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13.4 TOPICAL CORTICOSTEROIDS

13.4 TOPICAL CORTICOSTEROIDS

13.4 Topical corticosteroids
Potency of steroid required will depend on age, site and chronicity. Face, flexures, skin of the young and more acute eczemas
require weaker preparations. Palms, soles and heavily lichenified chronic eczemas require more potent preparations. Try to use
the weakest preparation which will keep the eczema in check, but if control is lost, use a short, sharp course of a potent 
preparation. 
Creams are best for wet and weepy lesions. 
Ointments are best for dry and scaly lesions.

POTENCY – MILD 
First line:    
GREEN        Hydrocortisone cream 0.5%, 1%, 2.5% , ointment 0.5%, 1%, 2.5%  
GREEN       Hydrocortisone cream 0.25% & crotamiton 10% (Eurax-Hydrocortisone®)       
Second line:     
GREEN       Fluocinolone 0.0025%cream (Synalar 1 in 10 Dilution®) 
                   (for patients intolerant to hydrocortisone) 
 
POTENCY - MILD WITH ANTIMICROBIAL 
GREEN      Hydrocortisone 1% & miconazole 2% cream, ointment (Daktacort®) 
GREEN      Hydrocortisone 0.5% & nystatin 100,000 units/g cream (Timodine®) 
 
POTENCY – MODERATE 
First line:    
GREEN      Clobetasone butyrate 0.05% cream, ointment (Eumovate®)  
Second line: 
GREEN      Betamethasone valerate 0.025% cream, ointment (Betnovate RD®) 
GREEN      Fluocinolone 0.00625% cream, ointment (Synalar 1 in 4 Dilution®)   
AMBER     Fludroxycortide occlusive tape 4micrograms/cm2 (Haelan®)    (Dermatology initiation only)
GREEN      Clobetasone butyrate with nystatin and oxytetracycline cream (Trimovate® cream)  - short term use only 
                     
 
POTENCY – MODERATE WITH ANTIMICROBIAL 
  see below for alternative** 
 
POTENCY - POTENT  
First line: 
GREEN      Betamethasone valerate 0.1% cream, ointment (Betnovate®)   
Second line:  
GREEN      Fluocinolone 0.025% cream, ointment (Synalar®) 
AMBER     Mometasone furoate 0.1% cream, ointment, lotion (Elocon®)     (Dermatology initiation only)   
AMBER     Diflucortolone valerate 0.1%  cream, oily cream, ointment (Nerisone®)   
 
Scalp preparations 
First line: 
GREEN      Betamethasone valerate scalp application 0.1% (Betacap®)
GREEN      Betamethasone valerate mousse (Bettamousse®)
Second line: 
GREEN      Fluocinolone 0.025% gel (Synalar®) 
GREEN      Hydrocortisone butyrate 0.1% water miscible lotion (Locoid Crelo®) 
 
POTENCY – POTENT WITH ANTIMICROBIAL  
GREEN      Betamethasone dipropionate 0.064%  
                   (≡ betamethasone 0.05%), clotrimazole 1%, cream (Lotriderm®)**  
GREEN      Fluocinolone acetonide 0.025% & Clioquinol 3% crea, ointment (Synalar C®)      
 
POTENCY - POTENT WITH SALICYLIC ACID  
GREEN      Betamethasone valerate 0.05% & salicylic acid 3% ointment (Diprosalic®)    
 
POTENCY - VERY POTENT  
Avoid long-term use without dermatologist supervision
GREEN      Clobetasol 0.05% 
                   cream, ointment (Dermovate®)   
                   scalp application (Dermovate®)    
GREEN      Diflucortolone valerate 0.3%
                   oily cream, ointment (Nerisone Forte®)     
AMBER     Clobetasol propionate 500micrograms/gram shampoo (Etrivex®)  
 
Clobetasol Propionate shampoo - Scalp Psoriasis 
Clobetasol shampoo should be kept in place without covering for 15 minutes before rinsing. The treatment duration should be
limited to a maximum of 4 weeks. As soon as clinical results are observed, applications should be spaced out or replaced, if 
needed, by an alternative treatment. If no improvement is seen within four weeks, reassessment of the diagnosis may be 
necessary. Repeated courses may be used to control exacerbations provided the patient is under regular medical supervision.
 
POTENCY – VERY POTENT WITH ANTIMICROBIAL 
Avoid long-term use without dermatologist supervision
GREEN      Clobetasol 0.05% & neomycin/nystatin cream, ointment 
                  (Dermovate-NN® brand discontinued prescribe as  generic