Skin Health Topical Steroid Strengths The 7 Drug Classifications By Heather L. Brannon, MD Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Updated on October 20, 2021 Medically reviewed Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Casey Gallagher, MD Medically reviewed by Casey Gallagher, MD Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Expert Board Print Table of Contents View All Table of Contents How Topical Steroids Work Formulations Classification by Strength Treatment Considerations Medication Options Topical steroids, or topical corticosteroids, are medications that are applied directly to your skin to provide relief for skin conditions that cause skin inflammation and irritation. They can be prescribed or purchased over-the-counter (OTC) and come in a variety of strengths and forms, such as creams or ointments. This article will explore how topical steroids work, the way they are grouped based on strength, and examples of medications. Robert Brook / Getty Images How Topical Steroids Work Topical steroids help by reducing inflammation in your skin. Inflammation is a sign of an immune response. The treatment is applied to an affected area of skin to help reduce symptoms such as rashes, scaly patches, itching, pain, redness, or swelling. For example, eczema, also known as atopic dermatitis, is a group of skin conditions that lead to itchy and inflamed skin with a scaly rash. Eczema is common in children. If you experience a flare-up of eczema, you can apply a cream to help you stop scratching the area and allow your skin to heal. Topical steroids may be used for other skin conditions such as: Psoriasis, an autoimmune disorder that causes scaly patches of skin Seborrheic dermatitis, a skin rash with red patches and greasy yellow scales that typically affects the scalp Contact dermatitis, a red rash caused by contact with a substance that irritates the skin or causes an allergic reaction to it The skin has two main layers: an outer layer called the epidermis and the inner layer called the dermis. The strength of a topical steroid is determined by a test that measures how much it can cause your blood vessels to constrict in the upper part of the dermis. As blood vessels constrict, it can reduce swelling and discomfort. Recap Topical steroids constrict blood vessels to reduce inflammation. They may be prescribed for autoimmune disorders that affect the skin, allergic reactions, and conditions that result in rashes. Formulations Topical steroids are usually applied in a thin layer and massaged into your skin anywhere from one to four times a day.They can come in different forms including: Creams, which are the most commonly prescribed, are a mixture of water and oils and usually contain a preservative. They're especially good for hairy and wet areas and are easily applied without a greasy feel. Ointments are made of oils and little to no water and don't usually contain a preservative. They're great for dry, scaly skin or areas with thick skin like the soles of your feet and the palms of your hands. Gels are made with water and propylene glycol, a synthetic alcohol. Like creams, they're easy to apply. Solutions, foams, and lotions usually contain oil, water, and chemicals and are used on your scalp. Recap Topical steroids come in both oily and non-greasy options. The type prescribed varies based on the area of skin where it will be applied. Classification by Strength Topical steroids come in a range of strengths and are divided into seven classes based on how strong they are. The strongest steroids are in Class I (class one) and the weakest steroids are in Class VII (class seven). Class I topical steroids are approximately 600 to 1,000 times stronger than those in Class VII. It is important to note that the percentages listed on a product label do not reflect the product's strength. For example, a 0.01% Class I topical steroid is far more potent than a 3% Class VII steroid. Treatment Considerations The appropriate steroid strength, or potency, depends on a variety of factors. For example, babies absorb topical steroids much faster than adults, so they may require a low-potency steroid. Areas of the body where skin touches skin, such as the armpits or under the breasts, or sensitive areas of skin such as the eyelids, also absorb topical steroids quickly and may only need a low-potency formulation. However, thick, rough skin on the palms of your hands and the soles of your feet usually absorbs topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid. The greater the potency of a topical steroid, the greater the risk of side effects. Side Effects Common side effects of topical steroids include: Skin thinning Easy bruising Enlarged blood vessels (telangiectasia) Thickening of hair (hypertrichosis) Stretch marks in the armpits or groin Burning or stinging where the medication is applied Your healthcare provider can help you weigh the risks and benefits of using a topical steroid and to find a strength that may be best suited for your skin condition. How long the drug should be used will also vary based on your condition. Follow all instructions for using the drug properly and contact your provider if it isn't helping with your symptoms or it leads to more irritation. You may need a change in potency or formulation or you may need to stop using the medication. Medication Options There are many medications and formulations within each class of topical steroids. Topical Steroid Class I The highest potency topical steroids include: Temovate (clobetasol propionate) 0.05% ointment Ultravate (halobetasol propionate) 0.05% cream, ointment, or lotion Psorcon (diflorasone diacetate) 0.05% ointment Diprolene (betamethasone dipropionate) 0.25% ointment or gel Topical Steroid Class II These topical steroids are considered highly potent: Lidex (fluocinonide) 0.05% cream, gel, ointment, or solution Halog (halcinonide) 0.1% cream, ointment, or solution Cyclocort (amcinonide) 0.1% ointment Topicort (desoximetasone) 0.25% cream or ointment Topical Steroid Class III These topical steroids are considered potent: Elocon (mometasone furoate) 0.1% ointment Cutivate (fluticasone propionate) 0.005% ointment Betanate (betamethasone dipropionate) 0.05% cream Kenalog (triamcinolone acetonide) 0.5% cream or ointment Topical Steroid Class IV These topical steroids are considered moderately potent: Synalar (fluocinolone acetonide) 0.025% cream or ointment Cordran (flurandrenolide) 0.05% cream, ointment, or lotion Triderm (triamcinolone acetonide) 0.1% cream, ointment, or lotion Elocon (mometasone furoate) 0.1% cream, lotion, or solution Cutivate (fluticasone propionate) 0.05% cream Topical Steroid Class V These topical steroids are considered somewhat potent: Westcort (hydrocortisone valerate) 0.2% cream or ointment Locoid (hydrocortisone butyrate) 0.1% ointment Dermatop (prednicarbate) 0.1% cream or ointment Pandel (hydrocortisone probutate) 0.1% cream Topical Steroid Class VI These topical steroids are considered mild: Desonate (desonide) 0.05% gel Synalar (fluocinolone acetonide) 0.025% cream, solution, or shampoo Locoid (hydrocortisone butyrate) 0.1% cream, lotion, or solution Topical Steroid Class VII These topical steroids are considered the least potent: Hytone (hydrocortisone) 2.5% cream and lotion Hydrocortisone 1% (many over-the-counter brands of creams, ointments, and lotions) Anusol-HC (hydrocortisone acetate) 0.5% and 1% creams Recap There are seven classes of topical steroids based on strengths. As you go up in class and potency, the risk of side effects increases. Summary Topical steroids are medications applied to the skin to reduce inflammation and irritation. They come in over-the-counter and prescription options with a range of strengths and formulations. Class VII steroids, which includes OTC hydrocortisone creams, are the mildest, while Class I are the strongest. Your doctor can help you to decide if a topical steroid makes sense for treating your skin condition and what potency and length of treatment may be most helpful in your case. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? 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