Topical Corticosteroids: Comparison Chart Prepared by Loren Regier BA, BSP www.RxFiles.

ca Sept 04
POTENCY
1,2,3,4
& $
Ultra--High ---Mid ----Low-
DRUG/STRENGTH C
(grouped by formulation & potency)
BRAND NAME
1 2 3 4 5 6 7
SIZE /
COMMENTS
CREAMS cause less occlusion, are suitable for non-acute, wet lesions & tend to be cosmetically more acceptable
Betamethasone dipropionate glycol 0.05% Diprolene Glycol, Topilene Glycol
PB
$26
15,50g
PG,
Clobetasol propionate 0.05% Dermovate, Others $22
15,50g PG
Desoximetasone 0.25% Topicort
PB, WA
$29
20,60g

Fluocinonide 0.05%
Lidex, Lyderm
Lidemol (Emollient Base)
$24
$27
15,60g PG

Halcinonide 0.1% Halog $26

15,30,60g PG
Halobetasol propionate 0.05% Ultravate %
Exception Drug Status in Sask.
t
$34
15,50g
Betamethasone dipropionate 0.05% Diprosone, Taro-Sone
PG
;Lotriderm
1%clotrimazole OHPG
$15
High Potencyagents:
reserve for resistant
conditions/ thick
skin areas due to
potential for local &
systemic side effects.
Ultra Potent agents:
max ~50g/week;
limit duration
apply OD-BID
15,50,450g

Amcinonide 0.1% Ratio,Amcort $17 Cyclocort (lanolin,paraben,PG,tartrazine,urea free) $25

15,30,60g
OH,
Beclomethasone dipropionate 0.025% Propaderm $28
15,45g OH
Clobetasone butyrate 0.05% Eumovate $23
15,30g
Desoximetasone 0.05% Topicort Mild
PB, WA
, Desoxi $23
20,60g

Diflucortolone valerate 0.1% Nerisone Cr

PB
, Nerisone Oily Cr (NP),(Nerisalicoily
3%SA

t
) $21
30g

Mometasone furoate 0.1% Elocom (Once daily recommended) $30

15,50,100g PG
Triamcinolone acetonide 0.1% Kenalog, Triaderm, Aristocort-R R=reg $10
15,30,500g PG
Betamethasone valerate 0.1%
0.05%
Betaderm
PG
, Ratio-Ectosone
PB
Betaderm
PG
, Ratio-Ectosone Mild
PB
$8
15,~450g

low cost
Fluocinolone acetonide 0.025%
0.01%
Fluoderm regular
Fluoderm mild
$19
$10
15,500g PG, PB
Hydrocortisone valerate 0.2% Westcort, Hydroval
PB
$14
15,45,60g
PG,
Triamcinolone acetonide 0.025% Triaderm $9
15,30,500g PG
Desonide 0.05% Desocort $17
15,60g PG
Hydrocortisone/Urea 1%/10% Uremol-HC $14
50,225g PG ;8-15C
Hydrocortisone 2.5%
1%
0.5% (OTC)
Emo-Cort
Hyderm, Emo-Cort
Hyderm, others
Low Potency: preferred
when necessary on thin
skin areas, in elderly,
young children or infants
or if used long-term.
Caution if on face or thin
skin areas!
$15
$8
$13
45,225g
15,~450g
OD-QID
low cost
OINTMENTS Ointments are more occlusive, greasy; more effective in dry, scaly, or hyperkeratinized skin areas
Betamethasone dipropionate glycol 0.05% Diprolene glycol, Topilene glycol $26
15,50g PG
Betamethasone dipropionate 0.05%+SA 3%Diprosalic (SA=Salicylic Acid-karatolytic) $32
15,50g psoriasis
Clobetasol propionate 0.05% Dermovate
PG
, Others
PG
$22
15,50g PB &
lanolin free
Halobetasol propionate 0.05% Ultravate %
Exception Drug Status in SK
t
$34
15,50g PG
Amcinonide 0.1% Cyclocort $25 (tartrazine free); Ratio $17
15,30,60g OH
Betamethasone dipropionate 0.05% Diprosone, Topisone $15
15,50,450g
Desoximetasone 0.25% Topicort $29
20,60g PG
Fluocinonide 0.05% Lidex, Lyderm $20
15,60g PG
Halcinonide 0.1% Halog $24
30,60g
Betamethasone valerate 0.1% Betaderm $8
454g low cost
Mometasone furoate 0.1% Elocom, Ratio (Once daily recommended) $22
High Potencyagents:
-see comments above
in the cream section
Ultra Potent agents:
-see comments above
in the cream section
Ointments MORE
potent than creams!
15,50,100g PG
Triamcinolone acetonide 0.1%
0.1% oral top
Kenalog, Triaderm
PB
, Aristocort R (NP)
Kenalog Orabase/Oracort Dental 7.5g=$18
$13
15,30,454g

