Corticosteroids (Topical)

This monograph includes information on the following:

1) Alclometasone ^†
2) Amcinonide
3) Beclomethasone ^*
4) Betamethasone
5) Clobetasol
6) Clobetasone ^*
7) Clocortolone ^†
8) Desonide
9) Desoximetasone
10) Dexamethasone ^†
11) Diflorasone
12) Diflucortolone ^*
13) Flumethasone ^*
14) Fluocinolone
15) Fluocinonide
16) Flurandrenolide
17) Fluticasone ^†
18) Halcinonide
19) Halobetasol ^†
20) Hydrocortisone
21) Mometasone
22) Prednicarbate ^†
23) Triamcinolone

INN:
Beclomethasone— Beclometasone ^{21}
Flumethasone —Flumetasone ^{21}
Flurandrenolide—Fludroxycortide ^{21}
Halobetasol— Ulobetasol ^{21}
Hydrocortisone —Cortisol ^{21}

BAN:
Desoximetasone—Desoxymethasone ^{21}
Flurandrenolide—Flurandrenolone ^{21}
Hydrocortisone—Cortisol ^{21}

JAN:
Beclomethasone—Beclometasone ^{21}
Flumethasone—Flumetasone ^{21}
Flurandrenolide—Fluoxycortide ^{21}
Hydrocortisone—Cortisol ^{21}
Hydrocortisone buteprate—Hydrocortisone butyrate propionate ^{21}

VA CLASSIFICATION
Alclometasone
Topical
Primary: DE200

Amcinonide
Topical
Primary: DE200

Beclomethasone
Topical
Primary: DE200

Betamethasone
Topical
Primary: DE200

Clobetasol
Topical
Primary: DE200

Clobetasone
Topical
Primary: DE200

Clocortolone
Topical
Primary: DE200

Desonide
Topical
Primary: DE200

Desoximetasone
Topical
Primary: DE200

Dexamethasone
Topical
Primary: DE200

Diflorasone
Topical
Primary: DE200

Diflucortolone
Topical
Primary: DE200

Flumethasone
Topical
Primary: DE200

Fluocinolone
Topical
Primary: DE200

Fluocinonide
Topical
Primary: DE200

Flurandrenolide
Topical
Primary: DE200

Fluticasone
Topical
Primary: DE200

Halcinonide
Topical
Primary: DE200

Halobetasol
Topical
Primary: DE200

Hydrocortisone
Dental
Primary: OR900

Topical
Primary: DE200

Mometasone
Topical
Primary: DE200

Triamcinolone
Dental
Primary: OR900

Topical
Primary: DE200

Commonly used brand name(s): 9-1-1²⁰; Aclovate¹; Acticort 100²⁰; Aeroseb-Dex¹⁰; Aeroseb-HC²⁰; Ala-Cort²⁰; Ala-Scalp HP²⁰; Allercort²⁰; Alphaderm²⁰; Alphatrex⁴; Anusol-HC²⁰; Aristocort²³; Aristocort A²³; Aristocort C²³; Aristocort D²³; Aristocort R²³; Bactine²⁰; Barriere-HC²⁰; Beben⁴; Beta-HC²⁰; Beta-Val⁴; Betacort Scalp Lotion⁴; Betaderm⁴; Betaderm Scalp Lotion⁴; Betatrex⁴; Betnovate⁴; Betnovate-1/2⁴; Bio-Syn¹⁴; CaldeCORT Anti-Itch²⁰; CaldeCORT Light²⁰; Carmol-HC²⁰; Celestoderm-V⁴; Celestoderm-V/2⁴; Cetacort²⁰; Cloderm⁷; Cordran¹⁶; Cordran SP¹⁶; Cormax⁵; Cort-Dome²⁰; Cortacet²⁰; Cortaid²⁰; Cortate²⁰; Cortef²⁰; Cortef Feminine Itch²⁰; Corticaine²⁰; Corticreme²⁰; Cortifair²⁰; Cortoderm²⁰; Cortril²⁰; Cutivate¹⁷; Cyclocort²; Decaderm¹⁰; Decadron¹⁰; Decaspray¹⁰; Delacort²⁰; Delta-Tritex²³; Dermabet⁴; Dermacort²⁰; Dermarest DriCort²⁰; Dermatop²²; DermiCort²⁰; Dermovate⁵; Dermovate Scalp Lotion⁵; Dermtex HC²⁰; DesOwen⁸; Diprolene⁴; Diprolene AF⁴; Diprosone⁴; Drenison¹⁶; Drenison-1/4¹⁶; Ectosone Mild⁴; Ectosone Regular⁴; Ectosone Scalp Lotion⁴; Elocom²¹; Elocon²¹; Emo-Cort²⁰; Emo-Cort Scalp Solution²⁰; Epifoam²⁰; Eumovate⁶; Florone¹¹; Florone E¹¹; Fluocet¹⁴; Fluocin¹⁵; Fluoderm¹⁴; Fluolar¹⁴; Fluonid¹⁴; Fluonide¹⁴; Flurosyn¹⁴; Flutex²³; FoilleCort²⁰; Gly-Cort²⁰; Gynecort²⁰; Gynecort 10²⁰; Halog¹⁸; Halog-E¹⁸; Hi-Cor 1.0²⁰; Hi-Cor 2.5²⁰; Hyderm²⁰; Hydro-Tex²⁰; Hytone²⁰; Kenac²³; Kenalog²³; Kenalog in Orabase²³; Kenalog-H²³; Kenonel²³; LactiCare-HC²⁰; Lanacort²⁰; Lanacort 10²⁰; Lemoderm²⁰; Licon¹⁵; Lidemol¹⁵; Lidex¹⁵; Lidex-E¹⁵; Locacorten¹³; Locoid²⁰; Luxíq⁴; Lyderm¹⁵; Maxiflor¹¹; Maximum Strength Cortaid²⁰; Maxivate⁴; Metaderm Mild⁴; Metaderm Regular⁴; MyCort²⁰; Nerisone¹²; Nerisone Oily¹²; Novobetamet⁴; Novohydrocort²⁰; Nutracort²⁰; Occlucort⁴; Olux Foam⁵; Orabase-HCA²⁰; Oracort²³; Oralone²³; Pandel²⁰; Penecort²⁰; Pentacort²⁰; Pharma-Cort²⁰; Prevex B⁴; Prevex HC²⁰; Propaderm³; Psorcon¹¹; Rederm²⁰; Rhulicort²⁰; S-T Cort²⁰; Sarna HC 1.0%²⁰; Sential²⁰; Synacort²⁰; Synalar¹⁴; Synalar-HP¹⁴; Synamol¹⁴; Synemol¹⁴; Teladar⁴; Temovate⁵; Temovate E⁵; Temovate Scalp Application⁵; Texacort²⁰; Topicort⁹; Topicort LP⁹; Topicort Mild⁹; Topilene⁴; Topisone⁴; Topsyn¹⁵; Triacet²³; Triaderm²³; Trianide Mild²³; Trianide Regular²³; Triderm²³; Tridesilon⁸; Ultravate¹⁹; Unicort²⁰; Uticort⁴; Valisone⁴; Valisone Reduced Strength⁴; Valisone Scalp Lotion⁴; Valnac⁴; Westcort²⁰.

Other commonly used names are:

• Beclometasone —Beclomethasone

• Cortisol —Hydrocortisone

• Fludroxycortide —Flurandrenolide

• Flumetasone —Flumethasone

• Ulobetasol —Halobetasol

Note: For a listing of dosage forms and brand names by country availability, see Dosage Forms section(s).

^*Not commercially available in the U.S.

^†Not commercially available in Canada.

Category:

Corticosteroid (topical)—

anti-inflammatory, steroidal (topical)—

Indications

Note: Bracketed information in the Indications section refers to uses that are not included in U.S. product labeling.

General considerations
Topical corticosteroids are indicated to provide symptomatic relief of ^{09} inflammation and/or ^{59} pruritus associated with acute and chronic ^{100} ^{101} ^{116} ^{124} corticosteroid-responsive disorders. ^{23} ^{24} ^{38} ^{72} ^{75} ^{76} ^{77} ^{80} ^{81} ^{82} ^{83} ^{84} ^{85} ^{86} ^{87} ^{89} ^{90} ^{91} ^{92} ^{94} ^{95} ^{96} ^{100} ^{102} ^{104} ^{105} ^{106} ^{109} ^{111} ^{112} ^{114} ^{115} ^{116} ^{118} ^{124} ^{126} ^{127} ^{128} ^{129} ^{132} ^{135} ^{136} ^{137} ^{138} ^{139} ^{142} ^{144} ^{149} ^{414} ^{415} ^{417} ^{418} ^{426} ^{440} ^{441} ^{443} ^{444} ^{445} ^{446} ^{447} ^{448} ^{449} ^{450} ^{451} ^{452} ^{453} ^{454} ^{455} ^{456} ^{457} ^{458} ^{459} ^{460} ^{462} ^{463} ^{464}

The location of the skin lesion to be treated should be considered in selecting a formulation. ^{167} ^{169} In areas with thinner skin, such as facial, eye, and intertriginous areas, low-potency corticosteroid preparations are preferred for long-term therapy. ^{93} ^{160} ^{167} ^{358} Low- to medium-potency products may be used on the ears, trunk, arms, legs, and scalp. ^{93} ^{167} Medium- to very high–potency formulations may be required for treatment of dermatologic disorders in areas with thicker skin, such as the palms and soles. ^{93} Lotion, aerosol, and gel formulations are cosmetically better suited for hairy areas. ^{167}

The type of lesion to be treated should also be considered in product selection. For dry, scaly, cracked, thickened, or hardened skin, ointments of medium potency are often used. ^{93} ^{102} ^{104} ^{112} ^{114} ^{115} ^{116} ^{117} ^{120} ^{127} ^{132} ^{144} ^{183} ^{247} ^{251} Medium-potency lotions, aerosols, ^{167} or creams are preferred in treating moister, weeping lesions or areas or in treating conditions with intense inflammation. ^{93} ^{102} ^{112} ^{114} ^{115} ^{116} ^{117} ^{120} ^{127} ^{132} ^{144} ^{147} ^{167} ^{247} ^{251} ^{358} High- to very high–potency ointments may be required to treat hyperkeratotic or thick skin lesions. ^{93}

Accepted

Dermatitis, atopic, mild to moderate ^{07} ^{88} ^{93} ^{98} ^{104} ^{105} ^{112} ^{116} ^{126} ^{142} ^{143} ^{144} ^{147} ^{178} ^{181} ^{182} ^{247} ^{249} ^{250} ^{251}
Dermatitis, contact ^{07} ^{88} ^{93} ^{98} ^{100} ^{102} ^{104} ^{105} ^{112} ^{116} ^{126} ^{131} ^{135} ^{136} ^{137} ^{142} ^{143} ^{144} ^{147} ^{159} ^{181} ^{195} ^{247} ^{248} ^{249} ^{250} ^{251} ^{441}
Dermatitis, nummular, mild ^{60} ^{88} ^{93} ^{102} ^{104} ^{105} ^{116} ^{126} ^{143} ^{144} ^{147} ^{195} ^{248} ^{250}
Dermatitis, seborrheic, facial and intertriginous areas ^{07} ^{08} ^{77} ^{88} ^{93} ^{98} ^{100} ^{102} ^{104} ^{105} ^{116} ^{126} ^{135} ^{137} ^{142} ^{143} ^{144} ^{147} ^{160} ^{169} ^{195} ^{247} ^{248} ^{249} ^{250} ^{251} ^{395} ^{400} ^{441}
Dermatitis, other forms of, mild to moderate ^{07} ^{98} ^{100} ^{102} ^{104} ^{126} ^{135} ^{136} ^{137} ^{143} ^{144} ^{147} ^{247} ^{249} ^{251} ^{395} ^{437} ^{438} ^{441}
Dermatoses, inflammatory, other, mild to moderate ^{07} ^{10} ^{38} ^{72} ^{75} ^{98} ^{142} ^{143} ^{144} ^{145} ^{147} ^{159} ^{249} ^{251}
Intertrigo ^{60} ^{88} ^{93} ^{98} ^{102} ^{104} ^{105} ^{126} ^{159} ^{161} ^{247}
Lichen planus, facial and intertriginous areas ^{93} ^{98} ^{116} ^{160} ^{249}
Lupus erythematosus, discoid, facial and intertriginous areas ^{93} ^{116} ^{126} ^{135} ^{137} ^{160} ^{195} ^{247} ^{249}
Polymorphous light eruption ^{60} ^{88} ^{93} ^{98} ^{102} ^{104} ^{112}
Pruritus, anogenital ^{88} ^{89} ^{93} ^{98} ^{102} ^{104} ^{105} ^{116} ^{126} ^{133} ^{136} ^{142} ^{143} ^{144} ^{147} ^{248} ^{250} ^{441} ^{443}
Pruritus senilis ^{98} ^{185}
Psoriasis, facial and intertriginous areas ^{10} ^{88} ^{93} ^{98} ^{100} ^{102} ^{104} ^{105} ^{116} ^{126} ^{135} ^{137} ^{143} ^{144} ^{147} ^{160} ^{167} ^{170} ^{195} ^{249} ^{250} ^{441} or
Xerosis, inflammatory phase ^{88} ^{93} ^{195}—Topical corticosteroids of low to medium potency (see Table 1, Pharmacology/Pharmacokinetics ) are indicated in the treatment of corticosteroid-responsive dermatologic disorders. Occlusive dressings also may be required for chronic or severe cases of lichen simplex chronicus, psoriasis, eczema, atopic dermatitis, or chronic hand eczema. ^{104} ^{105} ^{106} ^{109} ^{126} ^{358} The more potent topical corticosteroids and/or occlusive dressings may be required for conditions such as discoid lupus erythematosus, lichen planus, granuloma annulare, psoriatic plaques, and psoriasis affecting the palms, soles, elbows, or knees. ^{398}

Alopecia areata ^{60} ^{88} ^{195}
Dermatitis, atopic, moderate to severe ^{162} ^{169} ^{182} ^{183} ^{195} ^{248}
Dermatitis, exfoliative, generalized ^{60} ^{93} ^{98} ^{102} ^{104} ^{105} ^{126} ^{143} ^{144} ^{147} ^{160}
Dermatitis, nummular, moderate to severe ^{60} ^{93} ^{102} ^{104} ^{105} ^{116} ^{126} ^{143} ^{144} ^{147} ^{195}
Dermatitis, other forms of, moderate to severe ^{93} ^{98} ^{100} ^{102} ^{104} ^{109} ^{126} ^{135} ^{137} ^{143} ^{144} ^{162} ^{169} ^{172} ^{175} ^{177} ^{181} ^{437} ^{438}
Dermatoses, inflammatory, other, moderate to severe ^{98} ^{142} ^{143} ^{144} ^{147} ^{183} ^{356}
Granuloma annulare ^{72} ^{126} ^{162} ^{169} ^{395}
Keloids, reduction of associated itching ^{163} ^{394} ^{395} ^{399}
Lichen planus ^{72} ^{88} ^{93} ^{98} ^{104} ^{105} ^{116} ^{160} ^{249}
Lichen simplex chronicus ^{10} ^{60} ^{61} ^{88} ^{93} ^{98} ^{100} ^{102} ^{104} ^{105} ^{112} ^{143} ^{144} ^{147} ^{181} ^{247} ^{248} ^{249} ^{250} ^{251} ^{401}
Lichen striatus ^{60} ^{88}
Lupus erythematosus, discoid and subacute cutaneous ^{72} ^{88} ^{93} ^{160} ^{162} ^{169} ^{195} ^{247} ^{358}
Myxedema, pretibial ^{60} ^{88}
Necrobiosis lipoidica diabeticorum ^{60} ^{88} ^{162} ^{163} ^{169} ^{394} ^{400} ^{397}
Pemphigoid ^{93} ^{162} ^{169} ^{195} ^{357}
Pemphigus ^{88} ^{162} ^{169}
Pityriasis rosea ^{93} ^{160} ^{373}
Psoriasis ^{10} ^{88} ^{93} ^{97} ^{98} ^{100} ^{102} ^{104} ^{105} ^{110} ^{116} ^{126} ^{135} ^{137} ^{143} ^{144} ^{147} ^{160} ^{162} ^{166} ^{167} ^{168} ^{169} ^{170} ^{171} ^{172} ^{173} ^{174} ^{176} ^{177} ^{179} ^{180} ^{183} ^{248} ^{249} ^{250} ^{297} ^{355}
Sarcoidosis ^{60} ^{88} or
Sunburn ^{395}—Topical corticosteroids of medium to very high potency (see Table 1, Pharmacology/Pharmacokinetics) are indicated in the treatment of corticosteroid-responsive dermatologic disorders. Systemic therapy with, or intralesional injection of, a corticosteroid may be required for some of the disorders, as determined by the type and severity of the condition or inadequate response to topical therapy. ^{143} Occlusive dressings also may be required for conditions such as discoid lupus erythematosus; bullous disorders; lichen planus; granuloma annulare; psoriatic plaques; and psoriasis affecting the palms, soles, elbows, or knees. ^{72} ^{104} ^{105} ^{106} ^{109} ^{121} ^{126} ^{183}

Oral lesions, inflammatory or ulcerative (treatment)—Hydrocortisone acetate and triamcinolone acetonide dental pastes are indicated for adjunctive treatment and temporary relief of symptoms associated with nonherpetic oral inflammatory and ulcerative lesions, including recurrent aphthous stomatitis. ^{96} ^{146} ^{250} ^{300} ^{431} [ Formulations of high potency gels and very high potency ointments also are used in the treatment of aphthous stomatitis.]¹ ^{389} ^{394} ^{395} ^{396} ^{397} ^{402}
—[These agents also are used to treat other gingival disorders, such as desquamative gingivitis and oral lichen planus when the diagnosis has been confirmed by biopsy testing. ^{160} ^{250} ^{300} ^{396} Gel formulations of high potency corticosteroids and dental triamcinolone are used in the treatment of lichen planus of the mucous membranes. ^{160}]¹
—[Other topical corticosteroids also are used to treat gingival disorders.]¹

[Phimosis]¹—Topical corticosteroids are indicated for the treatment of phimosis in boys.^{473}^{474}^{475}^{476}^{477}^{478}^{479}^{480}^{481}^{482}^{483}

Unaccepted
Medium to very high potency topical corticosteroids should not be used in the treatment of rosacea ^{11} ^{62} ^{148} ^{167} ^{249} ^{358} and perioral dermatitis. ^{11} ^{148} ^{249} ^{251} ^{435} ^{463} Although topical corticosteroids may initially reduce the burning and pustulation associated with rosacea, a severe rebound flare-up may occur upon discontinuance of the steroid. ^{167}

Topical corticosteroids should not be used in the treatment of acne. ^{11} ^{62} ^{148} ^{167} ^{249} ^{251}

Topical corticosteroids are not indicated for routine gingivitis, which should be treated by the removal of local causative factors and an improvement in oral hygiene.

Alclometasone cream or ointment should not be used in the treatment of diaper dermatitis. ^{10}

¹ Not included in Canadian product labeling.

