 40 mg – 60 mg each morning until healing has occurred. As the skin heals, topical corticosteroids may be added as the prednisone is tapered.
CLINICAL
APPEARANCE
Vaginal Lichen Planus (LP)
LP of the Gums
Erosive LP
TREATMENT
Steroids
Steroid
Potencies
Antibiotics
Miscellaneous