Topical Corticosteroids: Comparison Chart www. …

1 Topical Corticosteroids: Comparison Chart Prepared by Loren Regier BA, BSP Sept 04 POTENCY 1,2,3,4 & $Ultra--High ---Mid ----Low-DRUG/STRENGTH C(grouped by formulation & potency)BRAND NAME1234567 SIZE /COMMENTS CREAMS cause less occlusion, are suitable for non-acute, wet lesions & tend to be cosmetically more acceptableBetamethasone dipropionate glycol Glycol, Topilene Glycol PB$2615,50gPG, Clobetasol propionate , Others$2215,50gPGDesoximetasone PB, WA$2920,60g Fluocinonide , LydermLidemol (Emollient Base )$24$2715,60gPG Halcinonide $2615,30,60gPGHalobetasol propionate Exception Drug Status in Sask. $3415,50gBetamethasone dipropionate , Taro-Sone PG;Lotriderm1% clotrimazole OH PG$15 High Potency agents:reserve for resistantconditions/ thickskin areas due topotential for local &systemic side Potent agents: max ~50g/week; limit duration apply OD-BID15,50,450g Amcinonide Ratio,Amcort $17 Cyclocort (lanolin,paraben,PG,tartrazine,urea free )$2515,30,60gOH, Beclomethasone dipropionate $2815,45gOHClobetasone butyrate $2315,30gDesoximetasone Mild PB, WA, Desoxi$2320,60g Diflucortolone valerate Cr PB, Nerisone Oily Cr (NP),(Nerisalic oily 3%SA )$2130g Mometasone furoate (Once daily recommended)$3015,50,100gPGTriamcinolone acetonide , Triaderm, Aristocort-R R=reg$1015,30,500gPGBetamethasone valerate , Ratio-Ectosone PBBetadermPG, Ratio-Ectosone Mild PB$815,~450g low costFluocinolone acetonide regular Fluoderm mild $19$1015,500gPG, PBHydrocortisone valerate , Hydroval PB$1415,45,60gPG, Triamcinolone acetonide $915,30,500gPGDesonide $1715,60gPGHydrocortisone/Urea 1%/10%Uremol-HC$1450,225gPG.

2 8-15 (OTC)Emo-CortHyderm, Emo-CortHyderm, othersLow Potency: preferredwhen necessary on thinskin areas, in elderly,young children or infantsor if used if on face or thinskin areas!$15 $8$1345,225g15,~450gOD-QIDlow costOINTMENTS Ointments are more occlusive, greasy; more effective in dry, scaly, or hyperkeratinized skin areasBetamethasone dipropionate glycol glycol, Topilene glycol$2615,50gPGBetamethasone dipropionate +SA 3%Diprosalic (SA=Salicylic Acid-karatolytic)$3215,50g psoriasisClobetasol propionate PG, Others PG$2215,50gPB &lanolin freeHalobetasol propionate Exception Drug Status in SK $3415,50gPGAmcinonide $25 (tartrazine free); Ratio$1715,30,60gOHBetamethasone dipropionate , Topisone$1515,50,450gDesoximetasone $2920,60gPGFluocinonide , Lyderm$2015,60gPGHalcinonide $2430,60gBetamethasone valerate $8454glow costMometasone furoate , Ratio (Once daily recommended)$22 High Potency agents:-see comments abovein the cream sectionUltra Potent agents:-see comments abovein the cream sectionOintments MORE potent than creams!

3 15,50,100gPGTriamcinolone acetonide oral topKenalog, Triaderm PB, Aristocort R (NP)Kenalog Orabase/Oracort Dental $18$1315,30,454g Clobetasone butyrate $2315,30gDiflucortolone valerate (NP)$2130 gFluocinolone acetonide PB; Synalar Reg. (NP) 60g$1115,454g Hydrocortisone valerate , Hydroval PB$1415,60gPG, Betamethasone valerate $8454glow costDesonide $1715,60gHydrocortisone 1%; (OTC)Cortoderm PB (1% Cortate D/C d 2004)Low Potency: -seecomments above in thecream section$815,~450gOD-QIDO ther steroidal: prednicarbate crm,oint; Dermatop; Potency Group 5 ; $25/30g {possibly less skin atrophy than other mid-potency agents} 5,6 Non-steroidal:tacrolimus , oint; Protopic $89/30g . Pimecrolimus 1% crm; Elidel $77/30g .Use BID; 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.