Pharmacology/Pharmacokinetics

Note: The following table lists topical corticosteroid products available in the U.S. and/or Canada. A potency rank of Low, Medium, High, or Very High also is listed for each preparation. ^{401}
Products with a Low potency ranking have a modest anti-inflammatory effect and are safest for chronic application. These products also are the safest products for use on the face and intertriginous areas, with occlusion, and in infants and young children. ^{395} ^{396} ^{401}
Products with a Medium potency ranking are used in moderate inflammatory dermatoses. ^{401} Examples of conditions for which these products are frequently used include chronic eczematous dermatoses such as hand eczema and atopic eczema. ^{401} Medium potency preparations may be used on the face and intertriginous areas for a limited duration. ^{401}
High potency preparations are used in more severe inflammatory dermatoses. ^{401} Examples of conditions for which these products are frequently used include more severe eczematous dermatoses, lichen simplex chronicus, and psoriasis. ^{401} They may be used for an intermediate duration, or for longer periods in areas with thickened skin due to chronic conditions. ^{396} ^{401} High potency preparations also may be used on the face and intertriginous areas but only for a short treatment duration. ^{401}
Very High potency products are used primarily as an alternative to systemic corticosteroid therapy when local areas are involved. ^{401} Examples of conditions for which Very High potency products are frequently used include thick, chronic lesions caused by psoriasis, lichen simplex chronicus, and discoid lupus erythematosus. ^{401} There is a high likelihood of skin atrophy with the use of Very High potency preparations. They may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used with these products. ^{401}

Generic drug name	Dosage Form(s)	Strength (%)	Potency Ranking
Alclometasone dipropionate
	Cream	0.05	Low ^{10}
	Ointment	0.05	Low ^{10}
Amcinonide
	Cream	0.1	High
	Lotion	0.1	High
	Ointment	0.1	High
Beclomethasone dipropionate
	Cream	0.025	Medium
	Lotion	0.025	Medium
	Ointment	0.025	Medium
Betamethasone benzoate
	Cream	0.025	Medium
	Gel	0.025	Medium
	Lotion	0.025	Medium
Betamethasone dipropionate
	Cream
	Diprolene AF	0.05	Very high
	Others	0.05	High
	Gel ^{434}
	Diprolene	0.05	Very high
	Lotion
	Diprolene	0.05	Very high
	Others	0.05	High
	Ointment
	Diprolene	0.05	Very high
	Others	0.05	High
	Topical aerosol	0.1	High
Betamethasone valerate
	Cream	0.01	Medium
	Cream	0.05	Medium
	Cream	0.1	Medium
	Foam	0.12	Medium
	Lotion	0.05	Medium
	Lotion	0.1	Medium
	Ointment	0.05	Medium
	Ointment	0.1	Medium
Clobetasol propionate
	Cream	0.05	Very high
	Ointment	0.05	Very high
	Solution	0.05	Very high
Clobetasone butyrate
	Cream	0.05	Medium
	Ointment	0.05	Medium
Clocortolone pivalate
	Cream	0.1	Low
Desonide
	Cream	0.05	Low
	Lotion ^{434}	0.05	Low
	Ointment	0.05	Low
Desoximetasone
	Cream	0.05	Medium
	Cream	0.25	High
	Gel	0.05	High
	Ointment	0.25	High
Dexamethasone
	Gel	0.1	Low
	Topical aerosol	0.01	Low
	Topical aerosol	0.04	Low
Dexamethasone sodium phosphate
	Cream	0.1 (phosphate)	Low
Diflorasone diacetate
	Cream	0.05	High
	Ointment
	Psorcon	0.05	Very high
	Others	0.05	High
Diflucortolone valerate
	Cream	0.1	Medium
	Ointment	0.1	Medium
Flumethasone pivalate
	Cream	0.03	Low
	Ointment	0.03	Low
Fluocinolone acetonide
	Cream	0.01	Medium
	Cream	0.025	Medium
	Cream	0.2	High
	Ointment	0.01	Medium
	Ointment	0.025	Medium
	Topical solution	0.01	Medium
Fluocinonide
	Cream	0.01	High
	Cream	0.05	High
	Gel	0.05	High
	Ointment	0.01	High
	Ointment	0.05	High
	Topical solution	0.05	High
Flurandrenolide
	Cream	0.0125	Low
	Cream	0.025	Medium
	Cream	0.05	Medium
	Lotion	0.05	Medium
	Ointment	0.0125	Low
	Ointment	0.025	Medium
	Ointment	0.05	Medium
	Tape	4 mcg/ cm	Medium
Fluticasone propionate
	Cream	0.05	Medium ^{434}
	Ointment	0.005	Medium ^{434}
Halcinonide
	Cream	0.025	High
	Cream	0.1	High
	Ointment	0.1	High
	Topical solution	0.1	High
Halobetasol propionate
	Cream	0.05	Very high ^{434}
	Ointment	0.05	Very high ^{434}
Hydrocortisone
	Cream	0.25	Low
	Cream	0.5	Low
	Cream	1	Low
	Cream	2.5	Low
	Lotion	0.25	Low
	Lotion	0.5	Low
	Lotion	1	Low
	Lotion	2	Low
	Lotion	2.5	Low
	Ointment	0.5	Low
	Ointment	1	Low
	Ointment	2.5	Low
	Topical aerosol solution	0.5	Low
	Topical spray solution	0.5	Low
	Topical solution	1	Low
	Topical solution	2.5	Low
Hydrocortisone acetate
	Cream	0.1	Low
	Cream	0.5	Low
	Cream	1	Low
	Lotion	0.5	Low
	Ointment	0.5	Low
	Ointment	1	Low
	Topical aerosol foam	1	Low
Hydrocortisone butyrate
	Cream	0.1	Medium
	Ointment	0.1	Medium
Hydrocortisone valerate
	Cream	0.2	Medium
	Ointment	0.2	Medium
Mometasone furoate
	Cream	0.1	Medium
	Lotion	0.1	Medium
	Ointment	0.1	Medium
Triamcinolone acetonide
	Cream	0.025	Medium
	Cream	0.1	Medium
	Cream	0.5	High
	Lotion	0.025	Medium
	Lotion	0.1	Medium
	Ointment	0.025	Medium
	Ointment	0.1	Medium
	Ointment	0.5	High
	Topical aerosol	0.015	Medium

Physicochemical characteristics:
Molecular weight—
    Alclometasone dipropionate: 521.05 ^{21}
    Amcinonide: 502.58 ^{20} ^{21}
    Beclomethasone dipropionate: 521.05 ^{21}
    Betamethasone: 392.47 ^{21}
    Betamethasone benzoate: 496.58 ^{21}
    Betamethasone dipropionate: 504.6 ^{21}
    Betamethasone sodium phosphate: 516.41 ^{21}
    Betamethasone valerate: 476.59 ^{21}
    Clobetasol propionate: 466.98 ^{21}
    Clobetasone butyrate: 478.99 ^{21}
    Clocortolone pivalate: 495.03 ^{21}
    Desonide: 416.52 ^{21}
    Desoximetasone: 376.47 ^{21}
    Dexamethasone: 392.47 ^{21}
    Dexamethasone sodium phosphate: 516.41 ^{21}
    Diflorasone diacetate: 494.54 ^{21}
    Diflucortolone valerate: 478.6 ^{188}
    Flumethasone pivalate: 494.58 ^{21}
    Fluocinolone acetonide: 452.5 ^{21}
    Fluocinolone acetonide, dihydrate: 488.53
    Fluocinonide: 494.54 ^{21}
    Flurandrenolide: 436.52 ^{21}
    Fluticasone propionate: 500.58 ^{21}
    Halcinonide: 454.97 ^{21}
    Halobetasol propionate: 484.97 ^{21}
    Hydrocortisone: 362.47 ^{21}
    Hydrocortisone acetate: 404.51 ^{21}
    Hydrocortisone buteprate: 488.62 ^{21}
    Hydrocortisone butyrate: 432.56 ^{21}
    Hydrocortisone valerate: 446.59 ^{21}
    Mometasone furoate: 521.44 ^{21}
    Prednicarbate: 488.58 ^{21}
    Triamcinolone acetonide: 434.51 ^{21}

Mechanism of action/Effect:

Corticosteroids diffuse across cell membranes and complex with specific cytoplasmic receptors. ^{164} ^{167} ^{300} These complexes then enter the cell nucleus, bind to DNA (chromatin), and stimulate transcription of messenger RNA (mRNA) and subsequent protein synthesis of various inhibitory enzymes responsible for the anti-inflammatory effects of topical corticosteroids. ^{132} ^{167} ^{194} ^{300} These anti-inflammatory effects include inhibition of early processes such as edema, fibrin deposition, capillary dilatation, movement of phagocytes into the area, and phagocytic activities. Later processes, such as capillary production, collagen deposition, and keloid formation also are inhibited by corticosteroids. ^{167} ^{194} ^{300} The overall actions of topical corticosteroids are catabolic. ^{132} ^{194} ^{300}

Factors that increase the clinical efficacy and potential for adverse effects ^{132} ^{167} of topical corticosteroids include enhancement of pharmacologic activity of the compound by altering molecular structure, ^{190} ^{300} increasing stratum corneum penetration of the compound, and increasing bioavailability of the compound from the vehicle. ^{193}

The pharmacologic activity of topical corticosteroids is increased by several changes in molecular structure. ^{190} ^{300} Addition of a 9-alpha-fluorine atom increases the anti-inflammatory glucocorticoid activity, but simultaneously increases undesired mineralocorticoid activity. ^{132} ^{167} ^{190} ^{300} Mineralocorticoid activity is diminished by addition of a 16-hydroxy or 16-methyl group. ^{132} ^{190} ^{300} Substitution or masking of 16- or 17-hydroxy groups with longer side chains such as acetonide, propionate, or valerate increases lipophilicity and subsequently stratum corneum penetration. ^{190} ^{300}

Dental paste in dental dosage forms acts as an adhesive vehicle for application of corticosteroids to oral mucosa. The vehicle also reduces pain by serving as a protective covering. ^{146} ^{281}

Absorption:

Absorbed systemically across the stratum corneum.

Stratum corneum penetration is primarily enhanced by increasing skin hydration and/or temperature, or by changes in molecular structure of the compound. ^{72} ^{75} ^{76} ^{77} ^{97} ^{98} ^{100} ^{102} ^{104} ^{105} ^{110} ^{111} ^{112} ^{113} ^{115} ^{116} ^{117} ^{118} ^{120} ^{124} ^{125} ^{126} ^{127} ^{129} ^{132} ^{133} ^{134} ^{135} ^{138} ^{139} ^{141} ^{142} ^{143} ^{144} ^{145} ^{146} ^{147} ^{167} ^{169} ^{190} ^{249} ^{251} ^{300} ^{390}

Hydrating the skin with occlusive dressings such as plastic wrap, a tight-fitting diaper or one covered with plastic pants, plastic tape, or dermatological patches can increase corticosteroid penetration by up to tenfold. ^{165} ^{300} Ointment bases inhibit evaporation of moisture from skin. ^{165} ^{167} ^{300} Intertriginous areas (axillae and groin) are self-occluding. Intertriginous areas and the face also have inherently thinner skin, are more macerated and therefore, allow for increased absorption. ^{93} ^{167} ^{247} ^{300} ^{358}

Absorption of topical corticosteroids has been greatly increased by altering the product vehicle ^{10} ^{28} or the drug substance itself. ^{165} ^{300} Vehicles containing substances that solubilize the corticosteroid enhance absorption. ^{193} Increasing the concentration of the drug increases skin penetration but also may increase wastage of the drug. ^{167} ^{300} ^{436} Decreasing drug particle size has been shown to increase topical bioavailability. ^{165}

Increased percutaneous absorption of corticosteroids also occurs when the skin or mucosa is abraded or inflamed, ^{10} ^{167} when body temperature is elevated, ^{117} with prolonged use, ^{10} ^{23} ^{24} ^{163} ^{251} or with extensive use. ^{10} ^{23} ^{24} ^{75} ^{77} ^{183}

There is some systemic absorption of topical corticosteroids through the oral mucosa; absorption increases with increased potency and prolonged use. ^{146}

Biotransformation:

Primarily in skin; once absorbed systemically, in the liver. ^{10} ^{22} ^{26} ^{261} Corticosteroids that contain substituted 17-hydroxyl groups or that are fluorinated are resistant to local metabolism in the skin. Repeated application results in a cumulative depot effect in the skin, ^{165} which may lead to a prolonged duration of action, increased side effects, and increased systemic absorption.

The following topical corticosteroids contain substituted 17-hydroxyl groups (S) and/or are fluorinated (F) compounds:

• Alclometasone dipropionate—S ^{10}

• Amcinonide—S, F ^{04}

• Beclomethasone dipropionate—S

• Betamethasone—F

• Betamethasone benzoate—S, F

• Betamethasone dipropionate—S, F ^{28}

• Betamethasone valerate—S, F

• Clobetasol propionate—S, F

• Clobetasone butyrate—S, F

• Clocortolone pivalate—S, F

• Desonide—S

• Desoximetasone—S (17-hydrogen), F

• Dexamethasone—F

• Dexamethasone sodium phosphate—F

• Diflorasone diacetate—S, F

• Diflucortolone valerate—F

• Flumethasone pivalate—F

• Fluocinolone acetonide—S, F

• Fluocinonide—S, F

• Flurandrenolide—S, F

• Fluticasone propionate—S, F ^{417} ^{418}

• Halcinonide—S, F

• Halobetasol propionate—S, F ^{414} ^{415}

• Hydrocortisone butyrate—S

• Hydrocortisone valerate—S

• Mometasone furoate—S

• Triamcinolone acetonide—S, F

Precautions to Consider

Carcinogenicity

Long-term animal studies to determine the carcinogenicity of topical corticosteroids have not been done. ^{05} ^{06} ^{10} ^{11} ^{12} ^{13} ^{14} ^{15} ^{17} ^{18} ^{19} ^{20} ^{22} ^{23} ^{24} ^{26} ^{27} ^{28} ^{29} ^{30} ^{31} ^{32} ^{33} ^{34} ^{35} ^{36} ^{37} ^{38} ^{39} ^{41} ^{42} ^{43} ^{44} ^{45} ^{46} ^{47} ^{48} ^{72} ^{75} ^{76} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} ^{440} ^{443}

Mutagenicity

Betamethasone—Betamethasone was found to be genotoxic in the in vitro human peripheral blood lymphocyte chromosome aberration assay with metabolic activation and in the in vivo mouse bone marrow micronucleus assay. ^{22}

Fluticasone—No mutagenicity was shown with fluticasone propionate in the Ames test, Escherichia coli fluctuation test, Saccharomyces cerevisiae gene conversion test, or Chinese hamster ovarian cell assay. ^{417} ^{418} Fluticasone was not clastogenic in mouse micronucleus or cultured human lymphocyte tests. ^{417} ^{418}

Halobetasol—Halobetasol propionate was not found to be genotoxic in the Ames/Salmonella assay, sister chromatid exchange test in Chinese hamster somatic cells, chromosome aberration studies of germinal and somatic cells of rodents, and a mammalian spot test to determine point mutations. ^{414} ^{415} ^{462} ^{463} It was found to be mutagenic in a Chinese hamster micronucleus test, and in a mouse lymphoma gene mutation assay in vitro . ^{414} ^{415}

Hydrocortisone and prednisolone—Studies on mutagenicity with hydrocortisone and prednisolone ^{10} ^{11} ^{29} ^{30} ^{31} ^{48} yielded negative results. ^{05} ^{06} ^{12} ^{13} ^{14} ^{15} ^{17} ^{18} ^{19} ^{20} ^{26} ^{27} ^{28} ^{32} ^{33} ^{34} ^{35} ^{36} ^{37} ^{38} ^{41} ^{42} ^{44} ^{45} ^{46} ^{47} ^{443}

Mometasone—No mutagenicity was shown with mometasone in the Ames test, mouse lymphoma assay, and a micronucleus test. ^{23} ^{24}

Pregnancy/Reproduction

Pregnancy—
Topical corticosteroids, especially the more potent ones, should not be used extensively, in large amounts, or for protracted periods in pregnant patients or in patients who are planning to become pregnant. ^{22} ^{28} ^{104} ^{105} ^{112} ^{113} ^{118} ^{126} ^{137} ^{138} ^{139} ^{141} ^{142} ^{143} ^{145} ^{248} ^{250} ^{261}

Adequate and well-controlled studies in humans have not been done. ^{10} ^{22} ^{28} ^{97} ^{98} ^{100} ^{101} ^{102} ^{104} ^{112} ^{113} ^{114} ^{115} ^{116} ^{117} ^{118} ^{120} ^{121} ^{122} ^{123} ^{124} ^{125} ^{126} ^{127} ^{129} ^{132} ^{133} ^{134} ^{135} ^{137} ^{138} ^{139} ^{141} ^{142} ^{143} ^{144} ^{145} ^{146} ^{147} ^{247} ^{248} ^{249} ^{250} ^{251} ^{443} ^{444} ^{445} ^{446} ^{447} ^{448} ^{449} ^{450} ^{451} ^{452} ^{453} ^{454} ^{455} ^{456} ^{457} ^{458} ^{459} ^{460} ^{462} ^{463} ^{464}

Studies in animals have shown that topical corticosteroids are systemically absorbed and may cause fetal abnormalities, especially when used in large amounts, with occlusive dressings, for prolonged periods of time, or if the more potent agents are used. ^{22} ^{443}

Betamethasone: A dose-related increase in fetal resorptions was observed in rabbits and mice given betamethasone dipropionate intramuscularly. ^{429} This effect was not observed in rats. ^{429} Teratogenic effects (umbilical hernia, cephalocele, cleft palate) were observed in rabbits when betamethasone dipropionate was administered intramuscularly. ^{429}

Desoximetasone: In studies in mice, rats, and rabbits, desoximetasone has been shown to be teratogenic and embryotoxic with subcutaneous or dermal use. ^{05} ^{432}

Fluticasone: In studies in mice, fluticasone was found to be teratogenic (cleft palate) with subcutaneous usage of doses approximately 14 and 45 times the usual human topical dose. ^{417} ^{418}

Halobetasol: In studies in rats and rabbits, halobetasol propionate administered systemically was shown to be teratogenic at doses 3 to 33 times the usual human topical dose. ^{414} ^{415} ^{462} ^{463} Cleft palate was observed in both species. ^{414} ^{415} ^{462} ^{463} Omphalocele was seen in rats only. ^{414} ^{415} Halobetasol propionate was shown to be embryotoxic in rabbits but not in rats. ^{414} ^{415}

Hydrocortisone dental dosage form: Studies have not been done in animals.

FDA Pregnancy Category C. ^{10} ^{22} ^{23} ^{24} ^{28} ^{72} ^{75} ^{76} ^{104} ^{247} ^{248} ^{249} ^{250} ^{261} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} ^{440} ^{441} ^{443} ^{444} ^{445} ^{446} ^{447} ^{448} ^{449} ^{450} ^{451} ^{452} ^{453} ^{454} ^{455} ^{456} ^{457} ^{458} ^{459} ^{460} ^{462} ^{463} ^{464}

Breast-feeding

It is not known whether topical corticosteroids are distributed into breast milk. ^{10} ^{22} ^{28} ^{72} ^{75} ^{76} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} ^{434} ^{443} However, problems in humans have not been documented. ^{104} ^{434}

Systemic corticosteroids are distributed into breast milk ^{10} ^{22} ^{28} ^{72} ^{75} ^{76} and may cause unwanted effects, such as growth suppression, in the infant. ^{10} ^{22} ^{434}

Topical corticosteroids should not be applied to the breasts prior to nursing. ^{65} ^{434}

Pediatrics

Children and adolescents have a large skin surface area to body weight ratio and less developed, thinner skin, which may result in absorption of greater amounts of topical corticosteroids compared with older patients. ^{05} ^{06} ^{10} ^{11} ^{12} ^{13} ^{14} ^{15} ^{17} ^{18} ^{19} ^{20} ^{22} ^{23} ^{24} ^{26} ^{27} ^{28} ^{29} ^{30} ^{31} ^{32} ^{33} ^{34} ^{35} ^{36} ^{37} ^{38} ^{41} ^{42} ^{43} ^{44} ^{45} ^{46} ^{47} ^{48} ^{72} ^{75} ^{76} ^{77} ^{182} ^{300} ^{361} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} Absorption also is greater in premature infants than in full term newborns, due to inadequate development of the stratum corneum. ^{165} ^{300}

Adrenal suppression, ^{10} ^{22} ^{28} ^{247} ^{249} Cushing's syndrome, ^{10} ^{22} ^{28} ^{63} ^{64} intracranial hypertension, ^{05} ^{06} ^{10} ^{11} ^{12} ^{13} ^{14} ^{15} ^{17} ^{18} ^{19} ^{20} ^{22} ^{23} ^{24} ^{26} ^{27} ^{28} ^{29} ^{30} ^{31} ^{32} ^{33} ^{34} ^{35} ^{36} ^{37} ^{38} ^{39} ^{41} ^{42} ^{43} ^{44} ^{45} ^{46} ^{47} ^{48} and growth retardation ^{10} ^{22} ^{28} ^{97} ^{104} ^{105} due to the systemic absorption of topical corticosteroids have been documented in children. ^{10} ^{28} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} Therefore, special care must be exercised when these agents are used in children and growing adolescents, ^{305} especially if factors that increase absorption are involved. ^{72} ^{75} ^{76} ^{77} ^{189} ^{195} It is recommended that only low-potency, unfluorinated topical corticosteroids that have a free 17-hydroxyl group be used in children or growing adolescents ^{305} unless there is a demonstrated need for one of the other topical corticosteroids. ^{162} ^{167} ^{182} ^{190}

Generally, pediatric therapy continuing for longer than 2 weeks and consisting of doses in excess of one daily application (with medium- or high-potency corticosteroids) or two daily applications (with low-potency corticosteroids) should be evaluated carefully by the physician. This is especially important if medication is applied to more than 5 to 10% of the body surface or if an occlusive dressing is used. A tight-fitting diaper or one covered with plastic pants may constitute an occlusive dressing. ^{72} ^{75} ^{76} ^{167} ^{247} ^{248}

Geriatrics

Although appropriate studies with topical corticosteroids have not been performed in the geriatric population, geriatrics-specific problems are not expected to limit the usefulness of topical corticosteroids in the elderly. However, elderly patients may be more likely to have pre-existing skin atrophy secondary to aging. Purpura and skin lacerations that may raise the skin and subcutaneous tissue from deep fascia may be more likely to occur with the use of topical corticosteroids in geriatric patients. ^{167} ^{248} ^{250} Therefore, topical corticosteroids should be used infrequently, for brief periods, or under close medical supervision in patients with evidence of pre-existing skin atrophy. ^{358} ^{363} Use of lower potency topical corticosteroids also may be necessary in some patients. ^{248} ^{250} ^{358} ^{363} ^{373}

Laboratory value alterations
The following have been selected on the basis of their potential clinical significance (possible effect in parentheses where appropriate)—not necessarily inclusive (» = major clinical significance):

With physiology/laboratory test values
Eosinophil count, total    (may be decreased as plasma cortisol concentration is decreased ^{167})

Glucose    (because of the intrinsic hyperglycemic activity of corticosteroids, blood and urine concentrations may be increased if significant absorption of the corticosteroid occurs ^{10} ^{23} ^{24} ^{72} ^{75} ^{76} ^{146})

Hypothalamic-pituitary-adrenal (HPA) axis function as assessed by:
Adrenocorticotropic hormone (ACTH, corticotropin) or
Cortisol, blood ^{10} ^{22} ^{93} ^{167} ^{172} ^{174} ^{183} ^{190} ^{192} or
Cortisol, urine (24-hour) ^{10} ^{362} or
17-hydroxycorticosteroids, urine (24-hour) ^{10} ^{167}    (may be decreased if significant absorption of the corticosteroid occurs, especially in children ^{10} ^{23} ^{24} ^{72} ^{75} ^{76})

Medical considerations/Contraindications
The medical considerations/contraindications included have been selected on the basis of their potential clinical significance (reasons given in parentheses where appropriate)— not necessarily inclusive (» = major clinical significance).

