INTRODUCTION
Topical corticosteroids are widely prescribed by dermatologists and primary care
providers for both acute and chronic inflammatory skin diseases. Topical steroids are prescribed at 21% of office visits to dermatologists.1 With
over 24 approved topical steroids available in the US,2 knowledge of the differences in potencies and formulations is key to proper prescribing
patterns. Strength or potency is classified by groups I-VII, with group I being superpotent and group VII being low potency, and is based on the
vasoconstrictive properties of the steroid molecule which have been established through vasoconstrictor assays.3 Most other countries outside the
US use a narrower categorization of class I-IV, with class IV being very potent and class I mild. Available formulations include creams, ointments,
lotions, gels, solutions, and foams, greatly expanding the number of options to choose from in this drug class. An understanding of these different
formulations is significant since the vehicle influences the rate of absorption, patient preferences, and therefore the efficacy of the medication.4,5
Severity of disease, extent of lesions, location being treated, duration of treatment, and age of patient must all be considered in choosing an
appropriate topical corticosteroid.4,6
Disadvantages of topical steroids include atrophy, striae, telangiectasias, acne, and
rosacea.6 Systemic absorption leading to adrenal suppression and Cushing syndrome may occur.7 Additionally, contact dermatitis can result from an allergy to
ingredients found in the topical steroid vehicle or to the steroid molecule itself. Potential allergens include ingredients and preservatives commonly used
in vehicles, especially creams.8 Solutions and ointments tend to be the least allergenic. Allergies to corticosteroid molecules themselves has gained
recognition, with a reported prevalence that varies between 0.5-5%.9-11 While the potential of having an allergy to any corticosteroid exist, as well as the
possibility for cross-reactivity, tixocortol pivalate, not commercially available in the US, budesonide, and hydrocortisone 17-butyrate are the most common
culprits.11-13 Tixocortol pivalate, used as a stand-in for hydrocortisone, and budesonide are now routinely screened for in patch test panels.12 A thorough
knowledge of topical corticosteroids and their potential adverse effects, including the possibility for a contact allergy, is key to recognizing and
preventing occurrences.
While topical steroid prescribing patterns by dermatologists have been studied, the foundation upon which these physicians choose a specific steroid based on their knowledge of this drug class has not been fully characterized.1 This study aims to assess dermatologists’ knowledge of topical corticosteroids potency, and which products they prefer in cases of suspected steroid or vehicle allergenicity.
