Therapy

Current topical corticosteroid preparationsPaul L. Tan, Pharm.D.,* Gary L. Barnett, B.S.,* Franklin P. Flowers, M.D.,**and Oscar E. Araujo, Ph.D. *** Gainesville, FL

A brief review of the development, desirability, potency, and side effects oftopical corticosteroids is presented. Because of potential sensitizing agentspresent in vehicles delivering corticosteroids and because new products areconstantly being marketed, a detailed listing of single and combinationproducts, as well as the constituents of their vehicles, has been compiled toaid the practicing physician. (J AM ACAD DERMATOL 14:79-93, 1986.)

Corticosteroids are the most potent and effec­tive local anti-inflammatory medications avail­able. They are recommended for many dermato­logic conditions, including pruritic eruptions (e.g.,dermatitis and eczema), hyperplastic disorders(e.g., psoriasis), and infiltrate disorders (e.g., sar­coid, granuloma annulare),

In 1952 Sulzberger and Witten! showed topicalhydrocortisone to be superior to most of the der­matologic preparations available at that time. Be­cause of the following desirable qualities, the pop­ularity of topical corticosteroids has steadily in­creased over the years:

1. Broad applicability in treating a wide variety ofcommon eruptions

2. Rapid onset of action when applied even in smallamounts

3. Ease of application4. Cosmetic acceptability5. Low sensitizing potential6. Long-term shelf stability7. Compatibility with almost all other topical med­

ications8. Rare occurrence of untoward side effects

Topical steroids, when used for brief periods onlimited areas without occlusion, are usually highly

From the Division of Dermatology. Department of Medicine, Collegeof Medicine,**and the Department of Pharmacy Practice,***Col·lege of Pharmacy,*University of Florida.

Reprint requests to: Dr. Franklin P. Flowers, Box J·277, JHMHC,University of Florida, Gainesville, FL 32610/904·392-4984,

effective and relatively trouble free. A study of2,349 patients showed that the incidence of prob­lems (irritations, itching, burning, dryness, etc.)was low and was no greater than those found whenthe vehicle was used alone. 2

As a general rule, the more potent the topicalcorticosteroid, the less frequent the application.Furthermore, the greater the number of ingredientsin the vehicle, the greater is the chance for adversereactions to occur.

As a group, steroid molecules have a low degreeof chemical sensitivity but are occasionally re­sponsible for producing contact dermatitis. 3-5 Morecommonly, these adverse reactions are due to con­stituents of the bases, such as lanolin, preserva­tives, and antibiotics. 6-8

There are currently on the market hundreds oftopical corticosteroid preparations available in dif­ferent vehicles and in combination with anti-in­fectives, antipruritics, and other substances (suchas tars or keratolytic agents).

Tables I to V provide a list of most of the topicalsteroid preparations and combinations available inthe United States. Products for which vehicle in-.gredients were unavailable were excluded. Thepractitioner should find these tables particularlyhelpful not only in identifying potential sensitizersin the vehicle but also as an aid in prescribing thecorrect dosage form available. Nonprescriptionproducts containing 0.5% hydrocortisone havebeen omitted because they are infrequently rec­ommended by dermatologists.

79

Journal of the80 Tan et al American Academy of

Dennatology

Table I. Topical steroids (single ingredient)

Product Manufacturer Size Active ingredients

Aeroseb-Dex Herbert Laboratories, Spray 0.01 58 gm DexamethasoneIrvine, CA 92715

Aeroseb-HC Herbert Spray 0.5 58 gm HydrocortisoneAlphatrex Savage Laboratories, Cream 0.05 15 gm, 45 gm Betamethasone dipropionate

Melville, NY11747

Alphatrex Savage Ointment 0.05 15 gm, 45 gm Betamethasone dipropionateAristocort A Lederle Laboratories, Cream 0.025 15 gm, 60 gm Triamcinolone acetonide

