Table 4. Some Topical Drugs for Atopic Dermatitis Drug Vehicle CALCINEURIN INHIBITORS Pimecrolimus 1% adel (Novartis) Tacrolimus 0.03% Protopic (Astellas) Tacrolimus 0.1% Protopic (Astellas) CORTICOSTEROIDS Super-High Potency Betamethasone dipropionate augmented 0.05% int. lotion, gel Diprolene (Schering-Plough). gel Clobetasol propionate 0_059'0 Cormax (Watson) Ciao( (Gaiderma) Olux (Connetics Corp) Temovate (GSK) Fluocinonide 0.1% Vance (Megicis) Halobetasol propionate 0.05% Uttravate (Ranbaxy) High Potency Amcinonide 0.1% Betamethasone dipropionate 0.05% augmented aprolene AF (Schering-Plough) Beta methasone dipropionate 0.05 Desoximetasone 0.25% Topicort (Taro) Topicort 0.05% (Taro) Diflorasone diacetate 0.05% Fluocinonide 0_05% Halcinonide 0.1% Ha log (Ranbaxy) Mometasone furo ate al% Docon (Schering-Plough) Triamcinolone acelonide 0.5%., gel, foam. soln, soln lotion, spray. shampoo foam, soin,, gel,,, gel,, gel, gel gel gel,, soln. Table 4. Some Topical Drugs for Atopic Dermatitis (cont.) Drug Vehicle Medium-High Potency Amcinonide 0.1%. lotion Betamethasone dipropionate 0.05c.% Betamethasone valerate 0.19 Diflorasone diacetate 0.05% Fluocinonide emollient 0.05% Fluticasone propionate 0_005% Cutivate (PharmDerm) Triamcinolone acetonide 0.19/0 Triamcinolone acetonide 0.5% Medium Potency Betamethasone valerate 0.12% timid (Stiefel Labs) Flu ocinolone acetonide 0.0259'0 valerate 0.2% Westcort (Ranbaxy) Mometasone furoate 0.1% Elocon (Schering-Plough) Triamcinolone acetonide 0.19'0 Medium-Low Potency Betamethasone dipropionate 0.05% Betamethasone valerate 0.1% Desonide 0.059'0 Desowen (Galderma) 0_025% Flurandrenolide 0_05% Cordran (Aqua) Cordran SP (Aqua) Fluticasone propionate 0_05% Cutivate (PharmaDerm) foam Dint, lotion, lotion lotion lotion
BRAND NAME GENERIC NAME BRAND NAME GENERIC NAME CLASS 2 - Potent (cont.) CLASS 5 - Lower Mid-Strength (cont.) Halog Ointment/Cream, 0.1% Halcinonide DesOwen Lotion, 0.05% Desonide Lidex Cream/Gel/Ointment, 0.05% Psorcon Cream, 0.05% Fluocinonide Diflorasone diacetate Locoid Cream/Lotion/Ointment/ Solution, 0.1% Pandel Cream, 0.1% Topicort Cream/Ointment, 0.25% Desoximetasone Synalar Cream, 0.03/0.01% Topicort Gel, 0.05% Desoximetasone Westcort Cream, 0.2% valerate CLASS 3 - Upper Mid-Strength Cutivate Ointment, 0.005% Fluticasone propionate Lidex-E Cream, 0.05% Fluocinonide Luxiq Foam, 0.12% Betamethasone valerate Topicort LP Cream, 0.05% Desoximetasone CLASS 4 - Mid-Strength Cordran Ointment, 0.05% Flurandrenolide Elocon Cream/Lotion, 0.1% Mometasone furoate Kenalog Cream/Spray, 0.1% Triamcinolone acetonide Synalar Ointment, 0.03% Westcort Ointment, 0.2% valerate CLASS 5 - Lower Mid-Strength Capex Shampoo, 0.01% Cordran Cream/Lotion/Tape, 0.05% Flurandrenolide CLASS 6 - Mild Aclovate Cream/Ointment, 0.05% Derma-Smoothe/FS Oil, 0.01% Desonate Gel, 0.05% Synalar Cream/Solution, 0.01% Verdeso Foam, 0.05% CLASS 7 - Least Potent Cetacort Lotion, 0.5%/1% Cortaid Cream/Spray/Ointment, 1% Hytone Cream/Lotion, 1%/2.5% Micort-HC Cream, 2%/2.5% Nutracort Lotion, 1%/2.5% Synacort Cream, 1%/2.5% Alclometasone dipropionate Desonide Desonide Cutivate Cream/Lotion, 0.05% DermAtop Cream, 0.1% Fluticasone propionate Prednicarbate 12 National Psoriasis Foundation topical treatments 13
THE MERCK MANUALS ONLINE MEDICAL LIBRARY FOR HEALTHCARE P R O F E S S I O N A L S SECTION Dermatologic Disorders SUBJECT Principles of Topical Dermatologic Therapy TOPIC Principles of Topical Dermatologic Therapy RELATIVE POTENCY OF SELECTED TOPICAL CORTICOSTEROIDS CLASS* DRUG I II III IV V VI VII Betamethasone dipropionate 0.05% ment Clobetasol propionate 0.05% or ment Diflorasone diacetate 0.05% ment Halobetasol propionate 0.05% or ment Amcinonide 0.1% ment Betamethasone dipropionate 0.05% Betamethasone dipropionate 0.05% ment Desoximetasone 0.25%, 0.05% gel, or 0.25% ment Diflorasone