Hydrocortisone and betamethasone are examples of low- and high-potency topical corticosteroids. Topical corticosteroids have been ranked in terms of potency into four groups consisting of seven classes. Class I topical corticosteroids are the most potent and Class VII are the least potent. Efficacy and side-effects are greatest with the Class I ultra-high-potency preparations which should only be used for limited time periods (2-3 weeks). Representative preparations by group are listed in the table below. These groups may vary depending on the formulation and concentration and should be considered approximate. In general, ointments are more potent than creams or lotions. Potency is also increased when topical corticosteroids are used under occlusive dressings or in intertriginous areas.
Topical steroids are available as creams, lotions, gels and ointments; selection of an appropriate product can also provide good moisturization of the skin. The wide spectrum of potencies and bases allows these mediations to be used both effectively and safely while under the care of an experienced physician.
During flares, over-the-counter moisturizing preparations that include a topical corticosteroid (such as clobetasone butyrate and hydrocortisone) are helpful to control inflammation and restore the skin barrier. The intensive use of emollient-based products can reduce the need for topical steroids.
It is important to use the correct amount of topical steroid for your eczema, as instructed by your healthcare professional. Topical steroids should be applied with clean hands so that the skin just glistens. It can sometimes be difficult to judge how much steroid to use and there are guidelines on the amount required to cover body areas that are affected by eczema. These are based on the Finger Tip Unit (FTU), and explained in detail in our fact sheet which you can download as a pdf from the related documents to the right of this page.