Clobetasone butyrate 0.05% Eumovate $23

15,30g
Diflucortolone valerate 0.1% Nerisone (NP) $21
30 g
Fluocinolone acetonide 0.025% Fluoderm
PB
; Synalar Reg. (NP)
60g
$11
15,454g

Hydrocortisone valerate 0.2% Westcort, Hydroval

PB
$14
15,60g
PG,
Betamethasone valerate 0.05% Betaderm $8
454g low cost
Desonide 0.05% Desocort $17
15,60g
Hydrocortisone 1%; 0.5% (OTC) Cortoderm
PB
(1% Cortate D/Cd
2004
)
Low Potency: -see
comments above in the
cream section $8
15,~450g OD-QID
Other steroidal: prednicarbate 0.1% crm,oint; Dermatop; Potency Group 5 ; $25/30g 8& {possibly less skin atrophy than other mid-potency agents}
5,6
Non-steroidal:tacrolimus 0.03%,0.1% oint; Protopic $89/30g %&. Pimecrolimus 1% crm; Elidel $77/30g %.UseBID; atrophy; burning, skin infection~ csteroids}
FDA Mar/05 cancer warning: a few human reports & in 3 different animal species as amount of drug so did risk of cancer.
7
(continued): Topical Corticosteroids: Comparison Chart www.RxFiles.ca Sept 04
POTENCY & $
Ultra--High -- Mid --- Low-
DRUG/STRENGTH C
(by formulation & potency)
BRAND NAME
1 2 3 4 5 6 7
SIZE /
COMMENTS
GELS Gels are non-occlusive, non-greasy, quick drying, & do not leave residue; useful on hairy areas, face; irritating
Desoximetasone 0.05% Topicort Gel $25
20,60g OH
Fluocinonide 0.05% Lyderm, Topsyn Gel NP $20
15,60g
PG,
LOTIONS / SOLUTIONS Least occlusive; preferred in acute weeping lesions; axilla, foot, groin & hairy areas
Betamethasone dipropionate glycol 0.05% lot. Diprolene Glycol, Topilene Glycol $41
30,60ml PG, OH
Betamethasone dipropionate 0.05%+SA 2%lot. Diprosalic,Topisalic (SA=Salicylic Acid) $32
30,60ml
OH,
Clobetasol propionate 0.05% scalp lot.
0.05% topical solution
Dermovate, Others
Taro-clobetasol

