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Combination antibacterial/corticosteroid preparations should only be used short-term (for less than one week) to reduce the risk of antimicrobial resistance developing. Very high potency (Class 1) These topical corticosteroids are up to 600 times more potent than topical hydrocortisone. Generic name Brand name examples Augmented betamethasone dipropionate gel and ointment 0. Potent (Class 2) These topical corticosteroids are 100-150 times more potent than topical hydrocortisone. Generic name Brand name examples amcinonide ointment 0. Upper medium potency (Class 3) These topical corticosteroids are up to 25 times more potent than topical hydrocortisone. Generic name Brand name examples amcinonide 0. Medium potency (Class 4 and 5) These topical corticosteroids are between 2 and 25 times more potent than topical hydrocortisone. Generic name Brand name examples betamethasone valerate Beta-Val cream/lotion (0. Mild (Class 6) These topical corticosteroids are slightly more potent than topical hydrocortisone. Generic name Brand name examples alclometasone dipropionate 0. Least potent (Class 7) Hydrocortisone is the least potent topical corticosteroid. Generic name Brand name examples hydrocortisone 1%, 2. Note that potency charts vary depending on the source. This grouping of potencies is based on the best effort accumulation of data. Are topical steroids safe? Serious side effects are uncommon or rare when topical corticosteroids are used exactly as directed and for the time intended, but may include: Cushing syndrome: Rare, but the risk is higher if large quantities of a topical corticosteroid (>50g/week of clobetasone propionate or >500g/week of hydrocortisone) are used long-term Glaucoma or cataracts caused by excessive use of topical steroids near the eye. Topical steroids should not be confused with anabolic steroids often abused by body-builders to increase muscle mass. For a complete list of severe side effects, please refer to the individual drug monographs. What are the side effects of topical steroids? Common side effects reported with topical steroids include: Easy bruising and tearing of the skin Enlarged blood vessels (telangiectasia) Folliculitis (inflammation of the hair follicles) and miliaria (sweat rash): ointments Increased hair thickness and length in the area of application (hypertrichosis) Skin thinning Stinging or inflamed skin: creams Stretch marks (striae) especially in the armpits or groin. Side effects associated with more potent topical steroid use include: Perioral dermatitis (also called ‘Muzzle rash’). Consists of small, red, pus-filled bumps and mild peeling around the mouth Steroid rosacea: A rosacea-like condition near the middle of the face. Can worsen when the topical steroid is discontinued Pustular psoriasis: Clearly defined raised bumps filled with pus Topical corticosteroid withdrawal: Symptoms include red burning skin, swelling, or pimples after discontinuation of the topical corticosteroid. Topical corticosteroids can also mask the symptoms of infections caused by bacteria, fungi, or viruses, anabolic hormone levels.
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