Wayne, NJ 07470 0.1 15 gm, 60 gm0.5 IS gm, 240 gm

Aristocort A Lederle Ointment 0.1 IS gm, 60 gm Triamcinolone acetonide0.5 15 gm

Aristocort Lederle Cream 0.025 15 gm, 60 gm, 240 Triamcinolonegm, 5'14 Ib

0.2 IS gm, 60 gm, 240gm, 5.25-Ib jar

0.5 15 gm, 240 gmAristocort Lederle Ointment 0.1 15 gm, 60 gm, 240 Triamcinolone acetonide

gm, SIb0.5 15 gm, 240 gm

Benisone CooperCare, Inc., Gel 0.025 15 gm, 60 gm Betamethasone benzoatePalo Alto, CA94304

Benisone CooperCare Cream 0.025 15 gm, 60 gm Betamethasone benzoate

Benisone CooperCare Ointment 0.025 15 gm, 60 gm Betamethasone benzoateBenisone CooperCare Lotion 0.025 15 ml, 60 ml Betamethasone benzoate

Betatrex Savage Cream 0.1 15 gm, 45 gm Betamethasone valerate

Betatrex Savage Lotion 0.1 60 ml Betamethasone valerateBetatrex Savage Ointment 0.1 15 gm, 45 gm Betamethasone valerateBeta-Val Lemmon Co., Cream 0.1 15 gm, 45 gm Betamethasone valerate

Sellersville, PA18960

Cloderm Ortho Pharmaceu- Cream 0.1 15 gm, 45 gm Clocortolone pivalatetical Corp.,Raritan, NJ 08869

Cordran Dista Products Co., Lotion 0.05 15 ml, 60 ml FlurandrenolideIndianapolis, IN46285

Cordran Dista Ointment 0.025 30 gm, 60 gm, Flurandrenolide225 gm

0.05 15 gm, 30 gm, 60 gm,225 gm

Cordran SP Dista Cream 0.05 15 gm, 30 gm, 60 gm, Flurandrenolide225 gm

0.025 30 gm, 60 gm, 225gm

Cordi-an Dista Tape 4 I-Lg/ 80" X 3" FlurandrenolideTape cm2 24" X 3"

Volume 14Number 1January, 1986

Fluori- Fre-nated quency

Yes bid-tid

No bid-tidYes bid-tid

Yes bid-tidYes tid-qid

Yes tid-qid

Yes tid-qid

Yes tid-qid

Yes bid-qid

Yes bid-qid

Yes bid-qidYes bid-tid

Yes bid-tid

Yes bid-tidYes bid-tidYes qd-qid

Yes tid

Yes bid-tid

Yes bid-tid

Current topical corticosteroid preparations 81

Vehicle

Isopropyl myristate propellant (butane), alcohol (68.5%)

Isopropyl myristate propellant (butane), alcohol (68%)Water, mineral oil, polyethylene glycol 1000 monocetyl ether, cetostearyl alcohol,

monobasic sodium phosphate, chlorocresol, phosphoric acid, sodium hydroxide

Mineral oil, white petrolatumAquatain (proprietary cream base composed of emulsifying wax NF, isopropyl palmi­

tate, glycerin USP, sorbitol solution USP, lactic acid, 2% benzyl alcohol, purifiedwater)

Emulsifying wax NF, white petrolatum, propylene glycol, Tenox II(butylated hy­droxyanisole, propyl gallate, citric acid, propylene glycol), lactic acid

Mono and diglycerides, squalene NF, polysorbate 80, cetyl esters wax, polysorbate 60,stearyl alcohol, Tenox II, sorbitol solution USP

White petrolatum

Alcohol, carboxyvinyl polymer, propylene glycol, disodium edetate, diisopropanol­amine, purified water

Cetyl alcohol, glyceryl stearate, light mineral oil, propylene glycol, disodium mono­oleamidosulfosuccinate, citric acid, purified water