4 7(continued): Topical Corticosteroids: Comparison Chart Sept 04 POTENCY & $Ultra--High -- Mid --- Low-DRUG/STRENGTH C(by formulation & potency)BRAND NAME1234567 SIZE /COMMENTS GELS Gels are non-occlusive, non-greasy, quick drying, & do not leave residue; useful on hairy areas, face; irritatingDesoximetasone Gel$2520,60gOHFluocinonide , Topsyn Gel NP$2015,60gPG, LOTIONS / SOLUTIONS Least occlusive; preferred in acute weeping lesions; axilla, foot, groin & hairy areasBetamethasone dipropionate glycol Glycol, Topilene Glycol$4130,60mlPG, OHBetamethasone dipropionate +SA 2% ,Topisalic (SA=Salicylic Acid)$3230,60mlOH, Clobetasol propionate scalp lot. Topical solutionDermovate, OthersTaro-clobetasol $33$31 Max ~50ml/wkwith Ultrapotent agents20,60mlOHHalcinonide solutionHalog$3660mlBetamethasone dipropionate , Topisone, Taro-sone$22{?}

5 AHFS-Group 5}30,75mlOHAmcinonide lotion) Ratio $24;Cyclocort (lanolin,PG,tartrazine,urea free )$3820,60mlOH, Beclomethasone dipropionate lotionPropaderm$3320,60mlPGMometasone furoate lotionElocom$4330,75mlPG, OHBetamethasone valerate scalp lot. lotion lotionValisone, Ectosone, BetadermRatio-EctosoneRatio-Ectosone Mild$14$25$2130,75ml60ml60mlOHOH, PBOH, PBFluocinolone acetonide solution shampoo Topical oilSynalar Capex (12mg capsule+shampoo base)Derma-Smoothe/FS OH, peanut oil$36$25$2560ml180ml118mlPG; NPPG, PBDesonide lotionDesocort$1860,120mlPB, PGHydrocortisone / Urea 1%/10%Uremol-HC keratin softening/hydrating$15150mlHydrocortison e scalp lotion1% lotionEmo-cort OH Sarna-HC (camphor & menthol) Emo-Cort Sarna-HC (camphor & menthol) Emo-CortCortate (D/C by company 2004)$21$20$21$14$18$15 Emo-Cort=60mlSarna-HC 1% =150mlCortate=30mlCost =total cost for 30g/60ml in Sask.

6 Lowest price alternative used where avail. =not interchangeable in Sask. non-formulary in SK =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 alcoholTable 4: Potency * Classification1,2,3 - Ultra high potency steroids are up to 1000 times more potent than hydrocortisoneGroup 1 = Ultra High PotencyGroup 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, faceGroup 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!

7 Suitable for maintenance of most chronic conditionsafter 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 5: Quantities of Cream Required in an Adult8 Table 6: Non-steroid EmollientsSingleApplicationAreaAmount Needed toApply BID X7 Days1g1 hand15g2g2 hands; head; face; genital30g3g1 arm; front or back of trunk45g4g1 leg60g30-60gWhole body500-1000g* 1g of cream should cover ~100cm2 of area. Ointments spread easierthan creams 5-10% less ointment may be required than Ointment lanolin, petrolatum, light mineral oilAlpha-Keri (bath oil / soap) mineral oil, lanolin / glycerinAveeno (bath oil, lotion, oilated powder & bar) colloidal oatmealEucerin (cream, lotion) petrolatum & petrolatum liquidHydrous Emulsifying Ointment (HEO)Keri (lotion) mineral oil, lanolinLubriderm AHA (cream, lotion) lactic acid; Lubriderm lotionNutraderm (lotion) light mineral oilSarna Lotion contains camphor-menthol-phenolUremol 10%, (cream, lotion); 20% (cream) ureaVaseline (ointment).

8 Vaseline Intensive Care (lotions,creams) 1 American Hospital Formulary System (AHFS) Drug Information Merck Manual of Diagnosis and Therapy 1999 ( access verified May 27, 2003)3 WHO Model Prescibing Information: Drugs Used Dermatology, draft Stoughton R. The vasoconstrictor assay in bioequivalence testing: practical concerns and recent developments. Int J Dermatol 1992; Suppl 1 Brazzini B, Pimpinelli N. New & established Topical corticosteroids in dermatology: clinical pharmacology and therapeutic use. Am J Clin Dermatol. 2002;3(1) Korting HC, Unholzer A, Schafer-Korting M, Tausch I, Gassmueller J, Nietsch KH. Different skin thinning potential of equipotent medium-strength Pharmacol Appl Skin Physiol.

9 2002 Mar-Apr;15(2) FDA Issues Public Health Advisory Informing Health Care Providers of Safety Concerns Associated with the Use of Two Eczema Drugs, Elidel and Protopic Mar10,2005