Risk-benefit should be considered when the following medical problems exist
Allergy to corticosteroids ^{10} ^{22} ^{26} ^{27} ^{28} ^{29} ^{255} ^{261}
Infection at treatment site ^{04} ^{10} ^{22} ^{23} ^{24} ^{97} ^{98} ^{100} ^{101} ^{102} ^{104} ^{105} ^{110} ^{111} ^{112} ^{113} ^{114} ^{115} ^{116} ^{117} ^{118} ^{120} ^{121} ^{122} ^{123} ^{124} ^{125} ^{126} ^{127} ^{128} ^{129} ^{132} ^{133} ^{134} ^{135} ^{137} ^{138} ^{139} ^{141} ^{142} ^{143} ^{144} ^{145} ^{146} ^{147} ^{148} ^{167} ^{247} ^{248} ^{249} ^{250} ^{251} ^{404}    (may be exacerbated if no appropriate antimicrobial agent is used concurrently ^{393})

Skin atrophy, pre-existing ^{167}    (may be exacerbated due to atrophigenic properties of corticosteroids ^{167})

For use in the oral cavity:
Herpes simplex at treatment site ^{396}    (may be transmitted to other sites, including the eye ^{96})

With long-term use of more potent formulations or if substantial absorption occurs ^{404}:
Cataracts ^{93} ^{394} ^{404}    (corticosteroids may promote progression of cataracts, especially with the use of high- to very high–potency products in periorbital area ^{394} ^{404})

Diabetes mellitus ^{97} ^{394} ^{404}    (loss of control of diabetes may occur due to possible elevations in blood glucose ^{394} ^{404})

Glaucoma ^{93} ^{97} ^{394} ^{404}    (intraocular pressure may be increased, especially with the use of high- to very high–potency products in periorbital area ^{394} ^{404})

Tuberculosis ^{97} ^{394} ^{404}    (may be exacerbated or reactivated; appropriate antitubercular chemotherapy or prophylaxis should be administered concurrently ^{393} ^{394} ^{404})

Patient monitoring
The following may be especially important in patient monitoring (other tests may be warranted in some patients, depending on condition; » = major clinical significance):

Adrenal function assessment, may include blood or urine cortisol concentration or ACTH stimulation test ^{10} ^{22} ^{23} ^{24} ^{28} ^{120} ^{121} ^{122} ^{123} ^{125} ^{365}    (periodic monitoring may be advisable during and following use if factors that increase percutaneous absorption are present and treatment is prolonged ^{10} ^{28} ^{59} ^{64} ^{72} ^{75} ^{76} ^{77} ^{169} ^{358})

Side/Adverse Effects

Note: Generally, local or systemic adverse effects do not often occur with the use of low-potency topical corticosteroids. ^{93} ^{159} ^{167} ^{182} ^{247} ^{248} ^{250} ^{358} However, as with all topical corticosteroids, the incidence and severity of local or systemic side effects increase with factors that increase percutaneous absorption.
Percutaneous absorption of topical corticosteroids has resulted in systemic side effects such as hyperglycemia, glycosuria, and hypothalamic-pituitary-adrenal (HPA) axis suppression. ^{04} ^{10} ^{22} ^{28} ^{72} ^{75} ^{76} ^{77} ^{78} ^{79} ^{80} ^{81} ^{82} ^{83} ^{84} ^{85} ^{86} ^{87} ^{89} ^{90} ^{91} ^{92} ^{94} ^{95} ^{96} ^{97} ^{98} ^{101} ^{102} ^{104} ^{105} ^{110} ^{112} ^{113} ^{114} ^{115} ^{116} ^{117} ^{118} ^{120} ^{121} ^{122} ^{123} ^{124} ^{126} ^{129} ^{132} ^{133} ^{134} ^{138} ^{139} ^{141} ^{142} ^{143} ^{144} ^{145} ^{146} ^{147} ^{148} ^{160} ^{162} ^{167} ^{169} ^{189} ^{190} ^{247} ^{248} ^{249} ^{250} ^{251} ^{414} ^{415} ^{417} ^{418} ^{426} ^{429} ^{440} ^{441} ^{443} ^{444} ^{445} ^{446} ^{447} ^{448} ^{449} ^{450} ^{451} ^{452} ^{453} ^{454} ^{455} ^{456} ^{457} ^{458} ^{459} ^{460} ^{462} ^{463} ^{464} HPA axis suppression has resulted from use of low doses of very high–potency products ^{75} ^{162} ^{167} ^{414} ^{415} ^{429} ^{463} and from use of less potent topical steroid preparations when occlusive dressings or excessive quantities were used. ^{167} ^{247} ^{248} ^{251} ^{417} ^{418} In all cases of HPA axis suppression, the effect was reversible upon discontinuation of therapy. ^{10} ^{22} ^{28} ^{129} ^{141} ^{144} ^{146} ^{147} ^{169} ^{183} ^{414} ^{415} ^{417} ^{418} ^{429}

The following side/adverse effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:

Those indicating the need for medical attention
Incidence less frequent or rare ^{72} ^{364}

Allergic contact dermatitis ^{10}^{22}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{94}^{95}^{96}^{97}^{102}^{112}^{118}^{128}^{129}^{138}^{139}^{142}^{143}^{145}^{147}^{167}^{296}^{298}^{299}^{429}^{189}^{190}(burning and itching of skin; apparent chronic therapeutic failure)—also may be caused by vehicle ingredients

folliculitis,^{04}^{10}^{22}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{105}^{112}^{113}^{114}^{116}^{128}^{143}^{144}^{147}^{162}^{169}^{174}^{195}^{414}^{415}^{429}^{430} furunculosis,^{128} pustules,^{04}^{100}^{101}^{114}^{116}^{127}^{144}^{147} pyoderma,^{04}^{100}^{101}^{102}^{104}^{105}^{113}^{114}^{127}^{144}^{147}^{169}^{414}^{415} or vesiculation^{97}^{128}^{414}^{415}^{430} (painful, red or itchy, pus-containing blisters in hair follicles)—more frequent with occlusion or use of ointments in intertriginous areas

hyperesthesia (increased skin sensitivity)^{75}^{358}

numbness in fingers ^{11}^{415}^{417}^{418}

purpura (blood-containing blisters on skin)^{128}^{167}^{189}^{248}^{250}

skin atrophy (thinning of skin with easy bruising, especially when used on facial or intertriginous areas)^{04}^{10}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{121}^{122}^{123}^{124}^{125}^{126}^{128}^{129}^{132}^{134}^{135}^{137}^{138}^{139}^{141}^{142}^{143}^{144}^{145}^{147}^{148}^{160}^{167}^{169}^{175}^{189}^{195}^{247}^{248}^{249}^{250}^{251}^{414}^{415}^{429}^{430}

skin infection, secondary —more frequent with occlusion^{04}^{10}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{104}^{105}^{110}^{111}^{113}^{114}^{115}^{116}^{117}^{120}^{121}^{122}^{123}^{124}^{125}^{132}^{134}^{135}^{137}^{141}^{142}^{144}^{147}^{167}^{181}^{189}^{415}

stripping of epidermal layer —for tape dosage forms^{128}

telangiectasia (raised, dark red, wart-like spots on skin, especially when used on the face)^{04}^{93}^{97}^{101}^{111}^{113}^{114}^{115}^{116}^{117}^{120}^{121}^{122}^{123}^{124}^{125}^{132}^{134}^{141}^{144}^{147}^{155}^{162}^{167}^{169}^{174}^{189}^{195}^{248}^{250}^{358}^{415}^{429}^{430}

Incidence rare
—with prolonged use or other factors that increase absorption
Acneiform eruptions (acne or oily skin, especially when used on the face)^{10}^{22}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{104}^{105}^{112}^{113}^{116}^{127}^{135}^{143}^{144}^{147}^{162}^{167}^{189}^{195}^{248}^{250}^{415}

cataracts, posterior subcapsular (gradual blurring or loss of vision)—reported with use of systemic corticosteroids;^{04}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{122}^{123}^{124}^{125}^{127}^{129}^{134}^{141}^{144}^{147}^{358} caution is advised with use of high- and very high–potency topical corticosteroids in periorbital area

Cushing's syndrome (backache; filling or rounding out of the face; irritability; menstrual irregularities; mental depression; in men—unusual decrease in sexual desire or ability; unusual tiredness or weakness)^{10}^{23}^{24}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{104}^{105}^{153}^{167}^{247}^{248}

dermatitis, perioral (irritation of skin around mouth)^{10}^{22}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{167}^{189}^{195}

ecchymosis (unusual bruising)^{97}^{100}^{113}^{129}^{135}^{144}^{147}^{167}^{248}^{250}

edema (increased blood pressure; rapid weight gain; swelling of feet or lower legs)^{97}^{100}^{129}^{135}^{144}^{147}^{184}^{189}

gastric ulcer (loss of appetite; nausea; stomach bloating, burning, cramping, or pain; vomiting; weight loss)^{97}^{100}^{113}^{129}^{135}^{144}^{146}^{147}

glaucoma, secondary (eye pain; gradual decrease in vision; nausea; vomiting)^{167}^{189}^{358}—with use of high- and very high–potency topical corticosteroids in periorbital area

hirsutism^{144}^{147}^{248}^{250} or hypertrichosis (unusual increase in hair growth, especially on the face)^{04}^{10}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{94}^{95}^{96}^{97}^{98}^{101}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{120}^{121}^{122}^{123}^{124}^{125}^{127}^{129}^{132}^{134}^{135}^{141}^{143}^{144}^{147}^{189}

hypertension ^{97}^{100}^{113}^{129}^{135}^{144}^{147}

hypokalemic syndrome (irregular heartbeat; loss of appetite; muscle cramps or pain; nausea; severe weakness of extremities and trunk; vomiting)^{113}

hypopigmentation (lightened skin color)^{10}^{22}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{94}^{95}^{96}^{98}^{100}^{104}^{105}^{112}^{127}^{135}^{137}^{141}^{142}^{143}^{144}^{147}^{189}, or other changes in skin pigmentation^{04}^{97}^{101}^{110}^{111}^{113}^{114}^{115}^{116}^{117}^{120}^{121}^{122}^{123}^{124}^{125}^{129}^{132}^{134}

infection, aggravation of ^{97}^{100}^{129}^{135}^{144}^{147}^{248}^{250}

miliaria rubra (burning and itching of skin with pinhead-sized red blisters)^{04}^{10}^{22}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{113}^{114}^{128}^{144}^{147}^{154}^{415}

protein depletion (muscle weakness)^{97}^{100}^{113}^{129}^{135}^{144}^{146}^{147}

skin laceration (tearing of skin)^{144}^{147}

skin maceration (softening of skin)^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{121}^{122}^{123}^{124}^{125}^{126}^{128}^{129}^{132}^{134}^{135}^{137}^{138}^{139}^{141}^{142}^{143}^{144}^{145}^{147}^{160}^{162}^{167}^{169}^{175}^{189}^{195}

striae (reddish purple lines on arms, face, legs, trunk, or groin)^{04}^{10}^{22}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{121}^{122}^{123}^{124}^{125}^{126}^{132}^{134}^{135}^{137}^{138}^{139}^{141}^{142}^{143}^{144}^{145}^{147}^{148}^{160}^{162}^{167}^{169}^{189}^{195}^{248}^{249}^{250}

subcutaneous tissue atrophy ^{10}^{22}^{23}^{24}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{102}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{121}^{122}^{123}^{124}^{125}^{126}^{128}^{129}^{132}^{134}^{135}^{137}^{138}^{139}^{141}^{142}^{143}^{144}^{145}^{147}^{160}^{169}^{175}

unusual loss of hair —especially on the scalp

Those indicating need for medical attention only if they continue or are bothersome
Incidence less frequent or rare

Burning, dryness, irritation, itching, or redness of skin, mild and transient ^{04}^{10}^{23}^{24}^{28}^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{97}^{98}^{100}^{101}^{104}^{105}^{110}^{111}^{112}^{113}^{114}^{115}^{116}^{117}^{118}^{120}^{121}^{122}^{123}^{124}^{125}^{126}^{127}^{128}^{129}^{132}^{134}^{135}^{137}^{138}^{139}^{141}^{142}^{143}^{144}^{145}^{147}^{162}^{167}^{169}^{172}^{175}^{177}^{178}^{179}^{181}^{189}^{248}^{249}^{250}^{414}^{415}^{417}^{418}^{429}^{430}

increased redness or scaling of skin lesions, mild and transient ^{97}^{128}^{172}

skin rash, minor and transient ^{72}^{75}^{76}^{77}^{78}^{79}^{80}^{81}^{82}^{83}^{84}^{85}^{86}^{87}^{89}^{90}^{91}^{92}^{93}^{94}^{95}^{96}^{169}

Those not indicating need for medical attention

Stinging, mild and temporary —when foam, gel, lotion, solution, or aerosol form of medication is applied

Overdose
For more information on the management of overdose or unintentional ingestion, contact a Poison Control Center (see Poison Control Center Listing ).

Clinical effects of overdose
The following effects have been selected on the basis of their potential clinical significance (possible signs and symptoms in parentheses where appropriate)—not necessarily inclusive:
Chronic

Hypercorticism ^{148}

Treatment of overdose
For chronic topical overdose—Since there is no specific antidote available, treatment is symptomatic, supportive, and consists of discontinuance of topical corticosteroid therapy. ^{148} Gradual withdrawal of the preparation may be necessary. ^{101} ^{110} ^{113} ^{117} ^{120} ^{121} ^{122} ^{123} ^{125} ^{129} ^{144} ^{147} ^{373}

For acute oral overdose—Since there is no specific antidote available and serious adverse effects are unlikely, treatment consists of dilution with fluids. ^{373}

Patient Consultation
As an aid to patient consultation, refer to Advice for the Patient, Corticosteroids (Dental) . For alclometasone, clocortolone, desonide, dexamethasone, flumethasone, flurandrenolide ( Drenison-1/4 only), hydrocortisone, and hydrocortisone acetate—Corticosteroids—Low Potency (Topical) . For amcinonide, beclomethasone, betamethasone, clobetasol, clobetasone, desoximetasone, diflorasone, diflucortolone, fluocinolone, fluocinonide, flurandrenolide (except Drenison-1/4), fluticasone, halcinonide, halobetasol, hydrocortisone butyrate, hydrocortisone valerate, mometasone, and triamcinolone—Corticosteroids—Medium to Very High Potency (Topical) .

In providing consultation, consider emphasizing the following selected information (» = major clinical significance):

Before using this medication
»   Conditions affecting use, especially:
Allergy to corticosteroids

Pregnancy—Use restricted because of possible fetal abnormalities

Breast-feeding—Should not be applied to the breasts prior to nursing

Use in children—Adrenal suppression, Cushing's syndrome, intracranial hypertension, and growth retardation possible

Use in the elderly—Caution recommended because purpura and skin lacerations may be more likely

Proper use of this medication

For all topical corticosteroids
Keeping away from eyes ^{10} ^{391} ^{406}

» Not bandaging or otherwise wrapping the treated skin area unless directed to do so by physician ^{10}

Proper use of occlusive dressing, if prescribed

For dental paste dosage forms
Applying with cotton applicator; pressing, not rubbing, paste on lesion

Applying at bedtime and after meals for maximum effect ^{96}

For foam dosage form
Reading and following patient directions carefully

Not smoking while using; not using near an open flame

For aerosol dosage forms
Reading and following patient directions carefully

Avoiding breathing vapors of spray ^{94} ^{144}

Avoiding getting vapors of spray in eyes ^{144}

Not smoking while using aerosols; not using aerosols near an open flame

For flurandrenolide tape
Reading and following patient directions carefully
» Importance of not using more medication than the amount prescribed or recommended on package

» Checking with physician before using medication for other dental or skin problems

» Proper dosing
Missed dose: Using as soon as possible; not using if almost time for next dose

» Proper storage

Precautions while using this medication
» Checking with physician or dentist if symptoms do not improve within 1 week or condition becomes worse ^{96} ^{136}

For topical dosage forms
Not using tight-fitting diapers or plastic pants on a child if the diaper area is being treated with this medication

Side/adverse effects
Signs of potential side effects, especially allergic contact dermatitis; folliculitis, furunculosis, pustules, pyoderma, or vesiculation; hyperesthesia; numbness in fingers; purpura; skin atrophy; skin infection, secondary; stripping of epidermal layer (for tape dosage forms); and telangiectasia

Signs of potential side effects occurring with prolonged use or other factors that increase absorption, especially acneiform eruptions; cataracts, posterior subcapsular; Cushing's syndrome; dermatitis, perioral; ecchymosis; edema; gastric ulcer; glaucoma, secondary; hirsutism or hypertrichosis; hypertension; hypokalemic syndrome; hypopigmentation or other changes in skin pigmentation; infection, aggravation of; miliaria rubra; protein depletion; skin laceration; skin maceration; striae; subcutaneous tissue atrophy; and unusual loss of hair

Possible stinging when foam, gel, lotion, solution, or aerosol form of medication is applied

General Dosing Information

For topical dosage forms
To minimize the possibility of significant systemic absorption of corticosteroids during long term therapy, treatment may be interrupted periodically, small amounts of the preparation may be applied, or one area of the body may be treated at a time. ^{98} ^{100} ^{101} ^{102} ^{104} ^{105} ^{111} ^{112} ^{113} ^{114} ^{115} ^{116} ^{117} ^{120} ^{121} ^{122} ^{123} ^{124} ^{125} ^{126} ^{127} ^{129} ^{132} ^{134} ^{135} ^{137} ^{141} ^{144} ^{147} ^{169} ^{190} ^{248}

Occlusion, whether by oleaginous ointment, a thin film of polyethylene, dermatological patch, or tape, ^{128} promotes increased hydration of the stratum corneum and increased absorption. Rarely, ^{66} body temperature may be elevated if large areas are covered with an occlusive dressing; ^{15} ^{17} ^{18} ^{36} ^{37} ^{38} ^{127} ^{129} ^{147} occlusive dressings should not be used if body temperature is elevated. ^{04} ^{98} ^{100} ^{101} ^{113} ^{114} ^{115} ^{116} ^{118} ^{121} ^{127} ^{129} ^{132} ^{135} ^{137} ^{141} ^{144} ^{147} Use of intermittent, rather than continuous, occlusion may decrease the risk of side effects. ^{102} ^{104} ^{105} Generally, occlusive dressings should be changed every 24 hours or more frequently. ^{117} Very high–potency topical corticosteroid formulations should not be used with occlusive dressings. ^{59} ^{63} ^{66} ^{67} ^{368} ^{373} ^{463}

Rarely, gradual withdrawal of therapy or supplemental systemic corticosteroid therapy may be required to avoid symptoms of steroid withdrawal. ^{72} ^{75} ^{76} ^{77} ^{78} ^{79} ^{80} ^{81} ^{82} ^{83} ^{84} ^{85} ^{86} ^{87} ^{89} ^{90} ^{91} ^{92} ^{94} ^{95} ^{96} ^{113} ^{129} ^{144} ^{147} ^{167} Gradual withdrawal of therapy by decreasing the frequency of application or by using products of decreasing potency also may be necessary to avoid a rebound flare-up of certain conditions such as psoriasis. ^{167} ^{249} ^{251} Tachyphylaxis also may result from continual usage. ^{162} ^{167} ^{300}

Certain topical corticosteroids may be used as adjunctive therapy to antimicrobial agents for controlling inflammation, erythema, and pruritus associated with bacterial or fungal skin infections. If symptomatic relief is not noted within a few days to one week, the topical corticosteroid should be discontinued until the infection is controlled. ^{98} ^{100} ^{101} ^{110} ^{111} ^{113} ^{114} ^{115} ^{116} ^{117} ^{120} ^{121} ^{122} ^{123} ^{124} ^{125} ^{127} ^{129} ^{132} ^{134} ^{135} ^{137} ^{141} ^{144} ^{147}

For dental dosage forms only
Applying the paste with a cotton applicator will help to eliminate any possible absorption from contact with the skin.

