CORTICOSTEROIDS (TOPICAL/ LOCAL) alclometasone (al-kloe-met-a-sone) Aclovate amcinonide (am-sin-oh-nide) Cyclocort betamethasone (bay-ta-meth-a-sone) Betaderm, Beta-Val, Celestoderm, Dermabet, Diprolene, Diprolene AF, Diprosone, Luxiq, Prevex, Rivasone, Rolene, Rosone, Sernivo, Valisone, Valnac clobetasol (kloe-bay-ta-sol) Clobex, Cormax, Dermovate, Embeline, Embeline E, Olux, Olux-E, Temovate, Temovate E clocortolone (kloe-kore-toe-lone) Cloderm desonide (des-oh-nide) Desocort, Desonate, DesOwen, Tridesilon, Verdeso desoximetasone (dess-ox-i-met-a-sone) Desoxi, Topicort diflorasone (dye-flor-a-sone) fluocinolone (floo-oh-sin-oh-lone) Capex, Derma-Smoothe/FS, Fluoderm, Synalar fluocinonide (floo-oh-sin-oh-nide) Lidemol, Lidex, Lyderm, Tiamol, Topactin, Vanos flurandrenolide (flure-an-dren-oh-lide) Cordran, Cordran SP fluticasone (floo-ti-ka-sone) Cutivate halcinonide (hal-sin-oh-nide) Halog halobetasol (hal-oh-bay-ta-sol) Ultravate hydrocortisone (hye-droe-kor-ti-sone) Ala-Cort, Ala-Scalp, Anusol HC, Barriere-HC, CaldeCORT Anti-Itch, Carmol HC, Cortaid, Cortate, Corticaine, Cortifoam, Cortizone, Cortoderm, Emo-Cort, Hyderm, Hydroval, Lanacort 9-1-1, Locoid, Nutracort, Pandel, Prevex HC, Sarna HC, Synacort, Texacort, TopidermHC, Uremol HC mometasone (moe-met-a-sone) Elocom, Elocon prednicarbate (pred-ni-kar-bate) Dermatop triamcinolone (trye-am-sin-oh-lone) Aristocort C, Aristocort R, Triaderm, Triderm

Indications

Management of inflammation and pruritis associated

with various allergic/immunologic skin problems.

Action

Suppress normal immune response and inflammation.

Therapeutic Effects: Suppression of dermatologic

inflammation and immune processes. Clearing of

plaques.

Pharmacokinetics

Absorption: Minimal. Prolonged use on large surface

areas, application of large amounts, or use of occlusive

dressings mayqsystemic absorption.

Distribution: Remain primarily at site of action.

Metabolism and Excretion: Usually metabolized

in skin; some have been modified to resist local metabolism

and have a prolonged local effect.

Half-life: Betamethasone—3–5 hr (plasma), 36–

54 hr (tissue). Dexamethasone—3–4.5 hr (plasma),

36–54 hr (tissue). Hydrocortisone—1.5–2 hr

(plasma), 8–12 hr (tissue). Triamcinolone—2–5

hr (plasma), 18–36 hr (tissue).

TIME/ACTION PROFILE (response depends

on condition being treated)

ROUTE ONSET PEAK DURATION

Topical min–hr hr–days hr–days

Contraindications/Precautions

Contraindicated in: Hypersensitivity or known intolerance

to corticosteroids or components of vehicles

(ointment or cream base, preservative, alcohol); Untreated

bacterial or viral infections.

Use Cautiously in: Hepatic dysfunction; Diabetes

mellitus, cataracts, glaucoma, or tuberculosis (use of

large amounts of high-potency agents may worsen condition);

Patients with pre-existing skin atrophy; OB,

Lactation: Chronic use at high dosages may result in adrenal

suppression in mother and growth suppression in

children; Pedi: Children may be more susceptible to adrenal

and growth suppression. Clobetasol not recommended

for children 12 yr; desoximetasone not recommended

for children 10 yr (cream, ointment, gel)

or 18 yr (spray).

Adverse Reactions/Side Effects

Derm: allergic contact dermatitis, atrophy, burning,

dryness, edema, folliculitis, hypersensitivity reactions,

hypertrichosis, hypopigmentation, irritation, maceration,

miliaria, perioral dermatitis, secondary infection,

striae. Misc: adrenal suppression (qdose, long-term

therapy).

Interactions

Drug-Drug: None significant.

Route/Dosage

Topical (Adults and Children): 1–4 times daily

(depends on product, preparation, and condition being

treated).

Rect (Adults): hydrocortisone Aerosol foam—90

mg 1–2 times/day for 2–3 wk; then adjusted.

Availability

Alclometasone (generic available)

Cream: 0.05%. Cost: Generic—$97.51/45 g. Ointment:

0.05%. Cost: Generic—$50.47/15 g.

Amcinonide (generic available)

Cream: 0.1%. Cost: Generic—$38.88/30 g. Lotion:

0.1%. Cost: Generic—$325.73/60 mL. Ointment:

0.1%. Cost: Generic—$388.80/60 g.

Betamethasone (generic available)

Aerosol Foam: 0.12%. Cost: Generic—$236.90/50

g. Cream: 0.05%, 0.1%. Cost: Generic—0.05%

$39.51/15 g, 0.1% $24.17/15 g. Gel: 0.05%. Cost: Generic—$

61.48/15 g. Lotion: 0.05%, 0.1%. Cost: Generic—

0.05% $66.87/60 mL, 0.1% $78.09/60 mL.