t
$33
$31
Max ~50ml/wk
with Ultra
potent agents
20,60ml OH
Halcinonide 0.1% solution Halog $36
60ml
Betamethasone dipropionate 0.05% lot. Diprosone, Topisone, Taro-sone $22 {?AHFS-Group 5}
30,75ml OH
Amcinonide 0.1% lotion) Ratio $24; Cyclocort (lanolin,PG,tartrazine,urea free) $38
20,60ml
OH,
Beclomethasone dipropionate 0.025% lotion Propaderm $33
20,60ml PG
Mometasone furoate 0.1% lotion Elocom $43
30,75ml PG, OH
Betamethasone valerate 0.1% scalp lot.
0.1% lotion
0.05% lotion
Valisone, Ectosone, Betaderm
Ratio-Ectosone
Ratio-Ectosone Mild
$14
$25
$21
30,75ml
60ml
60ml
OH
OH, PB
OH, PB
Fluocinolone acetonide 0.01% solution
shampoo
topical oil
Synalar
Capex (12mg capsule+shampoo base)
Derma-Smoothe/FS
OH, peanut oil
$36
$25
$25
60ml
180ml
118ml
PG; NP
PG, PB
Desonide 0.05% lotion Desocort $18
60,120ml PB, PG
Hydrocortisone / Urea 1%/10% Uremol-HC keratin softening/hydrating $15
150ml
Hydrocortisone 2.5% scalp solution
2.5% lotion
1% lotion
0.5% lotion
Emo-cort
OH
xSarna-HC (camphor & menthol)
Emo-Cort
xSarna-HC (camphor & menthol)
Emo-Cort
Cortate (D/C by company 2004)
$21
$20
$21
$14
$18
$15
Emo-Cort=60ml
Sarna-HC 2.5%=75ml
1% =150ml
Cortate=30ml
Cost =total cost for 30g/60ml in Sask. Lowest price alternative used where avail. x =not interchangeable in Sask. 8non-formulary in SK t=covered by NIHB =not NIHB
= brand specific info in brand section; OH = benzyl or isopropyl alcohol; NP = no preservatives; PB = parabens; PG = propylene glycol; WA = wool alcohol
Table 4: Potency * Classification
1,2,3
- Ultra high potency steroids are up to 1000 times more potent than hydrocortisone
Group 1= Ultra High Potency
Group 2,3 = High Potency
reserve for resistant conditions; high potential for serious side effects (local & systemic)
suitable for short term intermittent use in severe eczematous dermatoses and psoriasis
often required for palms, soles, & scalp where thickened skin may require prolonged Tx
generally limit to OD-BID, & length of Tx. to 2-4 weeks followed by less potent agent
avoid use on large areas, thin skin areas, skin folds, in young children/infants, face
Group 4,5 = Mid Potency
suitable for intermittent long term use, chronic use in thick skin areas (hand eczema)
avoid on thin skin areas; extreme CAUTION if used on face, intertriginous areas (severe adverse effects)
Group 6,7 = Low Potency
safest for use in children, infants & elderly or when covering large or higher risk areas (face, eyelids,
skin flexures, scrotum); CAUTION still required! suitable for maintenance of most chronic conditions
after initial control obtained often applied BID-QID; apply less frequent (OD-BID) if ongoing use
*Actual potency may vary considerably depending on: site of application, skin condition, use of occlusion, and individual patient variation.
Table 5: Quantities of Cream Required in an Adult
8
Table 6: Non-steroid Emollients
Single
Application
Area Amount Needed to
Apply BID X7 Days
1g 1 hand 15g
2g 2 hands; head; face; genital 30g
3g 1 arm; front or back of trunk 45g
4g 1 leg 60g
30-60g Whole body 500-1000g
* 1g of cream should cover ~100cm
2
of area. Ointments spread easier
than creams 5-10% less ointment may be required than cream.
A&D Ointment lanolin, petrolatum, light mineral oil
Alpha-Keri (bath oil / soap) mineral oil, lanolin / glycerin
Aveeno (bath oil, lotion, oilated powder & bar) colloidal oatmeal
Eucerin (cream, lotion) petrolatum & petrolatum liquid
Hydrous Emulsifying Ointment (HEO)
Keri (lotion) mineral oil, lanolin
Lubriderm AHA (cream, lotion) lactic acid; Lubriderm lotion
Nutraderm (lotion) light mineral oil
Sarna Lotion contains camphor-menthol-phenol
Uremol 10%, (cream, lotion); 20% (cream) urea
Vaseline (ointment); Vaseline Intensive Care (lotions,creams)
www.RxFiles.ca
50

1
American Hospital Formulary System (AHFS) Drug Information 2004.
2
Merck Manual of Diagnosis and Therapy 1999 (http://www.merck.com/pubs/mmanual/tables/110tb1.htm access verified May 27, 2003)
3
WHO Model Prescibing Information: Drugs Used Dermatology, draft 1995.
4
Stoughton R. The vasoconstrictor assay in bioequivalence testing: practical concerns and recent developments. Int J Dermatol 1992; Suppl 1:26-28.
5
Brazzini B, Pimpinelli N. New & established topical corticosteroids in dermatology: clinical pharmacology and therapeutic use. Am J Clin Dermatol. 2002;3(1):47-58.
6
Korting HC, Unholzer A, Schafer-Korting M, Tausch I, Gassmueller J, Nietsch KH. Different skin thinning potential of equipotent medium-strength glucocorticoids.
Skin Pharmacol Appl Skin Physiol. 2002 Mar-Apr;15(2):85-91.
7
FDA Issues Public Health Advisory Informing Health Care Providers of Safety Concerns Associated with the Use of Two Eczema Drugs, Elidel and Protopic Mar
10,2005 http://www.fda.gov/bbs/topics/ANSWERS/2005/ANS01343.html