The paste should be pressed, not rubbed, on the lesion. ^{250} Rubbing the paste on the lesion will result in a granular, gritty sensation and cause the medication to crumble. A smooth, slippery film forms after application. ^{96} ^{146}

If significant repair or regeneration of oral tissues has not occurred in 7 days, the etiology of the lesion should be reinvestigated. ^{96} ^{146}

For treatment of adverse effects
If hypothalamic-pituitary-adrenal (HPA) axis suppression occurs, the topical corticosteroid should be discontinued ^{10} ^{28} ^{148} or substituted with a less potent preparation, or the frequency of application should be decreased. ^{10} ^{28} If adrenal suppression occurs upon discontinuation, it may be necessary to institute treatment with a systemic corticosteroid ^{10} ^{148} until adrenal function returns to normal. ^{148}

If a local infection develops at the site of application, discontinue occlusive dressings (if used) and institute appropriate antimicrobial therapy. ^{04} ^{10} ^{23} ^{24} ^{28} ^{72} ^{75} ^{76} ^{77} ^{94} ^{97} ^{98} ^{102} ^{104} ^{105} ^{110} ^{111} ^{113} ^{129} ^{142} ^{144} ^{147} ^{148} ^{247} ^{249} Until the infection is controlled, discontinuance of the topical corticosteroid may be necessary. ^{04} ^{10} ^{28}

If irritation or sensitization occurs at the site of application, discontinue use of the topical corticosteroid and institute appropriate symptomatic treatment. ^{04} ^{10} ^{28} ^{113} ^{114} ^{127} ^{129} ^{132} ^{134} ^{135} ^{137} ^{141} ^{144} ^{146} ^{147} ^{148} ^{247}

ALCLOMETASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; non-fluorinated.

Potency ranking—Low. ^{10}

Topical Dosage Forms

ALCLOMETASONE DIPROPIONATE CREAM USP

Usual adult and adolescent dose
Topical, to the skin, two or three times a day. ^{10}

Note: Therapy should be discontinued and the diagnosis reassessed if no improvement is seen after two weeks. ^{10}

Usual pediatric dose
Children up to 1 year of age: Use is not recommended. ^{10}

Children 1 year of age or older: See Usual adult and adolescent dose .

Note: Alclometasone should not be applied to the diaper area if the child still requires diapers or plastic pants. ^{10}

Strength(s) usually available
U.S.—

0.05% (Rx) [Aclovate (chlorocresol)^{10}^{157}]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 30 °C ( 36 and 86 °F), ^{10} unless otherwise specified by manufacturer. Store in a collapsible tube or a tight container. ^{16}

Auxiliary labeling:
   • For external use only. ^{10}
   • Do not use in or around the eye. ^{10}

ALCLOMETASONE DIPROPIONATE OINTMENT USP

Usual adult and adolescent dose
See Alclometasone Dipropionate Cream USP . ^{10}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.05% (Rx) [Aclovate^{10}]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 30 °C ( 36 and 86 °F), ^{10} unless otherwise specified by manufacturer. Store in a collapsible tube or a tight container. ^{16}

Auxiliary labeling:
   • For external use only. ^{10}
   • Do not use in or around the eye. ^{10}

AMCINONIDE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—High.

Topical Dosage Forms

AMCINONIDE CREAM USP

Usual adult dose
Topical, to the skin, two or three times a day. ^{04} ^{78}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.1% (Rx) [Cyclocort (benzyl alcohol 2%)^{20}^{78}^{157}]

Canada—

0.1% (Rx) [Cyclocort (benzyl alcohol 2%)^{04}^{157}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{20} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{20}

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{04}

AMCINONIDE LOTION

Usual adult dose
See Amcinonide Cream USP . ^{02} ^{04} ^{206} ^{261}

Usual pediatric dose
See Amcinonide Cream USP .

Strength(s) usually available
U.S.—

0.1% (Rx) [Cyclocort (benzyl alcohol 1%)^{20}]

Canada—

0.1% (Rx) [Cyclocort (benzyl alcohol 1%)^{04}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{20} in a well-closed container, unless otherwise specified by manufacturer. ^{261} Protect from freezing. ^{20}

Auxiliary labeling:
   • For external use only. ^{07} ^{261}
   • Do not use in or around the eye. ^{04} ^{261}

AMCINONIDE OINTMENT USP

Usual adult dose
See Amcinonide Cream USP . ^{04}

Usual pediatric dose
See Amcinonide Cream USP .

Strength(s) usually available
U.S.—

0.1% (Rx) [Cyclocort (benzyl alcohol 2%)^{20}]

Canada—

0.1% (Rx) [Cyclocort (benzyl alcohol 2%)^{04}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{20} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{20}

Auxiliary labeling:
   • For external use only. ^{79}
   • Do not use in or around the eye. ^{04} ^{79}

BECLOMETHASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; non-fluorinated.

Potency ranking—Medium.

Topical Dosage Forms

BECLOMETHASONE DIPROPIONATE CREAM

Note: Preferred dosage form for moist or weeping lesion surfaces. ^{148}

Usual adult dose
Topical, to the skin, one to three times a day. ^{148}

Usual pediatric dose
Children up to 1 year of age: Use is not recommended. ^{148}

Children 1 year of age or older: Dosage has not been established.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.025% (Rx) [Propaderm^{148}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{148}

BECLOMETHASONE DIPROPIONATE LOTION

Note: Preferred dosage form for large or hairy areas, or areas where the skin folds. ^{148}

Usual adult dose
See Beclomethasone Dipropionate Cream . ^{148}

Usual pediatric dose
See Beclomethasone Dipropionate Cream .

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.025% (Rx) [Propaderm^{148}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{148}

BETAMETHASONE

Summary of Differences

Pharmacology/pharmacokinetics ^{374}:
Substituted (benzoate, dipropionate, valerate); fluorinated (base, benzoate, dipropionate, valerate).

Potency ranking—
Betamethasone benzoate, Medium.

Betamethasone dipropionate (except for Diprolene and Diprolene AF products), High.

Diprolene and Diprolene AF products, Very high.

Betamethasone valerate, Medium.

Topical Dosage Forms

BETAMETHASONE BENZOATE CREAM

Usual adult dose
Topical, to the skin, two to four times a day. ^{26} ^{292}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Uticort^{26}^{292}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{26} in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{26} ^{292}
   • Do not use in or around the eye. ^{26} ^{292}

BETAMETHASONE BENZOATE GEL USP

Usual adult dose
See Betamethasone Benzoate Cream . ^{26} ^{100} ^{292}

Usual pediatric dose
See Betamethasone Benzoate Cream .

Strength(s) usually available
U.S.—

0.025% (Rx) [Uticort (alcohol 13.8%)^{26}^{158}^{292}]

Canada—

0.025% (base) (Rx) [Beben (alcohol)^{100}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{26} unless otherwise specified by manufacturer. Store in a tight container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{26} ^{292}
   • Do not use in or around the eye. ^{26} ^{100} ^{292}

BETAMETHASONE BENZOATE LOTION

Usual adult dose
Betamethasone Benzoate Cream . ^{26} ^{292}

Usual pediatric dose
Betamethasone Benzoate Cream .

Strength(s) usually available
U.S.—

0.025% (Rx) [Uticort (butylparaben) ( propylparaben) (methylparaben)^{26}^{292}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{26} in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{292}
   • Do not use in or around the eye. ^{292}
   • Shake well.

BETAMETHASONE DIPROPIONATE CREAM (AUGMENTED)

Note: The dosing and strengths of betamethasone dipropionate cream (augmented) are expressed in terms of betamethasone base. ^{28}

Usual adult dose
Topical, to the skin, one or two times a day. ^{28} ^{97} Augmented betamethasone dipropionate cream may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{28}

Usual adult prescribing limits
45 grams per week. ^{28}

Usual pediatric dose
Children up to 12 years of age: Use is not recommended. ^{28}

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Diprolene AF^{28}]

Canada—

0.05% (base) (Rx) [Diprolene^{97}]

Packaging and storage:
Store between 2 and 30 °C ( 36 and 86 °F), ^{28} unless otherwise specified by manufacturer. Store in a tight container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{28}
   • Do not use in or around the eye. ^{28}

BETAMETHASONE DIPROPIONATE CREAM USP

Note: The dosing and strengths of betamethasone dipropionate cream are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one or two times a day. ^{29} ^{98} ^{207} ^{243} ^{255} ^{259} ^{262} ^{263} ^{309} ^{310} ^{311} ^{412} ^{413} ^{440}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Alphatrex^{255}^{309}] [Diprosone^{29}] [Maxivate^{52}^{158}^{259}] [Teladar^{440}][Generic]^{158}^{262}^{263}^{310}^{311}

Canada—

0.05% (base) (Rx) [Diprosone^{98}] [Topilene^{412}] [Topisone^{413}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{309} unless otherwise specified by manufacturer. Store in a collapsible tube or a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{243} ^{255}
   • Do not use in or around the eye. ^{98} ^{243} ^{255}

BETAMETHASONE DIPROPIONATE GEL

Note: The dosing and strengths of betamethasone dipropionate gel are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one or two times a day. ^{429} Betamethasone dipropionate gel may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{401}

Usual pediatric dose
Children up to 12 years of age—Use is not recommended. ^{429}

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Diprolene^{429}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. Protect from freezing.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

BETAMETHASONE DIPROPIONATE LOTION (AUGMENTED)

Note: The dosing and strengths of betamethasone dipropionate lotion (augmented) are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, two times a day. ^{75} Augmented betamethasone dipropionate lotion may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{401}

Usual pediatric dose
Children up to 12 years of age—Dosage has not been established. ^{75}

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Diprolene^{75}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. Protect from light. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{75}
   • Do not use in or around the eye. ^{75}
   • Shake well.

BETAMETHASONE DIPROPIONATE LOTION USP

Note: The dosing and strengths of betamethasone dipropionate lotion are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, two times a day. ^{29} ^{76} ^{98} ^{207} ^{256} ^{259} ^{264} ^{312} ^{313} ^{314} ^{413}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Alphatrex^{256}^{312}] [Diprosone^{29}] [Maxivate^{01}^{02}^{52}^{158}^{259}][Generic]^{76}^{158}^{264}^{313}^{314}

Canada—

0.05% (base) (Rx) [Diprosone^{98}] [Occlucort^{466}] [Topisone^{413}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{312} ^{313} ^{314} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from light. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{264}
   • Do not use in or around the eye. ^{98} ^{264}
   • Shake well. ^{259} ^{313} ^{314}

BETAMETHASONE DIPROPIONATE OINTMENT (AUGMENTED)

Note: The dosing and strengths of betamethasone dipropionate ointment (augmented) are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one or two times a day. ^{30} ^{97} Augmented betamethasone dipropionate ointment may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{401}

Usual pediatric dose
Children up to 12 years of age—Use is not recommended. ^{30}

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Diprolene^{30}^{158}]

Canada—

0.05% (base) (Rx) [Diprolene^{97}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{30} ^{97}
   • Do not use in or around the eye. ^{30} ^{97}

BETAMETHASONE DIPROPIONATE OINTMENT USP

Note: The dosing and strengths of betamethasone dipropionate ointment are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one or two times a day. ^{29} ^{98} ^{207} ^{257} ^{259} ^{265} ^{266} ^{315} ^{316} ^{317} ^{412} ^{413}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (base) (Rx) [Alphatrex^{257}^{315}] [Diprosone^{29}] [Maxivate^{01}^{02}^{52}^{158}^{259}][Generic]^{158}^{265}^{266}^{316}^{317}

Canada—

0.05% (base) (Rx) [Diprosone^{98}] [Topilene^{412}] [Topisone^{413}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{315} ^{316} ^{317} unless otherwise specified by manufacturer. Store in a collapsible tube or a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{257}
   • Do not use in or around the eye. ^{98} ^{257}

BETAMETHASONE DIPROPIONATE TOPICAL AEROSOL

Note: The dosing and strengths of betamethasone dipropionate topical aerosol are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, a three-second spray three times a day. ^{29}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.1% (base) (Rx) [Diprosone (isobutane) ( isopropyl alcohol 10%) (propane)^{29}]

Canada—
Not commercially available.

Note: A three-second spray delivers the equivalent of 60 mcg of betamethasone. ^{29}

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing. ^{29}

Auxiliary labeling:
   • For external use only. ^{29}
   • Do not use in or around the eye. ^{29}

Note: Explain administration technique.
When dispensing, include patient instructions.

BETAMETHASONE VALERATE CREAM USP

Note: The dosing and strengths of betamethasone valerate cream are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one to three times a day. ^{31} ^{103} ^{104} ^{105} ^{203} ^{266} ^{267} ^{269} ^{318} ^{319} ^{320} ^{425}

Usual pediatric dose
Corticosteroid
Topical, to the skin, as a 0.01% (base) cream one or two times a day; or as a 0.1% cream once a day.

[Phimosis ]¹
Topical, to the skin, as a 0.05% cream two to four times a day; or as a 0.1% cream two times a day.^{473}^{474}^{475}^{476}^{477}^{478}^{479}^{480}^{481}^{482}^{483}

Strength(s) usually available
U.S.—

0.01% (base) (Rx) [Valisone Reduced Strength^{31}]

0.1% (base) (Rx) [Betatrex^{267}^{318}] [Beta-Val^{268}] [Dermabet^{199}] [Valisone^{31}] [Valnac][Generic]^{158}^{269}^{319}^{320}^{380}

Canada—

0.05% (base) (Rx) [Betaderm^{203}] [Betnovate-1/2^{103}] [Celestoderm-V/2^{104}] [Ectosone Mild^{105}] [Metaderm Mild^{107}] [Novobetamet^{108}] [Prevex B^{425}]

0.1% (base) (Rx) [Betaderm^{203}] [Betnovate^{103}] [Celestoderm-V^{104}] [Ectosone Regular^{105}] [Metaderm Regular^{107}] [Novobetamet^{108}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{318} ^{319} ^{320} unless otherwise specified by manufacturer. Store in a tight container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{31}
   • Do not use in or around the eye. ^{31} ^{104} ^{105} ^{107}

BETAMETHASONE VALERATE FOAM

Usual adult dose
Topical, to the scalp, two times a day. ^{22}

Usual pediatric dose
Safety and efficacy have not been established. ^{22}

Strength(s) usually available
U.S.—

0.12% (Rx) [Luxíq (ethanol 60.4%)^{22}]

Canada—
Not commercially available.

Packaging and storage:
Store between 20 and 25 °C (68 and 77 °F), ^{22} unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only. ^{22}
   • Do not use in or around the eye. ^{22}
   • Flammable—Keep away from heat or flame. ^{22}

BETAMETHASONE VALERATE LOTION USP

Note: The dosing and strengths of betamethasone valerate lotion are expressed in terms of betamethasone base.

Usual adult dose
Topical, to the skin, one or two times a day. ^{31} ^{101} ^{102} ^{103} ^{105} ^{106} ^{109} ^{266} ^{270} ^{321} ^{322} ^{323}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.1% (base) (Rx) [Betatrex^{270}^{321}] [Beta-Val^{268}] [Valisone^{31}][Generic]^{158}^{321}^{322}^{323}

Canada—

0.05% (base) (Rx) [Betnovate-1/2^{103}] [Ectosone Mild^{105}]

0.1% (base) (Rx) [Betacort Scalp Lotion^{101}] [Betaderm Scalp Lotion^{102}] [Betnovate^{103}] [Ectosone Regular^{105}] [Ectosone Scalp Lotion^{106}] [Valisone Scalp Lotion^{109}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F). ^{321} ^{322} ^{323} Store in a tight, light-resistant container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{31}
   • Do not use in or around the eye. ^{31} ^{101} ^{102} ^{105}
   • Shake well. ^{321} ^{322} ^{323}

BETAMETHASONE VALERATE OINTMENT USP

Note: The dosing and strengths of betamethasone valerate ointment are expressed in terms of betamethasone base.

Usual adult dose
See Betamethasone Valerate Cream USP . ^{31} ^{104} ^{203} ^{266} ^{272} ^{273} ^{324} ^{325} ^{326}

Usual pediatric dose
See Betamethasone Valerate Lotion USP .

Strength(s) usually available
U.S.—

0.1% (base) (Rx) [Betatrex^{272}^{324}] [Beta-Val] [Valisone^{31}] [Valnac][Generic]^{158}^{273}^{325}^{326}

Canada—

0.05% (base) (Rx) [Betaderm^{203}] [Betnovate-1/2^{103}] [Celestoderm-V/2^{104}] [Metaderm Mild^{107}]

0.1% (base) (Rx) [Betaderm^{203}] [Betnovate^{103}] [Celestoderm-V^{104}] [Metaderm Regular^{107}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). ^{324} ^{325} ^{326} Store in a tight container. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{31}
   • Do not use in or around the eye. ^{31} ^{104}

CLOBETASOL

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating: Very high.

Topical Dosage Forms

CLOBETASOL PROPIONATE CREAM USP^{25}

Usual adult dose
Topical, to the skin, two or three times a day. ^{11} ^{110} ^{274} Clobetasol propionate cream may be used for only a short duration of therapy and on small surface areas. ^{401} ^{434} Occlusive dressings should not be used. ^{401} ^{434}

Usual pediatric dose
Children up to 12 years of age—Use is not recommended. ^{11} ^{110} ^{169} ^{274}

Strength(s) usually available
U.S.—

0.05% (Rx) [Temovate^{11}^{158}^{274}] [Cormax^{466}] [Temovate E^{466}]

Canada—

0.05% (Rx) [Dermovate^{110}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F). ^{25} Store in a collapsible tube or tight container. ^{25} Do not refrigerate. ^{11} ^{25} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{11} ^{274}
   • Do not use in or around the eye. ^{11} ^{110} ^{274}

CLOBETASOL PROPIONATE FOAM^{25}

Usual adult dose
Topical, apply on the affected areas of the scalp, twice daily. Clobetasol propionate foam may be used for only a short duration of therapy and on small surface areas. Occlusive dressings should not be used.
^{470}
Usual adult prescribing limits
Amounts greater than 50 grams per week should not be exceeded, and treatment should not exceed two weeks.
^{470}
Usual pediatric dose
Children up to 12 years of age—Safety and efficacy have not been established
^{470}
Strength(s) usually available
U.S.—

0.05% (Rx) [Olux Foam (cetyl alcohol) ( ethanol) (polysorbate 80) ( potassium citrate) (propylene glycol) (purified water) (stearyl alcohol)]^{470}

Packaging and storage:
Store between 20 to 25°C (68 and 77 °F). Keep out of reach of children. Contents under pressure. Do not puncture or incinerate container. Do not expose to temperatures above 49°C (120°F). Protect from direct sunlight.^{470}

Auxiliary labeling:
   • For external use only. ^{470}
   • Do not use in or around the eye. ^{470}

Note: Explain administration technique.
When dispensing, include patient instructions.