Light mineral oil, glyceryl stearate, food starch modified, polyethyleneCetyl alcohol, stearyl alcohol, propylene glycol, sodium lauryl sulfate, purified water,

propyl, butyl, and methyl parabensWater, mineral oil, polyethylene glycol 1000 monocetyl ether, cetostearyl alcohol,

monobasic sodium phosphate, chlorocresol, phosphoric acid, sodium hydroxideIsopropyl alcohol, water, carbomer 934P, phosphoric acid, sodium hydroxideWhite petrolatum, mineral oilMineral oil, white petrolatum, polyethylene glycol 1000, ceteareth-I5, cetyl alcohol,

stearyl alcohol, propylene glycol, purified water, 4-chloro-m-cresol preservative

Water, white petrolatum, mineral oil, stearyl alcohol, polyoxyl40 stearate, carbomer934P, edetate disodium, sodium hydroxide, methylparaben, propylparaben

Glycerin, cetyl alcohol, stearic acid, glyceryl monostearate, mineral oil, polyoxyJ 40stearate, menthol, benzyl alcohol, purified water

White wax, cetyl alcohol, sorbitan sesquioleate, white petrolatum

Yes

Yes

bid-tid

gI2­24 h

Cetyl alcohol, citric acid, mineral oil, polyoxyl 40 stearate, propylene glycol, sodiumcitrate, stearic acid, purified water

Tape (retains insensible perspiration)

continued

82 Tan et al

Table I. Cont'd

Journal of theAmerican Academy of

Dermatology

DosageProduct Manufacturer form % Size Active ingredients

Cort-Dome Miles Pharmaceu­ticals,West Haven, CT06516

Cream 0.250.51.00.125

1,4ozY2, 1, 4 ozY2, 1 oz1 oz

HydrocortIsone

Cart-Dome Miles Lotion 0.125 6 oz Hydrocortisone0.25 40z0.5 40z1.0 1 oz

Cyclocort Lederle Cream 0.1 15 gm, 30 gm, 60 gm Amcinonide

Cyc1ocort Lederle Ointment 0.1 15 gm, 30 gm, 60 gm Amcinonide

Decaspray Merck Sharp & Spray 4 25 gm DexamethasoneDohme,West Point, PA19486

Derrnacort Rowen Laboratories, Cream 1 1 Ib HydrocortisoneInc., Lotion 1 40zBaudette, MN56623

Diprolene Schering Corp., Ointment 0.05 15 gm, 45 gm Betamethasone dipropionateKenilworth, NJ07033

Diprosone Schering Cream 0.05 15 gm, 45 gm Betamethasone dipropionate

Diprosone Schering Ointment 0.05 15 gm, 45 gm Betamethasone dipropionateDiprosone Schering Lotion 0.05 20 ml, 60 ml Betamethasone dipropionateDiprosone Schering Spray 0.1 85 gm Betamethasone dipropionate

Plorone The Upjohn Co., Cream 0.05 15 gm, 30 gm, 60 gm Difiorasone diacetateKalamazoo, MI49001

Plorone Upjohn Ointment 0.05 IS gm, 30 gm, 60 gm Diflorasone diacetateFluonid Herbert Ointment 0.025 15 gm, 60 gm Pluocinolone acetonidePluonid Herbert Cream 0.01 15 gm, 60 gm Fluocinolone acetonide

0.025 15 gm, 60 gm

Pluonid Herbert Solution 0.01 20 ml, 60 ml Fluocinoline acetonideHalciderrn E. R. Squibb & Cream 0.1 15 gm, 30 gm, 60 gm Halcinonide

Sons, Inc.,Princeton, NJ08540

Halog Squibb Cream 0.025 15 gm, 60 gm, Halcinonide240 gm

0.1 30 gm, 15 gm, 60 gm,240 gm

Volume 14Number 1January, 1986

Current topical corticosteroid preparations 83

Fluori­nated

No

No

Yes

Yes

Yes

No

Fre­quency

bid-qid

bid-qid

bid-tid

bid-tid

tid-qid

qd-qid

Vehicle

0.25%, 0.5% and 1.0% vehicles = glycerin, calcium acetate, cetyl-stearyl alcohol,sodium lauryl sulfate, aluminum sulfate, purified water, synthetic beeswax, whitepetrolatum, dextrin, light mineral oil, methylparaben

