Corticosteroids – The Classification System

Topical corticosteroid creams and ointments are classified numerically by potency from strongest to weakest 1 – 7. The implication is that the weakest probably won’t do much good but will cause no harm, to the strongest that will cure everything quickly but requires a little care in its usage.

Wherever a doctor cannot do good, he must be kept from doing harm.

Hippocrates

The number system is a guide but is often quoted in gospel fashion. Practitioners will often tell their patients, “Don’t worry it is a low strength cream, no problem, you can put it on your face, you can use it four to five times a day, you should not have any difficulty even in classes 5 – 7.”

These comments are really untrue because strict adherence to manufacturers recommendations are rarely followed, the classification system is impacted by the vehicle into which the chemical is compounded, and is also heavily influenced by how and where the chemical is applied.

Is it a lotion, a cream, an ointment, or a gel? Is it applied under saran wrap to get better penetration? Is it rubbed in vigorously or just dabbed on? Is it applied two, three or six times a day? Is the patient compulsive or lackadaisical? Furthermore is it applied in the armpits, in the groin, on the face or on the trunk? Or is it applied to the palms of the hands or soles of the feet where absorption is minimized due to the thickness of the skin.

By Dr Marvin Rapaport, MD|2021-10-19T03:16:58-07:00June 3rd, 2015|Red Skin Syndrome Causes|Comments Off

About the Author: Dr Marvin Rapaport, MD

In 1978 I initiated and set up the contact and photo dermatitis clinic at UCLA. There was a need to evaluate a large group of patients who exhibited severe eczematoid rashes, especially on the face. Patients were referred from all over Southern California. All patients underwent a lengthy history and examination. Further evaluations included blood studies, allergy patch testing, special sunlight (photo) testing and skin biopsies. From the start it was apparent that most patients experienced a mild dermatitis on various parts of the body that progressively worsened. Their histories always included numerous doctor visits, multiple physicians, and therapy consisting of an increasing amount of corticosteroids. My testing failed to reveal any specific culprit chemicals, cosmetics, perfumes, workplace or recreational exposures. It became increasingly clear that the physician’s therapy, the corticosteroids, was invariably causing the problem. I wrote 7 scientific articles that were published in the most august peer-reviewed dermatologic journals and I gave many lectures at various dermatology meetings. To this day an unfortunate reluctance exists on the part of most physicians to accept this simple concept.