CLOBETASOL PROPIONATE TOPICAL SOLUTION USP^{40}

Usual adult dose
Topical, to the scalp, two times a day. ^{110} ^{408} Clobetasol propionate topical solution may be used for only a short duration of therapy and on small surface areas. ^{401} ^{434} Occlusive dressings should not be used. ^{401} ^{434}

Usual pediatric dose
Children up to 12 years of age—Use is not recommended. ^{55} ^{110} ^{169} ^{408}

Strength(s) usually available
U.S.—

0.05% (Rx) [Temovate Scalp Application (isopropyl alcohol)^{408}]

Canada—

0.05% (Rx) [Dermovate Scalp Lotion (alcohol)^{03}^{110}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{40} Do not refrigerate. ^{40} Protect from freezing.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{110}

CLOBETASOL PROPIONATE OINTMENT USP^{40}

Usual adult dose
Topical, to the skin, two or three times a day. ^{11} ^{110} ^{274} Clobetasol propionate ointment may be used for only a short duration of therapy and on small surface areas. ^{401} ^{434} Occlusive dressings should not be used. ^{401} ^{434}

Usual pediatric dose
Children up to 12 years of age—Use is not recommended. ^{11} ^{110} ^{169} ^{274}

Strength(s) usually available
U.S.—

0.05% (Rx) [Temovate^{11}^{158}]

Canada—

0.05% (Rx) [Dermovate^{110}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a collapsible tube or tight container. ^{40} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{11} ^{274}
   • Do not use in or around the eye. ^{11} ^{110} ^{274}

CLOBETASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating—Medium.

Topical Dosage Forms

CLOBETASONE BUTYRATE CREAM

Usual adult dose
Topical, to the skin, two or three times a day. ^{111}

Usual adult prescribing limits
100 grams per week. ^{111}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.05% (Rx) [Eumovate^{111}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

CLOBETASONE BUTYRATE OINTMENT

Usual adult dose
See Clobetasone Butyrate Cream . ^{111}

Usual adult prescribing limits
See Clobetasone Butyrate Cream . ^{111}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.05% (Rx) [Eumovate^{111}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

CLOCORTOLONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating—Low.

Topical Dosage Forms

CLOCORTOLONE PIVALATE CREAM USP

Usual adult dose
Topical, to the skin, three times a day. ^{32} ^{301}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.1% (Rx) [Cloderm (methylparaben) ( propylparaben)^{32}^{301}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{301} unless otherwise specified by manufacturer. Store in a tight, light-resistant container. ^{16} Protect from freezing. ^{301}

Auxiliary labeling:
• For external use only. ^{32} ^{301}
• Do not use in or around the eye. ^{32} ^{301}

DESONIDE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; non-fluorinated.

Potency rating—Low.

Topical Dosage Forms

DESONIDE CREAM

Usual adult dose
Topical, to the skin, two to four times a day. ^{12} ^{88} ^{112} ^{275} ^{327} ^{433}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (Rx) [DesOwen^{204}^{275}^{327}^{433}] [Tridesilon^{12}][Generic]^{158}

Canada—

0.05% (Rx) [Tridesilon^{112}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer. Protect from freezing. ^{327}

Auxiliary labeling:
   • For external use only. ^{12} ^{275}
   • Do not use in or around the eye. ^{12} ^{112} ^{275}

DESONIDE LOTION

Usual adult dose
See Desonide Cream . ^{434}

Strength(s) usually available
U.S.—

0.05% (Rx) [DesOwen^{426}^{433}]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only.
   • Shake well before using. ^{426} ^{433}
   • Do not use in or around the eye.

DESONIDE OINTMENT

Usual adult dose
See Desonide Cream . ^{13} ^{112} ^{327} ^{433}

Usual pediatric dose
See Desonide Cream .

Strength(s) usually available
U.S.—

0.05% (Rx) [DesOwen^{302}^{327}^{433}] [Tridesilon^{13}]

Canada—

0.05% (Rx) [Tridesilon^{112}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a tight container, unless otherwise specified by manufacturer. Protect from freezing. ^{327}

Auxiliary labeling:
   • For external use only. ^{13}
   • Do not use in or around the eye. ^{13} ^{112}

DESOXIMETASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted (17-H); fluorinated.

Potency rating—
High (except cream 0.05%).

Cream 0.05%, Medium.

Topical Dosage Forms

DESOXIMETASONE CREAM USP

Usual adult dose
Topical, to the skin, two times a day. ^{113} ^{211} ^{432}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (Rx) [Topicort LP^{01}^{05}^{52}^{211}][Generic]^{432}

0.25% (Rx) [Topicort^{52}^{211}][Generic]^{432}^{466}

Canada—

0.05% (Rx) [Topicort Mild^{113}]

0.25% (Rx) [Topicort^{113}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{211}
   • Do not use in or around the eye. ^{113} ^{211}

DESOXIMETASONE GEL USP

Usual adult dose
See Desoximetasone Cream USP . ^{05} ^{230} ^{410}

Usual pediatric dose
See Desoximetasone Cream USP .

Strength(s) usually available
U.S.—

0.05% (Rx) [Topicort (alcohol 20%)^{05}^{52}^{230}]

Canada—

0.05% (Rx) [Topicort (alcohol)^{410}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{230} in well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{230}
   • Do not use in or around the eye. ^{230}

DESOXIMETASONE OINTMENT USP

Usual adult dose
See Desoximetasone Cream USP . ^{05} ^{231}

Usual pediatric dose
See Desoximetasone Cream USP .

Strength(s) usually available
U.S.—

0.25% (Rx) [Topicort^{05}^{52}^{231}]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{231} in well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{231}
   • Do not use in or around the eye. ^{231}

DEXAMETHASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Unsubstituted; fluorinated.

Potency rating—Low.

Topical Dosage Forms

DEXAMETHASONE GEL USP

Usual adult dose
Topical, to the skin, three or four times a day. ^{17}

Usual pediatric dose
Topical, to the skin, one or two times a day. ^{254}

Strength(s) usually available
U.S.—

0.1% (Rx) [Decaderm^{17}]

Canada—
Not commercially available.

Packaging and storage:
Store below 30 °C (86 °F), in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{17}
   • Do not use in or around the eye. ^{17}

DEXAMETHASONE TOPICAL AEROSOL (SOLUTION) USP

Usual adult dose
Topical, to the skin, two to four times a day. ^{18} ^{77} ^{205}

Usual pediatric dose
Topical, to the skin, one or two times a day. ^{254}

Strength(s) usually available
U.S.—

0.01% (Rx) [Aeroseb-Dex (alcohol 59%)^{77}^{158}^{205}]

0.04% (Rx) [Decaspray^{18}^{158}]

Note: Each one-second spray of 0.01% and 0.04% aerosols delivers 20 mcg ^{19} ^{77} ^{205} and 75 mcg ^{18} of dexamethasone, respectively.

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F). Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{18} ^{77}
   • Do not use in or around the eye. ^{18} ^{77}
   • Shake gently. ^{18} ^{77} ^{205}

Note: Explain administration technique.
When dispensing, include patient instructions.
This medication comes with a special applicator tube for use on the scalp.

DEXAMETHASONE SODIUM PHOSPHATE CREAM USP

Usual adult dose
See Dexamethasone Gel USP . ^{15}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.1% (phosphate) (Rx) [Decadron (methylparaben)^{15}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{15}
   • Do not use in or around the eye. ^{15}

DIFLORASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating—
High (except Psorcon ointment).

Psorcon ointment, Very high.

Topical Dosage Forms

DIFLORASONE DIACETATE CREAM USP

Usual adult dose
Topical, to the skin, one to four times a day. ^{33} ^{34} ^{80} ^{114} ^{115} ^{216} ^{276}

Note: Some patients may be maintained with once daily applications after the initial acute symptoms subside. ^{115} Once daily dosage also may be used to taper therapy before discontinuance. ^{115}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (Rx) [Florone^{07}^{33}^{158}^{276}] [Florone E^{80}] [Maxiflor^{34}^{216}] [Psorcon^{466}]

Canada—

0.05% (Rx) [Florone^{114}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{216} ^{276}
   • Do not use in or around the eye. ^{114} ^{115} ^{216} ^{276}

DIFLORASONE DIACETATE OINTMENT USP

Usual adult dose
See Diflorasone Diacetate Cream USP . ^{33} ^{34} ^{81} ^{114} ^{115} ^{216} ^{276}

Note: Psorcon may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used with Psorcon. ^{401}

Usual pediatric dose
See Diflorasone Diacetate Cream USP .

Note: Psorcon should be used cautiously in patients up to 12 years of age. ^{162}

Strength(s) usually available
U.S.—

0.05% (Rx) [Florone^{33}^{158}^{276}] [Maxiflor^{34}^{216}] [Psorcon^{81}^{158}]

Canada—

0.05% (Rx) [Florone^{114}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{81} ^{216}
   • Do not use in or around the eye. ^{81} ^{114} ^{115} ^{216}

DIFLUCORTOLONE

Summary of Differences

Pharmacology/pharmacokinetics:
Unsubstituted; fluorinated.

Potency rating—Medium.

Topical Dosage Forms

DIFLUCORTOLONE VALERATE CREAM

Usual adult dose
Topical, to the skin, one to three times a day. ^{117}

Note: Some patients may be maintained with once daily applications after the initial acute symptoms subside. ^{117} Once daily dosage may also be used to taper therapy before discontinuance. ^{117}

Usual adult prescribing limits
100 grams per week. ^{17}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.1% (Rx) [Nerisone^{117}] [Nerisone Oily^{117}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

DIFLUCORTOLONE VALERATE OINTMENT

Usual adult dose
See Diflucortolone Valerate Cream . ^{117}

Usual adult prescribing limits
See Diflucortolone Valerate Cream . ^{117}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.1% (Rx) [Nerisone^{117}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

FLUMETHASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Unsubstituted; fluorinated.

Potency rating—Low.

Topical Dosage Forms

FLUMETHASONE PIVALATE CREAM USP

Usual adult dose
Topical, to the skin, one to three times a day. ^{116} ^{232}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.03% (Rx) [Locacorten (methylparaben) ( propylparaben)^{116}^{232}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{116}

FLUMETHASONE PIVALATE OINTMENT

Usual adult dose
See Flumethasone Pivalate Cream USP . ^{116} ^{233}

Usual pediatric dose
See Flumethasone Pivalate Cream USP .

Strength(s) usually available
U.S.—
Not commercially available.

Canada—

0.03% (Rx) [Locacorten (methylparaben) ( propylparaben)^{116}^{233}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye. ^{116}

FLUOCINOLONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating—
Medium (except cream 0.2%).

Cream 0.2%, High.

Topical Dosage Forms

FLUOCINOLONE ACETONIDE CREAM USP

Usual adult dose
Topical, to the skin, two to four times a day. ^{06} ^{118} ^{120} ^{121} ^{126} ^{251} ^{294} ^{358} ^{445} ^{447} ^{451}

Usual pediatric dose
Topical, to the skin, as a 0.01% cream one or two times a day; or as a 0.025 or 0.2% cream once a day. ^{254} ^{358}

Note: The 0.2% strength is not recommended for use in children up to 2 years of age, should not be used for long periods, and should not be used in quantities greater than 2 grams per day. ^{06} ^{358}

Strength(s) usually available
U.S.—

0.01% (Rx) [Bio-Syn^{158}^{294}] [Fluocet] [Flurosyn] [Synalar^{06}^{158}^{447}][Generic]^{330}^{331}

0.025% (Rx) [Bio-Syn^{158}^{294}] [Fluocet] [Flurosyn^{158}] [Synalar^{06}^{158}^{447}] [Synemol^{06}^{447}][Generic]^{330}^{331}

0.2% (Rx) [Synalar-HP^{01}^{06}^{158}^{451}]

Canada—

0.01% (Rx) [Fluoderm^{118}] [Fluolar^{119}] [Fluonide^{126}] [Synalar^{120}] [Synamol^{121}]

0.025% (Rx) [Fluoderm^{118}] [Fluolar^{119}] [Fluonide^{126}] [Synalar^{120}] [Synamol^{121}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06} ^{118} ^{294}
   • Do not use in or around the eye. ^{06} ^{118} ^{120} ^{121} ^{126} ^{294}

FLUOCINOLONE ACETONIDE OINTMENT USP

Usual adult dose
See Fluocinolone Acetonide Cream USP . ^{06} ^{118} ^{120} ^{158} ^{251} ^{322} ^{323}

Usual pediatric dose
Topical, to the skin once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Flurosyn^{158}] [Synalar^{158}]

Canada—

0.01% (Rx) [Fluoderm^{118}]

0.025% (Rx) [Fluoderm^{118}] [Synalar^{120}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06} ^{118}
   • Do not use in or around the eye. ^{06} ^{118} ^{120}

FLUOCINOLONE ACETONIDE TOPICAL SOLUTION USP

Usual adult dose
See Fluocinolone Acetonide Cream USP . ^{06} ^{82} ^{120} ^{277} ^{329} ^{334} ^{335} ^{444}

Usual pediatric dose
Topical, to the skin one or two times a day. ^{254}

Strength(s) usually available
U.S.—

0.01% (Rx) [Fluonid^{277}^{278}^{329}] [Synalar^{06}^{82}^{158}^{444}][Generic]^{158}^{334}^{335}

Canada—

0.01% (Rx) [Synalar^{120}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{327} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{327}

Auxiliary labeling:
   • For external use only. ^{06}
   • Do not use in or around the eye. ^{06} ^{120}

FLUOCINONIDE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency rating—High.

Topical Dosage Forms

FLUOCINONIDE CREAM USP

Usual adult dose
Topical, to the skin, two to four times a day. ^{06} ^{122} ^{123} ^{124} ^{244} ^{249} ^{295} ^{336} ^{419} ^{450}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (Rx) [Fluocin^{158}^{295}] [Licon^{158}^{336}] [Lidex^{06}^{158}] [Lidex-E^{06}^{158}^{450}][Generic]^{158}^{244}

Canada—

0.01% (Rx) [Lidex^{123}^{419}]

0.05% (Rx) [Lidemol^{122}] [Lidex^{123}^{419}] [Lyderm^{124}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), ^{336} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06} ^{244} ^{295}
   • Do not use in or around the eye. ^{06} ^{122} ^{123} ^{124} ^{244} ^{295}

FLUOCINONIDE GEL USP

Usual adult dose
See Fluocinonide Cream USP . ^{06} ^{125} ^{449}

Usual pediatric dose
See Fluocinonide Cream USP .

Strength(s) usually available
U.S.—

0.05% (Rx) [Lidex^{06}^{158}^{449}][Generic]^{359}^{360}

Canada—

0.05% (Rx) [Topsyn^{125}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06}
   • Do not use in or around the eye. ^{06} ^{125}

FLUOCINONIDE OINTMENT USP

Usual adult dose
See Fluocinonide Cream USP . ^{06} ^{123} ^{416} ^{419}

Usual pediatric dose
See Fluocinonide Cream USP .

Strength(s) usually available
U.S.—

0.05% (Rx) [Lidex^{06}^{158}][Generic]^{416}^{466}

Canada—

0.01% (Rx) [Lidex^{123}^{419}]

0.05% (Rx) [Lidex^{123}^{419}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06}
   • Do not use in or around the eye. ^{06} ^{123}

FLUOCINONIDE TOPICAL SOLUTION USP

Usual adult dose
See Fluocinonide Cream USP . ^{06} ^{249} ^{419} ^{448}

Usual pediatric dose
See Fluocinonide Cream USP .

Strength(s) usually available
U.S.—

0.05% (Rx) [Lidex (alcohol 35%)^{06}^{158}^{448}][Generic]^{359}^{360}

Canada—

0.05% (Rx) [Lidex (alcohol 35%)^{419}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{06}
   • Do not use in or around the eye. ^{06} ^{249}

FLURANDRENOLIDE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—
Medium (except cream and ointment 0.0125%).

Cream and ointment 0.0125%, Low.

Topical Dosage Forms

FLURANDRENOLIDE CREAM USP

Usual adult dose
Topical, to the skin, two or three times a day. ^{36} ^{127} ^{279}

Usual pediatric dose
Topical, to the skin, as a 0.025% cream one or two times a day; ^{253} ^{254} or as a 0.05% cream once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Cordran SP^{36}^{158}^{279}]

0.05% (Rx) [Cordran SP^{36}^{158}^{279}]

Canada—

0.0125% (Rx) [Drenison-1/4^{127}]

0.05% (Rx) [Drenison^{127}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from light. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{279}
   • Do not use in or around the eye. ^{127} ^{279}

FLURANDRENOLIDE LOTION USP

Usual adult dose
See Flurandrenolide Cream USP . ^{36} ^{279}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.05% (Rx) [Cordran^{158}^{279}][Generic]^{158}

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Store in a tight container. ^{16} Protect from heat, light, and freezing. ^{16}

Auxiliary labeling:
   • For external use only. ^{279}
   • Do not use in or around the eye. ^{279}
   • Shake well.

FLURANDRENOLIDE OINTMENT USP

Usual adult dose
See Flurandrenolide Cream USP . ^{36} ^{127} ^{279}

Usual pediatric dose
Topical, to the skin, as a 0.025% ointment one or two times a day; ^{253} ^{254} or as a 0.05% ointment once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Cordran^{36}^{158}^{279}]

0.05% (Rx) [Cordran^{36}^{158}^{279}]

Canada—

0.0125% (Rx) [Drenison-1/4^{127}]

0.05% (Rx) [Drenison^{127}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from light. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{279}
   • Do not use in or around the eye. ^{127} ^{279}

FLURANDRENOLIDE TAPE USP

Usual adult dose
Topical, to the skin, as a tape containing 4 mcg of flurandrenolide per square centimeter, to be replaced every twelve to twenty-four hours. ^{36} ^{128} ^{280}

Usual pediatric dose
Topical, to the skin, as a tape containing 4 mcg of flurandrenolide per square centimeter; to be replaced once a day.

Strength(s) usually available
U.S.—

4 mcg per square centimeter (Rx) [Cordran^{36}^{158}^{280}]

Canada—

4 mcg per square centimeter (Rx) [Drenison^{128}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F).

Auxiliary labeling:
   • For external use only.

Note: Explain administration technique.
When dispensing, include patient instructions.

Additional information:
Tape of flexible polyethylene film impregnated with flurandrenolide in the acrylic adhesive serves as an occlusive dressing, and should not be used in intertriginous areas or applied to lesions exuding serum. ^{128} ^{280}

FLUTICASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—Medium.

Topical Dosage Forms

FLUTICASONE PROPIONATE CREAM

Usual adult dose
Atopic Dermatitis
Topical, apply to affected skin once or twice daily.
^{472}
Other corticosteroid-responsive dermatoses
Topical, apply to affected skin twice daily.
^{472}

Usual pediatric dose
Children 3 months of age and older: See Usual adult dose. Use should not continue beyond 4 weeks.^{472}

Children up to 3 months of age: Safety and efficacy have not been established.^{472}

Usual geriatric dose
See Usual adult dose.
^{472}
Strength(s) usually available
U.S.—

0.05% (Rx) [Cutivate (propylene glycol) ( mineral oil) (cetostearyl alcohol) (Ceteth-20) (isopropyl myristate) (dibasic sodium phosphate) (citric acid) (purified water) ( imidurea)^{472}]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 30 °C (36 and 86 °F)^{472}

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

Note: Fluticasone propionate cream should not be used with occlusive dressings. Fluticasone propionate cream should not be applied in the diaper area, as diapers or plastic pants may constitute occlusive dressings.^{472}

FLUTICASONE PROPIONATE OINTMENT

Usual adult dose
Topical, apply to the skin twice daily^{471}.

Usual pediatric dose
Safety and efficacy have not been established.
^{471}
Usual geriatric dose
See Usual adult dose. ^{471}

Strength(s) usually available
U.S.—

0.005% (Rx) [Cutivate (propylene glycol) ( sorbitan sesquioleate) (microcrystalline wax) (liquid paraffin)^{471}]

Canada—
Not commercially available.

Packaging and storage:
Store between 2 and 30 °C (36 and 86 °F)^{471}

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

HALCINONIDE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—High.

Topical Dosage Forms

HALCINONIDE CREAM USP

Usual adult dose
Topical, to the skin, one to three times a day. ^{37} ^{84} ^{86} ^{129} ^{248}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Halog^{84}^{158}]

0.1% (Rx) [Halog^{84}^{158}] [Halog-E^{86}^{158}]

Canada—

0.1% (Rx) [Halog^{129}]

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{84} ^{86}
   • Do not use in or around the eye. ^{84} ^{86} ^{129} ^{248}

HALCINONIDE OINTMENT USP

Usual adult dose
Topical, to the skin, two or three times a day. ^{37} ^{85} ^{129}

Usual pediatric dose
See Halcinonide Cream USP .