diacetate 0.05% ment Fluocinonide 0.05%, gel, ment, or solution Halcinonide 0.1% Mometasone furoate 0.1% ment Amcinonide 0.1% or lotion Betamethasone dipropionate 0.05% Betamethasone dipropionate 0.05% lotion Betamethasone valerate 0.1% ment Diflorasone diacetate 0.05% Fluocinonide 0.05% Fluticasone propionate 0.005% ment Halcinonide 0.1% ment or solution Triamcinolone acetonide 0.1% ment 0.025% ment Flurandrenolide 0.05% ment Mometasone furoate 0.1% or lotion Triamcinolone acetonide 0.1% ment Triamcinolone acetonide 0.1% Betamethasone valerate 0.1% Desonide 0.05% ment 0.025% Flurandrenolide 0.05% Fluticasone propionate 0.05% butyrate 0.1%, ment, or solution valerate 0.2% or ment Triamcinolone acetonide 0.1% lotion or 0.025% ment Alclometasone dipropionate 0.05% or ment Betamethasone valerate 0.1% lotion Desonide 0.05% 0.01% or solution Flumethasone pivalate 0.03% Triamcinolone acetonide 0.1% Triamcinolone acetonide 0.025% or lotion 1% or 2.5%, 1% or 2.5% lotion, or 1% or 2.5% ment acetate (1% or 2.5%, 1% or 2.5% lotion, or 1% or 2.5% ment) and pramoxine hydrochloride 1% *Class I is the most potent, and class VII is the least potent. Potency depends on many factors, including the drug s characteristics and concentration and the base in which it is used.
TOPICAL STEROIDS Alclometasone dipropionate 0.05% Aclovate (crm, ) 0.01% Synalar (soln) base or acetate 0.5% Cortisporin* (crm) Betamethasone valerate 0.12% Luxiq (foam) Clocortolone pivalate 0.1% Cloderm (crm) Desonide 0.05% Desonate (gel) DesOwen (crm, lotion, ) Verdeso (foam) Topicort-LP (emollient crm) 0.01% Derma-Smoothe/FS (oil) Capex (shampoo) Amcinonide 0.1% Betamethasone dipropionate, augmented 0.05% Diprolene AF (emollient crm) Diprolene (lotion) Topicort (gel) Betamethasone dipropionate, augmented 0.05% Diprolene (, gel) NOTES Classification of topical steroid preparations by potency LOW POTENCY base or acetate 1% Cortisporin* () Hytone (crm, ) U-cort (crm) Vytone* (crm) INTERMEDIATE POTENCY 0.025% Synalar (crm, ) Flurandrenolide 0.025% Cordran-SP (crm) Cordran () Flurandrenolide 0.05% Cordran-SP (crm) Cordran (lotion, ) Fluticasone propionate 0.005% Cutivate () Fluticasone propionate 0.05% Cutivate (crm, lotion) probutate 0.1% Pandel (crm) HIGH POTENCY Desoximetasone 0.25% Topicort (emollient crm, ) Diflorasone diacetate 0.05% Psorcon e (emollient crm, emollient ) Fluocinonide 0.05% Lidex (crm, gel,, soln) Lidex-E (emollient crm) SUPER HIGH POTENCY Clobetasol propionate 0.05% Clobex (lotion, shampoo, spray) Cormax (, scalp application) Olux (foam) Olux-E (foam) Temovate (crm, gel,, scalp application) Temovate-E (emollient crm) *Indicates that the product has more than one active ingredient. Also available as a ally. Also available as a or ment ally. Also available as a, ment, or lotion ally. base or acetate 2.5% Anusol-HC (crm) Hytone (crm, ) Triamcinolone acetonide 0.025% Kenalog (crm, lotion, ) butyrate 0.1% Locoid (crm,, soln) Locoid Lipo (crm) valerate 0.2% Westcort (crm, ) Mometasone furoate 0.1% Elocon (crm, lotion, ) Prednicarbate 0.1% Dermatop (emollient crm, ) Triamcinolone acetonide 0.1% Kenalog (crm, lotion) Triamcinolone acetonide 0.2% Kenalog (aerosol) Halcinonide 0.1% Halog (crm,, soln) Triamcinolone acetonide 0.5% Kenalog (crm) Fluocinonide 0.1% Vanos (crm) Flurandrenolide 4mcg/sq cm Cordran (tape) Halobetasol propionate 0.05% Ultravate (crm, ) The classification is based on vasoconstrictor assays and clinical studies. Potency varies according to the corticosteroid, its concentration, and the vehicle. In general, corticosteroids in lotions, s, gels, and ments are increasingly more potent due to increased absorption from these vehicles. Absorption is increased by prolonged therapy, large areas of skin damage, and the use of occlusive dressings which may cause an increase in the incidence of side effects. (Rev. 8/2009)