0.125% = isopropyl myristate, methylparaben, propylparaben, cholesterol, white pet­rolatum, synthetic beeswax, stearic acid, polyoxyethylene, sorbitan monostearate,aluminum sulfate, propylene glycol, calcium acetate, dextrin, purified water

Glyceryl monostearyl, cetyl-stearyl alcohol, sodium lauryl sulfate, butyl stearate, alu­minum sulfate, calcium acetate, dextrin, isopropyl myristate, polyoxyethylene, sor­bitan monolaurate, glycerin, purified water, methylparaben, propylparaben

Aquatain (proprietary cream base composed of emulsifying wax NF, isopropyl palmi­tate, glycerin USP, sorbitol solution USP, lactic acid, 2% benzyl alcohol, purifiedwater)

White petrolatum USP, benzyl alcohol NF, Tenox II (butylated hydroxyanisole, propylgallate, citric acid, propylene glycol)

Isopropypl myristate, isobutane

Stearyl alcohol, cetyl alcohol, isopropyl palmitate, citric acid, polyoxyethylene 40stearate, dibasic sodium phosphate, propylene glycol, water, sorbic acid

Yes bid

Yes qd-bid

Yes qd-bidYes bidYes tid

Yes qd-qid

Yes qd-qidYes bid-qidYes bid-qid

Yes bid-qidYes qd-tid

Propylene glycol, propylene glycol stearate, white wax, white petrolatum

Purified water, mineral oil, white petrolatum, polyethylene glycol 1000 monocetylether, cetearyl alcohol, monobasic sodium phosphate, chlorocresol, propylene gly­col, phosphoric acid

Mineral oil, white petrolatumIsopropyl alcohol, purified water slightly thickened with carbomer 934P, NaOHMineral oil, caprylic/capric triglyceride, isopropyl alcohol, propellant (butane and

propane)Propylene glycol, stearic acid, polysorbate 60, sorbitan monostearate and monooleate,

sorbic acid, citric acid, water

Polyoxypropylene 15, stearyl ether, stearic acid, lanolin alcohol, white petrolatumWhite petrolatumMethylparaben, propylparaben, stearic acid, propylene glycol, sorbitan monostearate,

sorbitan monooleate, polyoxyethylene sorbitan monostearate, citric acid, purifiedwater

Propylene glycol, citric acidPropylene glycol, dimethicone 350, castor oil, cetearyl alcohol, ceteareth-20, propyl­

ene glycol stearate, white petrolatum, purified water

Yes bid-tid 0.025% = glyceryl rnonostearate NF XII, cetyl alcohol, cetyl esters wax, polysorbate60, propylene glycol, dimethicone 350, purified water

0.1 % = glyceryl monostearate NF XII, cetyl alcohol, isopropyl palmitate, dimethi­cone 350, polysorbate 60, titanium dioxide, propylene glycol, purified water

continued

84 Tan et al

Table I. Cont'd

Journal of theAmerican Academy of

Dermatology

Dosage IProduct Manufacturer form % Size Active ingredients

Halog Squibb Ointment 0.1 IS gm, 30 gm, 60 gm, Halcinonide240 gm

Halog Squibb Solution 0.1 20 ml, 60 ml HalcinonideHalog-E Squibb Cream 0.1 15 gm, 30 gm, 60 gm Halcinonide

Hytone Dermik Laboratories, Cream 1 1 OZ, 4 oz HydrocortisoneInc., 2.5 1 ozFort Washington, 0.5 1 ozPA 19034

Hytone Dermik Ointment 2.5 1 oz Hydrocortisone1 1 OZ, 40z0.5 1 oz

Hytone Dermik Lotion 2.5 20z Hydrocortisone1 40z

Kenalog Squibb Cream 0.025 15 gm, 60 gm, 80 gm, Triamcinolone acetonide240 gm, 5Y4 lb