Strength(s) usually available
U.S.—

0.1% (Rx) [Halog^{85}^{158}]

Canada—

0.1% (Rx) [Halog^{129}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{85}
   • Do not use in or around the eye. ^{85} ^{129}

HALCINONIDE TOPICAL SOLUTION USP

Usual adult dose
See Halcinonide Ointment USP . ^{83} ^{129}

Usual pediatric dose
See Halcinonide Cream USP .

Strength(s) usually available
U.S.—

0.1% (Rx) [Halog^{83}^{158}]

Canada—

0.1% (Rx) [Halog^{129}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{83}
   • Do not use in or around the eye. ^{83} ^{129}

HALOBETASOL

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—Very high.

Topical Dosage Forms

HALOBETASOL PROPIONATE CREAM

Usual adult dose
Topical, to the skin, one or two times a day. ^{414} ^{462} Halobetasol propionate cream may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{401}

Usual pediatric dose
Dosage has not been established. ^{462}

Strength(s) usually available
U.S.—

0.05% (Rx) [Ultravate^{414}^{462}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

HALOBETASOL PROPIONATE OINTMENT

Usual adult dose
Topical, to the skin, one or two times a day. ^{415} ^{463} Halobetasol propionate ointment may be used for only a short duration of therapy and on small surface areas. ^{401} Occlusive dressings should not be used. ^{401}

Usual pediatric dose
Dosage has not been established. ^{463}

Strength(s) usually available
U.S.—

0.05% (Rx) [Ultravate^{415}^{463}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

HYDROCORTISONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted (butyrate, valerate); non-fluorinated.

Potency ranking—Low (acetate and base); Medium (butyrate and valerate).

Dental Dosage Forms

HYDROCORTISONE ACETATE DENTAL PASTE

Usual adult dose
Topical, to the oral mucous membranes, two or three times a day after meals and at bedtime. ^{281}

Usual pediatric dose
Dosage has not been established. ^{281}

Strength(s) usually available
U.S.—

0.5% (Rx) [Orabase-HCA^{39}^{281}]

Canada—
Not commercially available.

Packaging and storage:
Store between 4 and 30 °C (39 and 86 °F), unless otherwise specified by manufacturer. Protect from light. Protect from freezing.

Auxiliary labeling:
   • For use in the mouth only.

Topical Dosage Forms

HYDROCORTISONE CREAM USP

Usual adult dose
Topical, to the skin, one to four times a day. ^{06} ^{07} ^{08} ^{41} ^{87} ^{90} ^{134} ^{135} ^{217} ^{218} ^{229} ^{247} ^{285} ^{337} ^{338} ^{339} ^{340} ^{341} ^{342} ^{446}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{07} ^{08}

Children 2 years of age or older—Topical, to the skin, as a 0.25% to 0.5% cream one to four times a day; ^{07} ^{08} ^{285} or as a 1% cream one or two times a day. ^{253} ^{254}

Strength(s) usually available
U.S.—

0.25% (OTC) [Cort-Dome^{41}^{158}]

0.5% (OTC) [Bactine^{01}^{07}] [Cort-Dome^{41}^{158}] [Cortifair^{286}] [DermiCort] [Dermtex HC] [Hydro-Tex (sodium bisulfite)^{87}^{158}] [Hytone^{285}][Generic]^{158}

1% (Rx) [Ala-Cort^{01}] [Allercort^{158}^{342}] [Alphaderm^{90}] [Cort-Dome^{41}^{158}] [Cortifair^{208}^{286}] [Dermacort^{158}^{202}^{227}^{229}] [Hi-Cor 1.0] [Hydro-Tex ( sodium bisulfite)^{87}^{158}] [Hytone^{287}] [Lemoderm^{158}^{337}] [Nutracort^{217}^{218}^{377}] [Penecort^{210}] [Synacort^{06}^{158}^{446}][Generic]^{158}^{338}^{339}

2.5% (Rx) [Allercort^{158}^{342}] [Anusol-HC^{443}] [Hi-Cor 2.5] [Hytone^{287}] [Lemoderm^{158}^{337}] [Penecort^{210}] [Synacort^{06}^{158}^{446}][Generic]^{158}^{340}^{341}

Canada—

0.5% (OTC) [Cortate^{130}] [Unicort^{135}]

0.5% (Rx) [Sential (urea 4%)^{411}]

1% (Rx) [Barriere-HC^{245}] [Emo-Cort^{134}] [Prevex HC^{425}] [Unicort^{135}]

2.5% (Rx) [Emo-Cort^{134}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{41}

Auxiliary labeling:
   • For external use only. ^{07} ^{08} ^{41} ^{90} ^{227}
   • Do not use in or around the eye. ^{07} ^{08} ^{41} ^{90} ^{134} ^{135} ^{227}

HYDROCORTISONE LOTION USP

Usual adult dose
See Hydrocortisone Cream USP . ^{08} ^{134} ^{149} ^{213} ^{229} ^{242} ^{247} ^{282} ^{287} ^{342} ^{343} ^{377} ^{420}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{08}

Children 2 years of age or older—Topical, to the skin, as a 0.25% to 0.5% lotion, one to four times a day; ^{08} or as a 1% lotion one or two times a day; ^{253} ^{254} or as a 2.5% lotion once a day.

Strength(s) usually available
U.S.—

0.25% (OTC) [Cetacort^{158}^{212}] [Cort-Dome^{158}^{282}]

0.5% (OTC) [Cetacort^{158}^{212}] [Delacort] [MyCort] [S-T Cort^{343}][Generic]^{158}

1% (Rx) [Acticort 100^{158}] [Ala-Cort^{158}] [Allercort^{342}] [Beta-HC^{420}] [Cetacort^{158}^{212}^{213}] [Dermacort^{158}^{202}^{228}^{229}] [Gly-Cort^{158}] [Hytone^{287}] [LactiCare-HC^{158}] [Lemoderm^{337}] [Nutracort^{242}^{377}] [Pentacort^{158}] [Rederm^{158}][Generic]^{158}

2% (Rx) [Ala-Scalp HP^{01}^{52}]

2.5% (Rx) [Hytone^{287}] [LactiCare-HC^{158}] [Nutracort^{377}]

Canada—

0.5% (OTC) [Cortate^{130}] [Emo-Cort^{134}]

1% (Rx) [Emo-Cort^{134}] [Sarna HC 1.0%^{149}]

2.5% (Rx) [Emo-Cort^{134}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{228}

Auxiliary labeling:
   • For external use only. ^{08} ^{212} ^{228}
   • Do not use in or around the eye. ^{08} ^{212} ^{228}
   • Shake well. ^{213} ^{228} ^{242}

HYDROCORTISONE OINTMENT USP

Usual adult dose
See Hydrocortisone Cream USP . ^{08} ^{287} ^{337} ^{342} ^{344} ^{345}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{08}

Children 2 years of age or older—Topical, to the skin, as a 0.5% ointment one to four times a day; ^{08} or as a 1% ointment one or two times a day; ^{253} ^{254} or as a 2.5% ointment once a day.

Strength(s) usually available
U.S.—

0.5% (OTC)[Generic]^{158}

1% [Allercort^{342}] [Cortril^{158}] [Hytone^{287}] [Lemoderm^{337}][Generic]^{158}^{344}^{345}

2.5% (Rx) [Allercort^{342}] [Hytone^{287}][Generic]^{158}

Canada—

0.5% (OTC) [Cortate^{130}]

1% (Rx) [Cortate^{130}] [Cortef^{131}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{08}
   • Do not use in or around the eye. ^{08}

HYDROCORTISONE TOPICAL SOLUTION

Usual adult dose
See Hydrocortisone Cream USP . ^{134} ^{221} ^{455} ^{456} ^{464}

Usual pediatric dose
Topical, to the skin one or two times a day. ^{253} ^{254}

Strength(s) usually available
U.S.—

0.5% (OTC) [Aeroseb-HC (alcohol 58%)^{288}] [CaldeCORT Anti-Itch ( alcohol 89.5%)^{09}] [Cortaid (alcohol 46%) ( parabens)^{284}^{456}][Generic]^{378}

1% (OTC) [Maximum Strength Cortaid (alcohol 55%) ( parabens)^{455}]

1% (Rx) [Penecort (alcohol 57%)^{210}] [Texacort (alcohol 33%)^{158}^{221}]

2.5% (Rx) [Texacort (alcohol 49%)^{464}]

Canada—

2.5% (Rx) [Emo-Cort Scalp Solution (alcohol)^{134}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{221}
   • Do not use in or around the eye. ^{134} ^{221}

HYDROCORTISONE ACETATE CREAM USP

Usual adult dose
Topical, to the skin, one to four times a day. ^{06} ^{51} ^{89} ^{136} ^{137} ^{139} ^{283} ^{284} ^{379} ^{375} ^{383} ^{422} ^{423} ^{441} ^{452} ^{453} ^{459} ^{460}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{283}

Children 2 years of age and older—See Usual adult dose . ^{282} ^{284} ^{379} ^{422} ^{423}

Strength(s) usually available
U.S.—

0.5% (OTC) [Corticaine^{89}^{158}] [FoilleCort] [Gynecort] [Lanacort^{158}^{379}] [9-1-1^{56}] [Pharma-Cort][Generic]^{158}

0.5% (base) (OTC) [CaldeCORT Light^{01}^{09}] [Cortaid^{284}^{459}] [Cortef Feminine Itch^{283}^{452}^{453}][Generic]^{158}

1% (OTC) [Anusol-HC^{375}^{383}] [Gynecort 10^{423}] [Lanacort 10^{422}]

1% (base) (OTC) [Dermarest DriCort^{441}] [Maximum Strength Cortaid^{460}]

1% (Rx) [Carmol-HC (sodium bisulfite)^{158}^{225}][Generic]^{158}

Canada—

0.1% (Rx) [Corticreme^{137}]

0.5% (OTC) [Cortacet^{136}] [Hyderm^{139}] [Novohydrocort^{140}]

1% (Rx) [Corticreme^{137}] [Hyderm^{139}] [Novohydrocort^{140}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{283} ^{284}
   • Do not use in or around the eye. ^{283} ^{284}

HYDROCORTISONE ACETATE TOPICAL AEROSOL FOAM

Usual adult dose
See Hydrocortisone Acetate Cream USP . ^{293}

Usual pediatric dose
Topical, to the skin, one or two times a day. ^{253} ^{254}

Strength(s) usually available
U.S.—

1% (Rx) [Epifoam (butane) (methylparaben ) (propane) (propylparaben )^{215}^{293}]

Canada—
Not commercially available.

Packaging and storage:
Store below 49 °C (120 °F), unless otherwise specified by manufacturer.

Auxiliary labeling:
   • Shake well. ^{293}
   • For external use only. ^{293}
   • Do not use in or around the eye. ^{293}

HYDROCORTISONE ACETATE LOTION USP

Usual adult dose
See Hydrocortisone Acetate Cream USP . ^{284} ^{454}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{284}

Children 2 years of age or older—See Usual adult dose . ^{284}

Strength(s) usually available
U.S.—

0.5% (base) (OTC) [Cortaid^{284}^{454}] [Rhulicort]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{284}
   • Do not use in or around the eye. ^{284}
   • Shake well.

HYDROCORTISONE ACETATE OINTMENT USP

Usual adult dose
See Hydrocortisone Acetate Cream USP . ^{138} ^{284} ^{457} ^{458}

Usual pediatric dose
Children up to 2 years of age—Dosage has not been established. ^{284}

Children 2 years of age or older—Topical, to the skin, as a 0.5% ointment one to four times a day; ^{284} or as a 1% ointment one or two times a day; ^{253} ^{254} or as a 2.5% ointment once a day.

Strength(s) usually available
U.S.—

0.5% (OTC) [Lanacort^{158}]

0.5% (base) (OTC) [Cortaid^{284}^{457}]

1% (Rx)[Generic]^{158}

1% (base) (OTC) [Maximum Strength Cortaid^{458}]

Canada—

0.5% (OTC) [Cortoderm^{138}] [Novohydrocort^{140}]

1% (Rx) [Cortef^{131}] [Cortoderm^{138}] [Novohydrocort^{140}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{284}
   • Do not use in or around the eye. ^{284}

HYDROCORTISONE BUTYRATE CREAM USP

Usual adult dose
Topical, to the skin, two or three times a day. ^{289}

Usual pediatric dose
Topical, to the skin, one or two times a day.

Strength(s) usually available
U.S.—

0.1% (Rx) [Locoid (methylparaben)^{289}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{289}
   • Do not use in or around the eye. ^{289}

HYDROCORTISONE BUTYRATE OINTMENT

Usual adult dose
See Hydrocortisone Butyrate Cream USP . ^{289}

Usual pediatric dose
See Hydrocortisone Butyrate Cream USP .

Strength(s) usually available
U.S.—

0.1% (Rx) [Locoid^{289}]

Canada—
Not commercially available.

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. Protect from freezing. ^{289}

Auxiliary labeling:
   • For external use only. ^{289}
   • Do not use in or around the eye. ^{289}

HYDROCORTISONE BUTYRATE TOPICAL SOLUTION

Usual adult dose
See Hydrocortisone Butyrate Cream USP . ^{289}

Usual pediatric dose
See Hydrocortisone Butyrate Cream USP .^{289}

Strength(s) usually available
U.S.—

0.1% (Rx) [Locoid^{469}]

Packaging and storage:
Store between 5 and 25 °C (41 and 77 °F).^{469}

Auxiliary labeling:
   • For external use only. ^{469}
   • Do not use in or around the eye. ^{469}

HYDROCORTISONE PROBUTATE CREAM

Usual adult dose
Topical, to the affected area once or twice daily. ^{468}

Usual pediatric dose
Dosage has not been established. ^{468}

Strength(s) usually available
U.S.—

0.1% (Rx) [Pandel]

HYDROCORTISONE VALERATE CREAM USP

Usual adult dose
Topical, to the skin, two or three times a day. ^{141} ^{290} ^{346}

Usual pediatric dose
Topical, to the skin, once a day.

Strength(s) usually available
U.S.—

0.2% (Rx) [Westcort^{290}^{346}]

Canada—

0.2% (Rx) [Westcort^{141}]

Packaging and storage:
Store below 25 °C (77 °F), unless otherwise specified by manufacturer. Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{290}
   • Do not use in or around the eye. ^{141} ^{290}

HYDROCORTISONE VALERATE OINTMENT

Usual adult dose
See Hydrocortisone Valerate Cream USP . ^{141} ^{290} ^{347}

Usual pediatric dose
See Hydrocortisone Valerate Cream USP .

Strength(s) usually available
U.S.—

0.2% (Rx) [Westcort^{290}^{347}]

Canada—

0.2% (Rx) [Westcort^{141}]

Packaging and storage:
Store below 26 °C (78 °F), ^{47} in a well-closed container, unless otherwise specified by manufacturer. Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{290}
   • Do not use in or around the eye. ^{141} ^{290}

MOMETASONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; non-fluorinated.

Potency ranking—Medium.

Topical Dosage Forms

MOMETASONE FUROATE CREAM USP^{40}

Usual adult dose
Topical, to the skin, once a day. ^{23} ^{424}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.1% (Rx) [Elocon^{23}^{158}^{214}]

Canada—

0.1% (Rx) [Elocom^{424}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), ^{23} unless otherwise specified by manufacturer. Store in a well-closed container. ^{40}

Auxiliary labeling:
   • For external use only. ^{23}
   • Do not use in or around the eye. ^{23}

MOMETASONE FUROATE LOTION

Usual adult dose
See Mometasone Furoate Cream USP . ^{409} ^{424}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.1% (Rx) [Elocon (isopropyl alcohol 40%)^{409}]

Canada—

0.1% (Rx) [Elocom^{424}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), in a well-closed container, unless otherwise specified by manufacturer.

Auxiliary labeling:
   • For external use only.
   • Do not use in or around the eye.

MOMETASONE FUROATE OINTMENT USP^{40}

Usual adult dose
See Mometasone Furoate Cream USP . ^{24} ^{424}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.1% (Rx) [Elocon^{24}^{158}^{214}]

Canada—

0.1% (Rx) [Elocom^{424}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 2 and 30 °C (36 and 86 °F), ^{24} unless otherwise specified by manufacturer. Store in a well-closed container. ^{40}

Auxiliary labeling:
   • For external use only. ^{24}
   • Do not use in or around the eye. ^{24}

PREDNICARBATE

Topical Dosage Form

PREDNICARBATE EMOLLIENT CREAM

Usual adult dose
Topical, to the affected area twice daily. ^{467}

Usual pediatric dose
Topical, to the affected area twice daily for up to 3 weeks in patients 1 year of age or older. ^{467}

Strength(s) usually available
U.S.—

0.1% (Rx) [Dermatop]

TRIAMCINOLONE

Summary of Differences

Pharmacology/pharmacokinetics:
Substituted; fluorinated.

Potency ranking—
Medium (except cream and ointment 0.5%).

Cream and ointment 0.5%, High.

Dental Dosage Forms

TRIAMCINOLONE ACETONIDE DENTAL PASTE USP

Usual adult dose
Topical, to the oral mucous membranes, two or three times a day after meals and at bedtime. ^{96} ^{146} ^{209} ^{431}

Usual pediatric dose
Dosage has not been established.

Strength(s) usually available
U.S.—

0.1% (Rx) [Kenalog in Orabase^{96}^{158}] [Oracort^{200}] [Oralone^{209}^{431}][Generic]^{470}

Canada—

0.1% (Rx) [Kenalog in Orabase^{146}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. ^{250} Store in a tight container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For use in the mouth only.

Topical Dosage Forms

TRIAMCINOLONE ACETONIDE CREAM USP

Usual adult dose
Topical, to the skin, two to four times a day. ^{72} ^{95} ^{143} ^{144} ^{145} ^{147} ^{222} ^{234} ^{235} ^{236} ^{238} ^{240} ^{250} ^{348} ^{349} ^{350} ^{351}

Usual pediatric dose
Topical, to the skin, as a 0.025% cream one or two times a day; ^{253} ^{254} or as a 0.1% or 0.5% cream once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Aristocort^{158}^{234}] [Aristocort A^{158}^{238}] [Flutex^{158}^{382}] [Kenac^{52}] [Kenalog^{72}^{158}] [Kenonel^{351}] [Triacet^{158}][Generic]^{349}^{350}

0.1% (Rx) [Aristocort^{158}^{235}] [Aristocort A^{158}^{239}] [Delta-Tritex^{158}] [Flutex^{158}^{382}] [Kenac^{52}^{158}] [Kenalog^{72}^{158}] [Kenalog-H^{95}^{158}] [Kenonel^{351}] [Triacet^{222}] [Triderm^{158}][Generic]^{350}

0.5% (Rx) [Aristocort^{158}^{236}] [Aristocort A^{158}^{240}] [Flutex^{158}^{382}] [Kenalog^{72}^{158}] [Kenonel^{351}] [Triacet^{158}][Generic]^{349}^{350}

Canada—

0.025% (Rx) [Aristocort D^{143}] [Triaderm^{145}] [Trianide Mild^{147}]

0.1% (Rx) [Aristocort R^{143}] [Kenalog^{144}] [Triaderm^{145}] [Trianide Regular^{147}]

0.5% (Rx) [Aristocort C^{143}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. ^{250} Store in a tight container. ^{16} Protect from freezing. ^{238} ^{250}

Auxiliary labeling:
   • For external use only. ^{145} ^{234}
   • Do not use in or around the eye. ^{143} ^{144} ^{145} ^{147} ^{234}

TRIAMCINOLONE ACETONIDE LOTION USP

Usual adult dose
See Triamcinolone Acetonide Cream USP . ^{92} ^{351}

Usual pediatric dose
Topical, to the skin, as a 0.025% lotion one or two times a day; ^{253} ^{254} or as a 0.1% lotion once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Kenalog^{92}^{158}]

0.1% (Rx) [Kenalog^{92}^{158}] [Kenonel^{351}]

Canada—
Not commercially available.

Packaging and storage:
Store between 15 and 30 °C (59 and 86 °F), ^{92} unless otherwise specified by manufacturer. Store in a tight container. ^{16} Protect from freezing. ^{92}

Auxiliary labeling:
   • For external use only. ^{92}
   • Do not use in or around the eye. ^{92}
   • Shake well.

TRIAMCINOLONE ACETONIDE OINTMENT USP

Usual adult dose
See Triamcinolone Acetonide Cream USP . ^{91} ^{143} ^{144} ^{145} ^{237} ^{241} ^{250} ^{304} ^{351} ^{352} ^{353} ^{354}

Usual pediatric dose
Topical, to the skin, as a 0.025% ointment one or two times a day; ^{253} ^{254} or as a 0.1 or 0.5% ointment once a day.

