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.

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.