0.1 15 gm, 60 gm, 80 gm,240 gm, 5Y4 Ib

0.5 20 gmKenalog Squibb Ointment 0.025 15 gm, 60 gm, Triamcinolone acetonide

240 gm0.1 15 gm, 60 gm, 80 gm,

240 gm0.5 20 gm

Kenalog Squibb Lotion 0.025 60 ml Triamcinolone acetonide0.1 15 ml, 60 ml

Kenalog Squibb Spray 23 gm, 63 gm Triamcinolone acetonideLidex Syntex Laboratories, Cream 0.05 15 gm, 30 gm, 60 gm, Fluocinonide

Inc., 120 gmPalo Alto, CA94303

Lidex Syntex Ointment 0.05 15 gm, 30 gm, 60 gm, Fluocinonide120 gm

Lidex-E Syntex Cream 0.05 15 gm, 30 gm, 60 gm, Fluocinonide120 gm

Lidex Syntex Gel 0.05 15 gm, 30 gm, 60 gm, Fluocinonide120 gm

Lidex Syntex Solution 0.05 20 ml, 60 ml FluocinonideLocoid Owen Laboratories, Cream 0.1 15 gm, 45 gm Hydrocortisone butyrate

Fort Worth, TX76101

Locorten Ciba Pharmaceutical, Cream 0.03 15 gm, 60 gm Flumethasone pivalateCo.,Summit NJ 07901

Maxiflor Herbert Cream 0.05 15 gm, 30 gm, 60 gm Diftorasone diacetate

Maxiftor Herbert Ointment 0.05 15 gm, 30 gm, 60 gm Diflorasone diacetatePenecort Herbert Cream 1 30 gm Hydrocortisone

2.5 30 gm

Volume 14Number IJanuary, 1986

Current topical corticosteroid preparations 85

Fluori- Fre·nated quency

Yes bid-tid

Yes bid-tidYes bid-tid

No bid-gid

No

No

Yes

Yes

Yes

YesYes

bid-gid

bid-gid

bid-tid

bid-tid

bid-gid

tid-qidbid-tid

Vehicle

Plasticized hydrocarbon gel, polyethylene and mineral oil gel base with polyethyleneglycol 400, polyethylene glycol 6000 distearate, polyethylene glycol 300, polyethyl­ene glycol 1540, and butylated hydroxytoluene

Edetate disodium, polyethylene glycol 300, purified waterPropylene glycol, dimethicone 350, castor oil, cetearyl alcohol, ceteareth-20 propylene

glycol stearate, white petrolatum, waterPurified water, propylene glycol, glyceryl monostearate SE, cholesterol and related ste­

rols, isopropyl myristate, polysorbate 60, cetyl alcohol, sorbitan monostearate, poly­oxyl 40 stearate, sorbic acid

Mineral oil, white petrolatum, sorbitan sesquioleate

Carbomer 940, propylene glycol, polysorbate 40, propylene glycol stearate, cholesteroland related sterols, isopropyl myristate, sorbitan palmitate, cetyl alcohol, triethanol­amine, sorbic acid, simethicone, purified water

Propylene glycol, cetearyl alcohol, ceteareth-20, white petrolatum, sorbitol solution,glyceryl monostearate, simethicone, sorbic acid, purified water

Plastibase (proprietary formulation of plasticized hydrocarbon), a polyethylene andmineral-oil gel base

Propylene glycol, cetyl alcohol, stearyl alcohol, sorbitan monopalmitate, polysorbate20, simethicone, purified water

Isopropyl palmitate, dehydrated alcohol, isobutane propellantStearyl alcohol, polyethylene glycol 8000, propylene glYCOl, 1,2,6-hexanetriol, citric

acid

Yes bid-gid

Yes bid-qid

Yes bid-qid

Yes bid-qidNo bid-tid

Yes tid-qid

Yes qd-qid

Yes qd-qidNo bid-qid

Amerchol CAB (proprietary mixture of sterols and higher alcohols), white petrolatum,propylene carbonate, propylene glycol