Strength(s) usually available
U.S.—

0.025% (Rx) [Flutex^{381}] [Kenalog^{91}^{158}][Generic]^{353}^{354}

0.1% (Rx) [Aristocort^{158}^{237}] [Aristocort A^{158}^{241}] [Flutex^{381}] [Kenac^{52}] [Kenalog^{91}^{158}] [Kenonel^{351}][Generic]^{353}^{354}

0.5% (Rx) [Aristocort^{158}] [Flutex^{381}] [Kenalog^{91}^{158}]

Canada—

0.025% (Rx) [Aristocort D^{143}] [Triaderm^{145}]

0.1% (Rx) [Aristocort R^{143}] [Kenalog^{144}] [Triaderm^{145}]

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F), unless otherwise specified by manufacturer. ^{91} ^{250} Store in a well-closed container. ^{16} Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{91} ^{145}
   • Do not use in or around the eye. ^{91} ^{143} ^{144} ^{145}

TRIAMCINOLONE ACETONIDE TOPICAL AEROSOL USP

Usual adult dose
Topical, to the skin, three or four times a day. ^{94} ^{144}

Usual pediatric dose
Topical, to the skin, one or two times a day. ^{253} ^{254}

Strength(s) usually available
U.S.—

0.015% (Rx) [Kenalog (alcohol 10.3%)^{94}]

Note: A 2-second spray delivers 0.2 mg of triamcinolone acetonide. ^{94} ^{144} Product applied to skin contains approximately 0.2% triamcinolone acetonide. ^{94} ^{144}

Canada—
Not commercially available. ^{465}

Packaging and storage:
Store below 40 °C (104 °F), preferably between 15 and 30 °C (59 and 86 °F). Protect from freezing.

Auxiliary labeling:
   • For external use only. ^{94}
   • Do not use in or around the eye. ^{94}

Note: Explain administration technique.
When dispensing, include patient instructions.

Revised: 06/17/2002

References

Cardinale VA, editor. Drug topics redbook. Oradell, NJ: Medical Economics Company, Inc., 1987 (abbreviated Redbook 1987).

Huff BB, editor. Physician's desk reference. Oradell, NJ: Medical Economics Company, Inc., 1988 (abbreviated PDR 1988) Maxivate package insert (Westwood) pp 2208-9.

Canadian Pharmaceutical Association. Compendium of pharmaceuticals and specialties, 22nd ed. Ottawa, Ontario: Author, 1987. (abbreviated CPS 1987) Dermovate product monograph.

Amcinonide cream/lotion/ointment (Cyclocort, Stiefel). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 404.

Topicort/Topicort LP In: PDR 1988.

Lidex/Lidex E/Carmol HC/Neosynalar/Synacort/Synalar/Synalar HP/Synemol. In: PDR 1988. Rev 1/87. Same as 1989.

Huff BB, editor. Physician's desk reference for nonprescription drugs. Oradell, NJ: Medical Economics Company, Inc; 1988. p 609.

Dermolate OTC-PDR 1988 (Schering) pp 689-90.

Caldecort (Pharmacraft-Pennwalt) OTC-PDR 1988 p 635.

Alclometasone dipropionate cream/ointment package insert (Aclovate, Glaxo Wellcome—US), Rev 04/96, Rec 10/30/96.

Temovate package insert (Glaxo—US), Rev 4/87, Rec 7/87.

Tridesilon cream (Miles). In: PDR 1988. p. 1462, Rev 1/84. Same as 1989.

Tridesilon ointment (Miles). In: PDR 1988. p. 1462-63, Rev 12/85. Same as 1989.

Medrol package insert (Upjohn—US), Rev 85.

Decadron phosphate cream package insert (MSD—US), Rev 4/83, Rec 8/92.

The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention Inc; 1995. p. 41-2, 74-5, 190, 192, 397, 469, 474, 667-71, 685-7, 730-1, 754-6, 758-9, 761, 765, 1575-7.

Decaderm package insert (MSD—US), Rev 4/83, Rec 8/92.

Decaspray package insert (MSD—US), 4/83, same as PDR 1988, 1989.

Aeroseb-Dex (Herbert). In: PDR 1988. p. 1038.

Amcinonide (Cyclocort, Fujisawa). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 1044.

Canada JR, editor. USP dictionary of USAN and international drug names 1998. Rockville, MD: The United States Pharmacopeial Convention Inc; 1997. p. 29, 43, 82, 94, 178, 179, 220, 222, 235, 316, 318, 321, 323, 351, 361, 362, 484, 598, 753.

Betamethasone valerate foam package insert (Luxíq, Connetics—US), Rev 02/99, Rec 03/99.

Elocon cream package insert (Schering), 4/87.

Elocon ointment package insert (Schering), 4/87.

The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 (9th supplement, 1998). p. 4534.

Uticort package insert (Parke-Davis), 1/82.

Diprolene cream package insert (Schering—US), 1/86. same as PDR 1988, 1989.

Betamethasone dipropionate cream (augmented) (Diprolene AF, Schering). In: PDR Physicians' desk reference. 53rd ed. 1999. Montvale, NJ: Medical Economics Company; 1999. p. 2831-2.

Diprosone In: PDR 1988. (Schering), Rev 12/85: 1900-1. Same as 1989.

Diprolene ointment package insert (Schering—US), 9/84, same as PDR 1988, 1989.

Valisone package insert (Schering—US), 12/85, same as PDR 1988, 1989.

Cloderm (Ortho). In: PDR 1986. p. 1306.

Florone (Dermik). In: PDR 1988. p. 900.

Maxiflor (Herbert). In: PDR 1988. p. 1042-3.

Fluonid (Herbert). In: PDR 1988. p. 1040-1.

Cordran/SP (Dista). In: PDR 1988. p. 905-6.

Halog-E (Princeton). In: PDR 1988. p. 1634-5.

Kenalog (Squibb). In: PDR 1988. p. 2054-5.

Orabase-HCA (Colgate-Hoyt). In: PDR 1988. p. 892-3.

The United States pharmacopeia. The national formulary. USP 23rd revision (January 1, 1995). NF 18th ed (January 1, 1995). Rockville, MD: The United States Pharmacopeial Convention, Inc; 1995 (2nd supplement, 1995). p. 2627-8, 2654-5.

Cort-Dome cream (Miles). In: PDR 1988. p. 1445. 1/84, same as PDR 1989.

Hytone cream/ointment/lotion (Dermik). In: PDR 1988. p. 900-1.

Penecort cream/ointment/solution (Herbert). In: PDR 1988. p. 1043.

Aeroseb-HC spray (Herbert). In: PDR 1988. p. 1038-9.

Epifoam (Reed and Carnick). In: PDR 1988. p. 1663-4. Rev 4/10/84.

Locoid cream/ointment (Owen). In: PDR 1988. p. 1518-9.

Westcort cream/ointment (Westwood). In: PDR 1988. p. 2212.

Celestone cream package insert (Schering—US), Rev 4/82.

Not used.

Not used.

Proctocort (Reid-Rowell). In: PDR 1988. p. 1673-4.

Lee FH, editor. American druggist blue book 1987-1988. New York: The Hearst Corporation; 1987.

Not used.

Not used.

Cort-Dome lotion (Miles). In: PDR 1988. p. 1446-7.

Panel comment, 7/20/88.

Not used.

Not used.

Panel comment, 7/11/88.

Finkel AJ, editor. CMIT. Current medical information and terminology. 5th ed. Chicago: American Medical Association; 1981.

Panel comment, 7/11/88.

Panel comment, 7/11/88.

Manufacturer comment, 7/11/88.

Manufacturer comment, 7/11/88.

Panel comment, 7/11/88.

Panel comment, 7/11/88.

Panel comment, 7/11/88.

Not used.

Not used.

Not used.

Not used.

Kenalog creams package insert (Squibb—US), Rev 2/88, Rec 10/88.

Not used.

Not used.

Diprolene lotion package insert (Schering—US), Rev 3/88, Rec 12/27/88.

Betamethasone dipropionate lotion USP 0.05% package insert (Copley—US), Rev 11/87, Rec 9/88.

Aeroseb-Dex package insert (Herbst—US), Rev 9/86, Rec 4/87.

Cyclocort topical cream package insert (Lederle—US), Rev 1/82, Rec 2/89.

Cyclocort ointment package insert (Lederle—US), Rev 3/82, Rec 2/89.

Florone E cream package insert (Dermik—US), Rev 3/88, Rec 3/13/89.

Psorcon ointment package insert (Dermik—US), Rev 6/88, Rec 10/88.

Synalar topical solution package insert (Syntex—US), Rev 11/82.

Halog solution package insert (Princeton—US), Rev 9/86, Rec 10/88.

Halog creams package insert (Princeton—US), Rev 9/86, Rec 10/88.

Halog ointment package insert (Princeton—US), Rev 9/86, Rec 10/88.

Halog-E cream package insert (Princeton—US), Rev 9/86, Rec 10/88.

Hydro-tex cream package insert (Syosett—US), Rev 11/83, Rec 8/88.

AMA Drug evaluations. 6th ed. Chicago: American Medical Association; September 1986.

Corticaine cream package insert (Glaxo—US), Rev 1/87, Rec 9/87.

Alphaderm cream package insert (Lemmon—US), Rev 1/88, Rec 9/88.

Kenalog ointments package insert (Squibb—US), Rev 4/86, Rec 10/88.

Kenalog lotions package insert (Squibb—US), Rev 4/86, Rec 10/88.

Wyngaarden JB, Smith LH, editors. Cecil textbook of medicine, 18th ed. Philadelphia: W.B. Saunders Co; 1988.

Kenalog spray package insert (Squibb—US), Rev 10/82, Rec 10/88.

Kenalog-H cream package insert (Squibb—US), Rev 4/86, Rec 10/88.

Kenalog in Orabase package insert (Squibb—US), Rev 11/83, Rec 10/88.

Diprolene (Schering). In: CPS 1988. p. 276.

Diprosone (Schering). In: CPS 1988. p. 277.

Not used.

Beben (PD). In: CPS 1988. p. 102.

Betacort (ICN). In: CPS 1988. p. 108.

Betaderm (Taro). In: CPS 1988. p. 108.

Betnovate (Glaxo). In: CPS 1988. p. 112.

Celestoderm-V and V/2 (Schering). In: CPS 1988. p. 149-50.

Ectosone (Technilag). In: CPS 1988. p. 297.

Ectosone (Technilab). In: CPS 1988. p. 297.

Metaderm (Riva). In: CPS 1988. p. 539.

Novobetamet (Novopharm). In: CPS 1988. p. 629.

Valisone (Schering). In: CPS 1988. p. 976.

Dermovate (Glaxo). In: CPS 1988. p. 247.

Eumovate (Glaxo). In: CPS 1988. p. 326.

Tridesilon (Miles). In: CPS 1988. p. 945.

Topicort (Hoechst). In: CPS 1988. p. 933-4.

Florone (Upjohn). In: CPS 1988. p. 338.

Flutone (Rorer). In: CPS 1988. p. 344-5.

Locacorten (Ciba). In: CPS 1988. p. 495-6.

Nerisone (Steifel). In: CPS 1988. p. 599-600.

Fluoderm (Taro). In: CPS 1988. p. 340.

Fluolar (Riva). In: CPS 1988. p. 340.

Synalar (Syntex). In: CPS 1988. p. 886-7.

Synamol (Syntex). In: CPS 1988. p. 887.

Lidemol (Syntex). In: CPS 1988. p. 487-8.

Lidex (Syntex). In: CPS 1988. p. 488.

Lyderm (Taro). In: CPS 1988. p. 507.

Topsyn (Syntex). In: CPS 1988. p. 934.

Fluonide (Technilab). In: CPS 1988. p. 340.

Drenison (Lilly). In: CPS 1988. p. 284-5.

Drenison tape (Lilly). In: CPS 1988. p. 285.

Halog (Squibb). In: CPS 1988. p. 378-9.

Cortate (Schering). In: CPS 1988. p. 202.

Cortef (Upjohn). In: CPS 1988. p. 202.

CPS 1988 Corticosteroids, topical monograph, p 203. Rev 1984.

Cortiment (Nordic). In: CPS 1988. p. 204.

Emo-cort (T.C.D.). In: CPS 1988. p. 302.

Unicort (A and H). In: CPS 1988. p. 970.

Cortacet (Ayerst). In: CPS 1988. p. 202.

Corticreme (Rougier). In: CPS 1988. p. 203.

Cortoderm (Taro). In: CPS 1988. p. 207.

Hyderm (Taro). In: CPS 1988. p. 402-3.

Novohydrocort (Novopharm). In: CPS 1988. p. 631.

Westcort (Westwood). In: CPS 1988. p. 1011.

Medrol (Upjohn). In: CPS 1988. p. 531.

Aristocort (Lederle). In: CPS 1988. p. 76.

Kenalog (Squibb). In: CPS 1988. p. 464.

Triaderm (Taro). In: CPS 1988. p. 942.

Kenalog in Orabase (Squibb). In: CPS 1988. p. 466.

Trianide (Technilab). In: CPS 1988. p. 944-5.

Beclomethasone dipropionate (Propaderm, Roberts). In: Gillis MC, editor. CPS Compendium of pharmaceuticals and specialties. 33rd ed. Ottawa: Canadian Pharmacists Association; 1998. p. 1387.

Sarna HC (Stiefel). In: CPS 1988. p. 831.

Not used.

Not used.

Not used.

Finkel AJ, editor. CMIT. Current medical information and terminology; 5th ed. Chicago: American Medical Association; 1981. p. 160.

Finkel AJ, editor. CMIT. Current medical information and terminology; 5th ed. Chicago: American Medical Association; 1981. p. 443.

Finkel AJ, editor. CMIT. Current medical information and terminology; 5th ed. Chicago: American Medical Association; 1981. p. 675.

Not used.

Golightly LK, et al. Pharmaceutical excipients: adverse reactions associated with inactive ingredients in drug products, part one. Med Toxicol 1988; 3: 128-65.

Cardinale VA, editor. Drug topics redbook. Oradell, NJ: Medical Economics Company Inc; 1988.

British Medical Association and The Pharmaceutical Society of Great Britain. British national formulary, number 15. London: BMA and The Pharmaceutical Press; 1988.

Rakel RE, editor. Conn's current therapy 1988. Philadelphia: W.B. Saunders Company; 1988. p. 673.

Graef JW, Cone TE, editors. Manual of pediatric therapeutics, 2nd ed. Boston: Little, Brown, and Company; 1984.

Stoughton RB, Cornell RC. Review of super-potent topical corticosteroids. Semin Dermatol Jun 1987; 6(2): 72-6.

Fusaro RM. Flexible classification for the clinical potency of topical corticosteroid proprietaries: an opinion. Drug Intell Clin Pharm May 1988; 22: 412-5.

Ponec M, Kempenaar JA. Biphasic entry of glucocorticoids into cultured human skin keratinocytes and fibroblasts. Arch Dermatol Res 1983; 275: 335-44.

Guy RH, et al. The bioavailability of dermatological and other topically administered drugs. Pharmaceut Res 1986; 3(5): 253-62.

Stoughton RB. Are generic formulations equivalent to trade name topical glucocorticoids? Arch Dermatol Oct 1987; 123: 1312-4.

Cornell RC, Stoughton RB. The use of topical steroids in psoriasis. Dermatol Clinics Jul 1984; 2(3): 397-409.

Floden CH, et al. Comparison of the response of psoriasis over a 6-month period, to clobetasol propionate and fluocinolone acetonide ointments. Curr Med Res Opin 1975; 3: 375-81.

Olsen EA, Cornell RC. Topical clobetasol-17-propionate: review of its clinical efficacy and safety. J Am Acad Dermatol 1986; 15: 246-55.

Lester RS. Efficacy of amcinonide lotion, 0.1% in the treatment of psoriasis of the scalp. Curr Ther Res Oct 1985; 38(4): 652-6.

Savin RC, et al. Comparative study of desoximetasone ointment 0.25% versus fluocinonide ointment 0.05% in patients with psoriasis. Clin Therap 1985; 8(1).

Jegasothy B, et al. Clobetasol propionate versus fluocinonide creams in psoriasis and eczema. Int J Dermatol 1985; 24(7): 461-5.

Zar E. Topical clobetasol propionate in the treatment of scalp psoriasis: a medium term follow-up Curr Ther Res 1980; 28(6): 997-1001.

Svartholm H, et al. Intermediate topical treatment of psoriasis with clobetasol propionate (Dermovate). Curr Med Res Opin 1982; 8(3): 154-7.

Moller H, et al. Intermittent maintenance therapy in chronic hand eczema with clobetasol propionate and flupredniden acetate. Curr Med Res Opin 1983; 8(9): 640-4.

Stankler L. A double-blind comparison of quarter strength clobetasol propionate in unguentum Merck with betamethasone valerate in psoriasis. Brit J Clin Prac Nov/Dec 1983; 389-91.

Sparkes CG, Wilson L. The clinical evaluation of a new topical corticosteroid, clobetasol propionate. Brit J Dermatol 1974; 90: 197-203.

Rajka G, Verjans HL. Hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream versus Desonide (Apolar) 0.1% ointment in the treatment of patients suffering from atopic dermatitis. J Int Med Res 1986; 14: 85-90.

Willis I, et al. Multicenter study comparing 0.05% gel formulations of desoximetasone and fluocinonide in patients with scalp psoriasis. Clin Ther 1986; 8(3): 275-82.

Sefton J, et al. Clinical evaluation of hydrocortisone valerate 0.2% ointment. Clin Ther 1984; 6(3): 282-93.

Gip L. Hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream and betamethasone 17-valerate (Celestone valerate) 0.1% cream in the treatment of patients suffering from eczematous skin disease. Curr Ther Res 1983; 34(5): 813-7.

Giannetti A, et al. Hydrocortisone 17-butyrate 0.1% (Locoid) or hydrocortisone acetate 1% ointment in children with atopic dermatitis? Curr Ther Res 1984; 36(3): 414-20.

Reinel D. Topical corticosteroids: application in patients with severe or resistant dermatoses. Curr Ther Res 1985; 37(2): 232-40.

Not used.

Not used.

Not used.

Not used.

Reynolds JEF, Prasad AB, editors. Martindale: the extra pharmacopeia. 28th edition. London: The Pharmaceutical Press; 1982.

Guin J.D. Contact sensitivity to topical corticosteroids. J Am Acad Dermatol 1984; 10: 773-82.

Parish LC, et al. Topical corticosteroids. Int J Dermatol 1985; 24(7): 435-6.

Not used.

Novak, et al. Adrenal suppression with high-potency corticosteroid ointment formulation in normal subjects. Clin Therap 1983; 6(1): 59-71.

Ozawa Y, et al. Influence of fatty acid-alcohol esters on percutaneous absorption of hydrocortisone butyrate propionate. Chem Pharm Bull 1988; 36(6): 2145-51.

Schimmer BP, Parker KL. Adrenocorticotropic hormone; adrenocortical steroids and their synthetic analogs; inhibitors of the synthesis and actions of adrenocortical hormones. In: Hardman JG, Limbird LE, Molinoff PB, Ruddon RW, editors. Goodman and Gilman's the pharmacological basis of therapeutics. 9th ed. New York: McGraw Hill; 1996. p. 1459-85.

Hurwitz S. Clinical pediatric dermatology. Philadelphia: W.B. Saunders Company; 1981.

Not used.

Not used.

Not used.

PharmIndex 1988; 30(8): 2.

PharmIndex 1988; 30(8): 3.

Not used.

PharmIndex 1988; 30(12): 16.

Betaderm (Taro). In: CPS 1988. p. 108.

Desowen package insert (Owen—US), Rec 11/88.

Aeroseb-Dex package labeling (Herbert—US).

PharmIndex 1988; 30(12): 4.

Maxivate cream/ointment/lotion (Westwood). In: PDR 1988. p. 2208-9.

Cortifair (Pharmafair). In: PDR 1988. p. 1629.

Oralone dental paste package insert (Thames—US), Rev 5/87, Rec 9/87.

Penecort cream/lotion/topical solution package insert (Herbert Labs—US), Rec 11/88.

Topicort/Topicort LP emollient cream package insert (Hoeschst-Roussel—US), Rev 11/87, Rec 12/88.

Cetacort lotions package insert (Owen—US), Rec 11/28/88.

Cetacort lotion package labeling (Owen—US).

Manufacturer letter.

Epifoam (Reed & Carnick). In: PDR 1988. p. 1663.

Maxiflor cream/ointment package insert (Allergan—US), Rec 11/88.

Nutracort cream package labeling (Owen—US), Rev 5/88, Rec 11/28/88.

