You visit your dermatologist looking for relief from this red, itchy skin irritation that’s driving you crazy. You’ve tried the strongest over-the-counter steroid cream, but it hasn’t done the trick. You meet with your doctor, and what does he recommend? Another steroid cream. And not just any steroid cream – this one is only HALF the percentage strength of the over-the-counter version.
Don’t you need a stronger product? Why is the dermatologist prescribing a weaker medication than the ones you bought straight off the shelf?
First of all, it’s important to understand why steroids the drug of choice for these irritated—maybe red and scaly—areas. Steroids block inflammation. You may not have an infection yet, but when these irritated areas spring up, steroids calm them down.
Why Don’t the Percentages Matter?
Prescription products may not appear to be better than those available at the drugstore, especially if the percentage strength is lower. In reality, concentrations don’t matter with steroids. The molecule, or type of drug, used along with the vehicle that carries it determines the potency of the product. Think of the molecule as the brand of the steroid; some are just stronger than others.
Which Type of Steroid Product Should I Use?
The vehicle is what you put the steroid into for application. Whether the product is in the form of a cream, ointment, or solution determines its strength. Ointments tend to be more powerful as they drive the steroid into the skin more effectively. Creams are only slightly less potent than an ointment. Foams and solutions are the least powerful option as they equalize the ingredients of the product.
Even within the vehicle, some products work better than others. Certain ointments drive steroids into the skin more quickly. Some creams carry the steroid more directly.
Let’s think of these factors in baseball terms. A ticket to a game does not guarantee a good seat because not all seats are the same. You could have a seat way up in the nosebleed section if you’re not careful!
So, let’s say you just look at the price of the ticket to see if you’re in a prime spot. Well, even tickets in the same price bracket can vary – you could be at the top of a section, behind a pole, or right on the front row.
If you want to know how your seat location ranks, you have to analyze your section, row, seat number, potential sight blockers, etc. It’s the same with a steroid product.
For example, the steroid Betamethasone Valerate only comes in one concentration. The potency then varies depending on the vehicle. A solution version would be the weakest option whereas a Betamethasone Valerate ointment would provide the strongest treatment.
Which Steroid Product Is Strongest?
To help compare the differences, Corticosteroids are ranked by seven potency classes: one being the highest and seven being the lowest strength. Your typical hydrocortisone cream from the store is going to be a seven. A Betamethasone Valerate product will fall into class one, two or three, depending on the vehicle.
Determining the potency of your product isn’t a matter of concentration. It’s a combination of the particular steroid you’re using and what’s carrying it. But understanding how strong of a product you receive isn’t as easy as reading a label. Too many factors are at play.
Trust your dermatologist to provide the product that will work best for your condition. In doing so, you’ll find relief from the rash that’s been driving you crazy and you’ll be able to focus on the game (Go Rangers!).
Itchy or irritated skin giving you problems? Give us a call to schedule an appointment.
Dr. R. Todd Plott is a board-certified dermatologist in Coppell, Keller, and Saginaw, TX. His specialization and professional interests include treating patients suffering with acne, identifying and solving complex skin conditions such as psoriasis, rosacea, atopic dermatitis, and identifying and treating all types of skin cancers. In his spare time, Dr. Plott enjoys cycling, traveling with his wife, and spending time with his children and new grandson.
Learn more about Dr. Plott.