Ointment: 0.05%, 0.1%. Cost: Generic—0.05%

$43.22/15 g, 0.1% $20.34/15 g. Spray: 0.05%. In

combination with: calcipotriene (Enstilar, Taclonex),

clotrimazole (Lotrisone); see Appendix B.

Clobetasol (generic available)

Cream: 0.05%. Cost: Generic—$24.94/30 g. Emollient

cream: 0.05%. Foam: 0.05%. Cost: Generic—

$551.63/100 g. Gel: 0.05%. Cost: Generic—$47.87/

30 g. Lotion: 0.05%. Cost: Generic—$288.96/59

mL. Ointment: 0.05%. Cost: Generic—$22.96/30 g.

Scalp solution: 0.05%. Cost: Generic—$21.31/25

mL. Shampoo: 0.05%. Cost: Generic—$385.29/118

mL. Spray: 0.05%. Cost: $335.22/59 mL.

Clocortolone

Cream: 0.1%. Cost: $183.74/30 g.

Desonide (generic available)

Cream: 0.05%. Cost: Generic—$88.27/15 g. Foam:

0.05%. Cost: $630.00/100 g. Gel: 0.05%. Cost:

$449.16/60 g. Ointment: 0.05%. Cost: Generic—

$70.30/15 g. Lotion: 0.05%. Cost: Generic—

$274.42/59 mL.

Desoximetasone (generic available)

Cream: 0.05%, 0.25%. Cost: Generic—0.05%

$195.09/100 g, 0.25% $197.03/60 g. Gel: 0.05%.

Cost: Generic—$87.57/15 g. Ointment: 0.25%.

Cost: Generic—$279.97/60 g. Spray: 0.25%. Cost:

$502.50/100 mL.

Diflorasone (generic available)

Cream: 0.05%. Cost: Generic—$169.23/30 g. Ointment:

0.05%. Cost: Generic—$179.53/30 g.

Fluocinolone (generic available)

Cream: 0.01%, 0.025%. Cost: Generic—0.01%

$44.57/15 g, 0.025% $33.93/15 g. Ointment: 0.025%.

Cost: Generic—$33.93/15 g. Solution: 0.01%. Cost:

Generic—$178.80/60 mL. Shampoo: 0.01%. Cost:

$416.76/120 mL. Oil: 0.01%. Cost: Generic—

$197.90/20 mL. In combination with: hydroquinone

and tretinoin (Tri-Luma). See Appendix B.

 Fluocinonide (generic available)

Cream: 0.05%, 0.1%. Cost: Generic—0.05%

$22.32/30 g; Vanos (0.1%)—$965.89/60 g. Gel:

0.05%. Cost: Generic—$67.10/60 g. Ointment:

0.05%. Cost: Generic—$55.76/60 g. Solution:

0.05%. Cost: Generic—$100.99/60 mL.

Flurandrenolide (generic available)

Cream: 0.025%, 0.05%. Cost: 0.05% $204.60/30 g.

Lotion: 0.05%. Cost: $394.68/60 mL. Tape: 4 mcg/

cm2. Cost: $214.96/1 unit.

Fluticasone (generic available)

Cream: 0.05%. Cost: Generic—$34.37/30 g. Lotion:

0.05%. Cost: Generic—$389.95/60 mL. Ointment:

0.005%. Cost: Generic—$34.30/30 g.

Halcinonide

Cream: 0.1%. Cost: $226.55/60 g. Ointment: 0.1%.

Cost: $133.22/30 g.

Halobetasol (generic available)

Cream: 0.05%. Cost: Generic—$193.26/50 g. Ointment:

0.05%. Cost: Generic—$88.67/15 g.

Hydrocortisone (generic available)

Cream: 0.1%, 0.2%, 0.5%Rx, OTC, 1%Rx, OTC, 2.5%. Gel:

1%Rx, OTC. Ointment: 0.1%, 0.2%, 0.5%Rx, OTC, 1%Rx, OTC,

2.5%. Lotion: 1%Rx, OTC, 2.5%. Solution: 1%, 2.5%.

Spray: 0.5%Rx, OTC, 1%Rx, OTC. Rectal cream: 1%. Rectal

aerosol: 10%. In combination with: acetic

acid, antifungals, anti-infectives, antihistamines, urea,

and benzoyl peroxide in various otic and topical preparations.

See Appendix B.

Mometasone (generic available)

Cream: 0.1%. Cost: Generic—$15.59/15 g. Ointment:

0.1%. Cost: Generic—$28.10/15 g. Lotion:

0.1%. Cost: $58.20/30 mL.

Prednicarbate (generic available)

Cream: 0.1%. Cost: Generic—$23.08/15 g. Ointment:

0.1%. Cost: Generic—$30.00/15 g.

Triamcinolone (generic available)

Cream: 0.025%, 0.1%, 0.5%. Cost: Generic—

0.025% $4.45/15 g, 0.1% $5.57/15 g, 0.5% $10.11/15

g. Ointment: 0.025%, 0.1%, 0.5%. Cost: Generic—

0.025% $10.11/80 g, 0.1% $5.58/15 g, 0.5% $10.10/

15 g. Lotion: 0.025%, 0.1%. Cost: Generic—0.025%

$37.79/60 mL, 0.1% $90.00/60 mL. In combination

with: acetic acid, antifungals, anti-infectives, antihistamines,

urea, and benzoyl peroxide in various otic and

topical preparations. See Appendix B.