Nutracort lotion package labeling (Owen—US), Rev 5/88, Rec 11/28/88.

Not used.

Not used.

Texacort solution package insert (Genderm—US), Rev 1986.

Triacet cream package labeling (Lemmon—US), Rec 10/28/88.

Not used.

Not used.

Carmol-HC lotion (Syntex). In: PDR 1989. p. 2139-40.

Not used.

Dermacort cream package labeling (Reid-Rowell—US), Rec 10/31/88.

Dermacort lotion package labeling (Reid-Rowell—US), Rec 10/31/88.

Dermacort cream/lotion package insert (Reid-Rowell—US), Rec 10/31/88.

Topicort gel package insert (Hoechst-Roussel—US), Rev 2/88, Rec 12/88.

Topicort ointment package insert (Hoechst-Roussel—US), Rev 1/86, Rec 12/88.

Locacorten cream package labeling (Ciba—Canada), Rec 12/88.

Locacorten ointment package labeling (Ciba—Canada), Rec 12/88.

Aristocort 0.025% cream package insert (Lederle—US), Rev 4/87, Rec 12/88.

Aristocort 0.1% cream package insert (Lederle—US), Rev 5/84, Rec 12/88.

Aristocort 0.5% cream package insert (Lederle—US), Rev 5/84, Rec 12/88.

Aristocort 0.1% ointment package insert, (Lederle—US), Rev 5/84, Rec 12/88.

Aristocort A cream 0.025% package insert (Lederle—US), Rev 3/84, Rec 12/88.

Aristocort A cream 0.1% package insert (Lederle—US), Rev 5/84, Rec 12/88.

Aristocort A cream 0.5% package insert (Lederle—US), Rev 8/86, Rec 12/88.

Aristocort A ointment 0.1% package insert (Lederle—US), Rev 3/84, Rec 12/88.

Nutracort cream package labeling (Owen—US), Rev 6/85, Rec 11/28/88.

Betamethasone dipropionate cream 0.05% package insert (Thames—US), Rec 9/21/87.

Fluocinonide cream 0.05% package insert (Thames—US), Rec 9/21/87.

Barriere-HC (A&H). In: CPS 1988. p. 101.

Not used.

ABPI 88-89. Efcortelan product monograph (Glaxo—UK), p 549.

ABPI 88-89. Halciderm product monograph (Squibb—UK), pp 1469-70.

ABPI 88-89. Metosyn/FAPG product monograph (Stuart—UK), pp 1534-5.

ABPI 88-89. Adcortyl in Orabase product monograph (Squibb—UK), p 1449.

ABPI 88-89. Synandone product monograph (ICI—UK), pp 631-2.

Not used.

Behrman RE, Vaughan VC, editors. Nelson textbook of pediatrics. 13th ed. Philadelphia: W.B. Saunders Company; 1987.

Kempe CH, Silver HK, O'Brien D. Current pediatric diagnosis and treatment. 6th ed. Los Altos, CA: Lange Medical Publishers; 1980.

Alphatrex cream package insert (Savage Labs—US), Rev 7/85, Rec 10/18/88.

Alphatrex lotion package insert (Savage Labs—US), Rev 12/85, Rec 10/18/88.

Alphatrex ointment package insert (Savage Labs—US), Rev 8/85, Rec 10/18/88.

Not used.

Maxivate (Westwood). In: PDR 1989. p. 2221-2.

Not used.

Cyclocort (Lederle). In: PDR 1989. p. 1114, Rev 8/88.

Betamethasone dipropionate 0.05% cream package insert (Pharmaderm—US), Rev 7/83.

Betamethasone dipropionate 0.05% cream package insert (Fougera—US), Rev 7/83, Rec 10/4/84.

Betamethasone dipropionate 0.05% lotion package insert (Fougera—US), Rev 2/85, Rec 11/26/85.

Betamethsone dipropionate 0.05% ointment package insert (Fougera—US), Rev 7/83, Rec 12/26/84.

Betamethasone dipropionate 0.05% ointment package insert (Pharmaderm—US), Rev 7/83, Rec 12/26/84.

Betatrex cream package insert (Savage Labs—US), Rec 10/18/88, Rev 7/86.

Beta-Val cream/ointment/lotion 0.1% package insert (Lemmon—US), Rev 12/84, Rec 11/21/85.

Betamethasone valerate cream 0.1% USP package insert (Fougera—US).

Betatrex lotion package insert (Savage—US), Rev 12/85, Rec 10/18/88.

Not used.

Betatrex ointment package insert (Savage—US), Rev 7/86, Rec 10/18/88.

Betamethasone valerate ointment USP 0.1% (Fougera—US), Rev 7/82, Rec 4/10/85.

Temovate (Glaxo). In: PDR 1989. p. 993-4.

DesOwen (Owen). In: PDR 1989. p. 1519.

Florone (Dermik). In: PDR 1989. p. 880.

Fluonid topical solution package labeling (Herbert—US), Rec 11/13/87.

Fluonid (Herbert). In: PDR 1989. p. 1016.

Cordran/SP (Dista). In: PDR 1989. p. 886-7.

Cordran tape (Dista). In: PDR 1989. p. 887.

Orabase-HCA (Colgate-Hoyt). In: PDR 1989. p. 868-9

Cort-Dome (Miles). In: PDR 1989. p.1443-4.

Cortef Feminine Itch cream (Upjohn). In: OTC-PDR 1989: 715.

Cortaid cream/ointment/lotion/spray. In: OTC-PDR 1989: 714.

Hytone 1/2% cream (Dermik). In: OTC-PDR 1989: 541.

Pharmafair products listing. In: PDR 1989. p. 1631-3.

Hytone (Dermik). In: PDR 1989. p. 881.

Aeroseb-HC (Herbert). In: PDR 1989. p. 1016.

Locoid cream/ointment package insert (Owen—US), Rev 5/87, Rec 11/28/88.

Westcort (Westwood). In: PDR 1989. p. 2225-6.

Not used.

Uticort gel/cream/lotion package insert (Parke Davis—US), Rev 5/87, Rec 2/17/89.

Epifoam (Reed & Carnick). In: PDR 1989. p. 1669.

Fluocinolone acetonide cream 0.01% and 0.025% (From Bio-Syn brand; Mfr-Clay-Park—US), Rev 8/86, Rec 2/24/89.

Fluocinonide cream 0.05% package insert (From Fluocin brand; Distr-Goldline, Mfr.-Clay-Park—US), Rev 6/87, Rec 2/24/89.

Tan PL, et al. Current topical corticosteroid preparations. J Am Acad Dermatol 1986; 14: 79-93.

Katz, HI, et al. Superpotent topical steroid treatment of psoriasis vulgaris—clinical efficacy and adrenal function. J Am Acad Dermatol 1987; 16(4): 804-11.

Cox NH. Contact allergy to clobetasol propionate. Arch Dermatol 1988; 124: 911-3.

Generali JA. Drug Forum. US Pharm Dec 1988: 14.

Miller JA, Munro DD. Topical corticosteroids: clinical pharmacology and therapeutic use. Drugs 1980; 19: 119-34.

Cloderm package insert (Hermal—US), Rev 7/87, Rec 3/1/89.

Manufacturer comment, 7/20/88.

Not used.

Aristocort A (Lederle). In: PDR 1989. p. 1108-9.

Reviewer comment USP-DI Review 1988; 9(6): 3051.

Not used.

Not used.

Not used.

Alphatrex cream package insert (Savage—US), Rev 9/86, Rec 2/89.

Betamethasone dipropionate cream USP package insert (Fougera—US), Rev 9/86, Rec 2/89.

Betamethasone dipropionate cream USP package insert (Pharmaderm—US), Rev 9/86, Rec 2/89.

Alphatrex lotion (Savage—US), Rev 9/86, Rec 2/89.

Betamethasone dipropionate lotion USP package insert (Pharmaderm—US), Rev 10/86, Rec 2/89.

Betamethasone dipropionate lotion USP package insert (Fougera—US), Rev 10/86, Rec 2/89.

Alphatrex ointment package insert (Savage—US), Rev 9/86, Rec 2/89.

Betamethasone dipropionate ointment package insert (Fougera—US), Rev 9/86, Rec 2/89.

Betamethasone dipropionate ointment package insert (Pharmaderm—US), Rev 9/86, Rec 2/89.

Betatrex cream package insert (Savage—US), Rev 8/88, Rec 2/89.

Betamethasone valerate cream package insert (Fougera—US), Rev 4/88, Rec 2/89.

Betamethasone valerate cream package insert (Pharmaderm—US), Rev 4/88, Rec 2/89.

Betatrex lotion package insert (Savage—US), Rev 5/88, Rec 2/89.

Betamethasone valerate lotion package insert (Fougera—US), Rev 5/88, Rec 2/89.

Betamethasone valerate lotion package insert (Pharmaderm—US), Rev 11/87, Rec 2/89.

Betatrex ointment package insert (Savage—US), Rev 7/88, Rec 2/89.

Betamethasone valerate ointment package insert (Fougera—US), Rev 4/88, Rec 2/89.

Betamethasone valerate ointment package insert (Pharmaderm—US), Rev 4/88, Rec 2/89.

DesOwen cream/ointment package insert (Owen—US), Rev 6/88, Rec 3/13/89.

Not used.

Fluonid topical solution package insert (Herbert—US), Rev 8/88, Rec 3/22/89.

Fluocinolone acetonide cream package insert (Fougera—US), Rev 4/85, Rec 2/89.

Fluocinolone acetonide cream package insert (Pharmaderm—US), Rev 4/85, Rec 2/89.

Not used.

Not used.

Fluocinolone acetonide topical solution package insert (Fougera—US), Rev 4/85, Rec 2/89.

Fluocinolone acetonide topical solution package insert (Pharmaderm—US), Rev 5/85, Rec 2/89.

Licon cream package insert (K-Line [Mfr.]; Major [Distr.]—US), Rev 8/23/84, Rec 3/20/89.

Lemoderm cream/ointment/lotion package insert (Thames [Mfr.]; Seneca [Distr.]—US), Rev 12/87, Rec 3/22/89.

Hydrocortisone cream 1% package insert (Pharmaderm—US), Rev 2/85, Rec 2/89.

Hydrocortisone cream 1% package insert (Fougera—US), Rev 10/84, Rec 2/89.

Hydrocortisone cream 2.5% package insert (Pharmaderm—US), Rev 5/86, Rec 2/89.

Hydrocortisone cream 2.5% package insert (Fougera—US), Rev 5/86, Rec 2/89.

Allercort cream/ointment/lotion package insert (Ambix [Mfr.]; LaSalle [Distr]—US), Rev 9/85, Rec 3/28/89.

S-T Cort Lotion package insert (Mericon [Mfr.]; Scot-Tussin [Distr]—US), Rev 6/84, Rec 3/13/89.

Hydrocortisone ointment package insert (Pharmaderm—US), Rev 2/85, Rec 2/89.

Hydrocortisone ointment package insert (Fougera—US), Rev 5/85, Rec 2/89.

Westcort cream package insert (Westwood—US), Rev 1982, Rec 2/89.

Westcort ointment package insert (Westwood—US), Rev 1982, Rec 2/89.

Trymex cream package insert (Savage—US), Rev 1/86, Rec 2/89.

Triamcinolone acetonide cream USP 0.025%. 0.1%, 0.5% package insert (Pharmaderm—US), Rev 10/86, Rec 2/89.2

Triamcinolone acetonide cream USP 0.025%. 0.1%, 0.5% package insert (Fougera—US), Rev 1/85, Rec 2/89.

Kenonel cream/ointment/lotion package insert (Thames [Mfr.]; Marnel [Distr]—US), Rev 12/87, Rec 3/20/89.

Trymex ointment package insert (Savage—US), Rev 1/86, Rec 2/89.

Triamcinolone acetonide ointment USP 0.025%, 0.1% (Fougera—US), Rev 10/86, Rec 2/89.

Triamcinolone acetonide ointment USP 0.025%, 0.1% (Pharmaderm—US), Rev 10/86, Rec 2/89.

Ellis CN, et al. Amcinonide lotion 0.1% in the treatment of patients with psoriasis of the scalp. Curr Ther Res 1988; 44(2): 315-24.

Lynfield Y, et al. Amcinonide lotion 0.1% in the treatment of patients with seborrheic dermatitis of the scalp and/or other hairy areas. Curr Ther Res 1988; 44(2): 304-14.

Westerhof W. Treatment of bullous pemphigoid with topical clobetasol propionate. J Am Acad Dermatol 1989; 20(3): 458-61.

Panel comment, 5/22/89 and telephone conversation 7/20/89.

FDA Orange book 1989 and March cumulative list.

Manufacturer comment, 5/29/89.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Not used.

Not used.

Panel comment, 5/22/89.

Not used.

Not used.

Not used.

Not used.

Panel comments, 5/29/89.

Not used.

Anusol-HC product labeling (Parke Davis—US), Rev 8/89.

Not used.

Nutracort package insert (Owen Labs—US), Rev 10/87, Rec 3/23/89.

Hydrocortisone spray 1/2% package labeling (Rugby—US), Rec 5/8/89.

Lanacort package insert (Combe—US), Rec 5/1/89.

Betamethasone valuate cream 0.1% package insert (UDL—US), Rev 8/87, Rec 4/25/89.

Flutex ointment package insert (Syossett—US), Rec 1989.

Flutex cream package insert (Syossett—US), Rec 1989.

Anusol-HC cream package insert (Parke Davis—US), Rev 1/89, Rec 9/5/89.

Not used.

Not used.

Not used.

Not used.

Not used.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Panel comment, 5/22/89.

Not used.

Not used.

Panel ballot, 06/15/90.

Panel comment, 06/20/90.

Panel comment, 06/15/90.

Panel comment, 06/15/90.

Reviewers' consensus on monograph revision of 06/15/90.

Panel comment, 06/15/90.

Panel comment, 06/15/90.

USP-DI. Table 1—Pharmacology 1990 ed.

Panel comment, 06/15/90.

Not used.

Panel comment, 06/15/90.

Not used.

Reviewers' consensus on monograph revision of 06/15/90.

Not used.

Temovate scalp application package insert (Glaxo—US), Rev 1/90, Rec 6/11/90.

Elocon lotion package insert (Schering—US), Rev 3/89, Rec 2/2/90.

Topicort/Mild/Gel package insert (Hoescht—Canada), Rev 3/30/89, Rec 2/27/90.

Sential cream package insert (Pharmacia—Canada), Rev 3/4/88, Rec 7/13/90.

Topilene package insert (Technilab—Canada), Rev 6/90, Rec 7/25/90.

Topisone package insert (Technilab—Canada), Rev 6/90.6/90, Rec 7/25/90.

Ultravate cream package insert (Westwood Squibb—US), Rev 1990, Rec 1/28/90.

Ultravate ointment package insert (Westwood Squibb—US), Rev 1990, Rec 1/28/90.

Fluocinonide ointment package insert (Lemmon—US), Rev 2/91, Rec 2/92.

Cutivate cream package insert (Glaxo—US), Rev 1/91, Rec 7/22/91.

Cutivate ointment package insert (Glaxo—US), Rev 1/91, Rec 7/22/91.

Lidex product monograph (Syntex—Canada), Rev 3/8/88, Rec 2/91.

Beta-HC package insert (Beta Dermaceuticals—US), Rev 6/87, Rec 4/13/89.

Not used.

Lanacort 10 package labeling (Combe—US), Rec 9/30/91.

Gynecort 10 package labeling (Combe—US), Rec 9/30/91.

Elocon product monograph (Schering—Canada), Rev 10/22/90, Rec 7/16/91.

Prevex B and Prevex HC creams package insert (Trans-CanaDerm—Canada), Rec 7/3/90.

Desowen (Owen/Galderma—US). In: PDR 1992: 1682-3.

Not used.

Not used.

Diprolene gel package insert (Schering—US), Rev 8/91, Rec 2/92.

Diprolene glycol ointment, cream, lotion product monograph (Schering—Canada), Rev 8/29/90, Rec 8/13/90.

Oralone dental paste package insert (Thames—US), Rev 7/88, Rec 5/5/92.

Desoximetasone cream package insert (Turo—Canada—US product), Rev 7/16/90, Rec 5/5/92.

DesOwen cream/ointment/lotion package insert (Owen/Galderma—US), Rev 3/90, Rec 5/5/92.

Reviewers' consensus on monograph revision of 05/28/92.

Manufacturer comment, 05/28/92.

Manufacturer comment, 05/28/92.

Panel comment, 05/25/92.

Panel comment, 05/25/92.

Not used.

Teladar cream package insert, Rev 2/88, Rec 8/17/92.

Dermarest DriCort package insert, Rec 8/24/92.

Not used.

Anusol HC cream 2.5% package insert, Rev 5/91, Rec 7/92.

Synalar topical solution package insert, Rev 4/91, Rec 7/92.

Synemol cream package insert, Rev 4/91, Rec 7/92.

Synacort cream package insert, Rev 7/91, Rec 7/92.

Synalar cream package insert, Rev 4/91, Rec 7/92.

Lidex topical solution package insert, Rev 4/91, Rec 7/92.

Lidex gel package insert, Rev 7/91, Rec 7/92.

Lidex-E cream package insert, Rev 4/91, Rec 7/92.

Synalar-HP cream package insert, Rev 1/83, Rec 7/92.

Cortef feminine itch cream package insert, Rec 7/92.

Cortef feminine itch cream package labeling, Rec 7/92.

Cortaid lotion package labeling, Rec 7/92.

Maximum Strength Cortaid Anti-Itch Spray package labeling, Rec 7/92.

Cortaid Anti-Itch Spray package labeling, Rec 7/92.

Cortaid ointment package labeling, Rec 7/92.

Maximum Strength Cortaid ointment package labeling, Rec 7/92.

Cortaid cream package labeling, Rec 7/92.

Maximum Strength Cortaid cream package labeling, Rec 7/92.

Not used.

Ultravate cream package insert, Rev 1990, Rec 5/6/92.

Ultravate ointment package insert, Rev 1990, Rec 5/6/92.

Texacort topical solution package insert, Rec 7/6/92.

Manufacturer comment, 5/28/92.

Hutchison TA, Shahan DR & Anderson ML (Eds): DRUGDEX® System. MICROMEDEX, Inc., Englewood, Colorado (11/2000).

Product Information: Dermatop®, prednicarbate. Physician's Desk Reference (electronic version), MICROMEDEX, Inc., Englewood, Colorado, USA (11/2000).

Product Information: Pandel®,hydrocortisone probutate. Physician's Desk Reference (electronic version), MICROMEDEX, Inc., Englewood, Colorado, USA (11/2000).

Product Information:Locoid®,hydrocortisone butyrate. Physician's Desk Reference (electronic version), MICROMEDEX, Inc., Englewood, Colorado, USA (11/2000).

Product Information: Olux™ Foam, clobetasol propionate. Connectics Corporation, Palo Alto, CA. (PI issued 06/2000) PI reviewed 02/2001.

Product Information: Cutivate®, fluticasone propionate ointment. Glaxo Wellcome, San Diego, CA. (PI revised 12/2000) PI reviewed 05/2001.

Product Information: Cutivate®, fluticasone propionate cream. Glaxo Wellcome, San Diego, CA. (PI revised 12/2000) PI reviewed 05/2001.

Reviewers' consensus on ballot of 04/2002.

Lund L, Wai KH, Mui LM, et al. Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study. Scand J Urol Nephrol 2000;34:267-9.

Golubovic Z, Milanovic D, Vukadinovic V, Rakic I, Perovic S. The conservative treatment of phimosis in boys. : Br J Urol 1996;78:786-8 .

Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology 2000;56:307-10.

Wright JE. The treatment of childhood phimosis with topical steroid. Aust N Z J Surg 1994;64:327-8.

Monsour MA, Rabinovitch HH, Dean GE. Medical management of phimosis in children: our experience with topical steroids. J Urol 1999;162:1162-4.

Meulen PH, Delaere KP. A conservative treatment of phimosis in boys. Eur Urol 2001;40:196-9.

Lindhagen T. Topical clobetasol propionate compared with placebo in the treatment of unretractable foreskin. Eur J Surg 1996;162:969-72.

Jorgensen ET, Svensson A. The treatment of phimosis in boys, with a potent topical steroid (clobetasol propionate 0.05%) cream. Acta Derm Venereol 1993;73:55-6.

Ng WT, Fan N, Wong CK, et al. Treatment of childhood phimosis with a moderately potent topical steroid. ANZ J Surg 2001;71:541-3.

Kikiros CS, Beasley SW, Woodward AA. The response of phimosis to local steroid application. Pediatr Surg Int 1993;8:329-32.

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