Potency of Topical Steroid Creams

Ok, I've decided to go all scientific on you all today (Sorry, I've been reading too much of Miss Kitty's Blog!) and talk about steroid cream potency.

I think this is an important subject to address and I base this on the fact that I was very ignorant about this subject up until recently. Yes, I knew that steroid creams came in various strengths and that different parts of the body absorb them in different ways.

The three main creams that I used over the years were Hydrocortisone, Eumovate and Betnovate. I knew hydrocortisone was mild enough to be sold over the counter and the only cream that doctors recommend to be used on the face, but how to the other two compare in strength? Well, I presumed that the Eumovate was a bit stronger than the hydrocortisone (and still used it on my face!) and that the Betnovate was stronger still, but had no clue how much stronger, maybe four times as strong? Boy, was I wrong.

According to Demnetnz.org, steroid creams come in a range of increasing potencies. The chart on their site is more useful than others I have seen because it actually compares the creams with hydrocortisone to show how strong they are.

Hydrocortisone is classed as a mild steroid and is on its own in Group 4. Bear in mind however, that people have become addicted to hydrocortisone cream over a prolonged time period, so it can be by no means considered "safe".

The next class is Group 3, the moderate steroids and includes my old friend Eumovate (Clobetasone butyrate) and another cream called Triamcinolone acetonide (Aristocort™ Cream/Ointment, Viaderm KC™ Cream/Ointment, Kenacomb™ Ointment).

Now for the shock: These creams are 2-25 times as potent as hydrocortisone! Ouch.

Group 2 contains the more potent steroids, including Betnovate, a cream that I dutifully slathered on my face, against doctors orders for over a year. These include Betamethasone valerate (Beta™ Cream/Ointment/Scalp Application, Betnovate™ Lotion/C Cream/C Ointment, Fucicort™),Betamethasone dipropionate (Diprosone™ Cream/Ointment, Daivobet® 50/500 Ointment/Gel),Diflucortolone valerate (Nerisone™ C/Cream/Fatty Ointment/Ointment), Hydrocortisone 17-butyrate (Locoid™ C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion) , Mometasone furoate (Elocon™ Cream/Lotion/Ointment)  and Methylprednisolone aceponate (Advantan™ Cream/Ointment)

These steroids are a staggering 100-150 as potent as hydrocortisone. This came as a major revelation for me because I did not realise just how strong they were. In other words, my twice daily slathering of Betnovate was like putting 200 applications of hydrocortisone on my skin. No wonder my skin is messed up.

Now for the big guns of Group 1. These include Clobetasol propionate (Dermol™ Cream/Ointment) and Betamethasone dipropionate (Diprosone™ OV Cream/Ointment).

You may want to sit down for this. These creams are up to 600 times more potent than hydrocortisone. and sadly, these very potent creams are commonly prescribed to treat eczema by dermatologists. Why? Because the weaker stuff is not working...

When these fail, dermatologists have no choice but to supplement with oral steroids like prednisone.

It also really matters where you apply the creams. The following chart is taken from the same site and shows absorption rates for various parts of the body:

Forearm absorbs 1%

Armpit absorbs 4%

Face absorbs 7%

Eyelids and genitals absorb 30%

Palm absorbs 0.1%

Sole absorbs 0.05%

So use a strong steroid on your eyelids and you are asking for trouble....

The site also goes on to explain that 500g of hydrocortisone a week is enough to cause adrenal gland suppression, which may lead to a more serious condition called Cushings Syndrome.

I hope that this research will help you to understand better how steroid creams vary in strength and potency. A worrying trend indeed. Ever wonder why eczema is a "Western Disease" and rarely occurs in Third world countries? Well, we "lucky" folks in the west have better access to medicines like these....