Stearyl alcohol, cetyl alcohol, alcohol, mineral oil, propylene glycol, sorbitan mono­stearate, polysorbate 60, citric acid, purified water

Propylene glycol, propyl gallate, edetate disodium, carbomer 940 with NaOH or Hel

Alcohol (35%), diisopropyl adipate, citric acid, propylene glycolCetostearyl alcohol, cetaph-20, mineral oil, white petrolatum, citric acid, sodium ci­

trate, methylparaben

Cetyl alcohol NF, sodium lauryl sulfate NF, propylene glycol, purified water, methyl­paraben, propylparaben

Propylene glycol, stearic acid, polysorbate 60, sorbitan monostearate and monooleate,sorbic acid, citric acid, water

Polyoxypropylene I5-stearyl ether, stearic acid, lanolin alcohol, white petrolatumBenzyl alcohol, petrolatum, stearyl alcohol, propylene glycol, isopropyl myristate, poly­

oxyl 40 stearate, carbomer 934, sodium lauryl sulfate, edetate disodium, sodium hy­droxide, water

con tillued

86 Tan et al

Table I. Cont'd

Journal of theAmerican Academy of

Dermatology

DosageProduct Manufacturer form % Size Active ingredients

Penecort Herbert Solution 1 30 rn1 HydrocortisonePro-Cort Barnes-Hind Phar- Cream 0.5 Y20Z, 10z Hydrocortisone

maceuticals, Inc.,Sunnyvale, CA94086

Proctocort Rowell Cream 1 30 gm Hydrocortisone

Synacort Syntex Cream 1 15 gm, 30 gm, 60 gm Hydrocortisone2.5 30 gm

Synalar Syntex Cream 0.025 15 gm, 30 gm, 60 gm, F1uocinolone acetonide120 gm, 425 gm

0.01 15 gm, 45 gm, 60 gm,120 gm, 425 gm

Synalar Syntex Ointment 0.025 15 gm, 30 gm, 60 gm, Fluocinolone acetonide120 gm, 425 gm

Synalar Syntex Solution 0.01 20 ml, 60 m1 Fluocinolone acetonideSyna1ar-HP Syntex Cream 0.2 12 gm Fluocino1one acetonide

Synemol Syntex Cream 0.025 15 gm, 30 gm, 60 gm, Fluocino1one acetonide120 gm

Texacort CooperCare Lotion 1 oz Hydrocortisone(scalp)

Topicort Hoechst-Roussel Cream 0.25 15 gm, 60 gm, DesoximetasonePharmaceuticals, 120 gmInc.,Somerville, NJ08876

Topicort-LP Hoechst-Roussel Cream 0.05 15 gm, 60 gm Desoximetasone

Topicort Hoechst-Roussel Gel 0.05 15 gm, 60 gm Desoximetasone

Topicort Hoechst-Roussel Ointment 0.25 15 gm, 60 gm Desoximetasone

Tridesilon Miles Cream 0.05 15 gm, 60 gm, 5 lb Desonide

Tridesilon Miles Ointment 0.05 15 gm, 60 gm DesonideTrymex Savage Cream 0.025 15 gm, 80 gm, 1 lb Triamcinolone acetonide

0.1 Same0.5 15 gm

Trymex Savage Ointment 0.025 15 gm, 80 gm Triamcinolone acetonide0.1 15 gm, 80 gm

Uticort Parke-Davis, Cream 0.25 15 gm, 60 gm Betamethasone benzoateMorris Plains, NJ07950

Uticort Parke-Davis Gel 0.025 15 gm, 60 gm Betamethasone benzoate

Uticort Parke-Davis Lotion 0.025 15 ml, 60 ml Betamethasone benzoate

Uticort Parke-Davis Ointment 0.025 15 gm, 60 gm Betamethasone benzoate

Volume 14Number 1January, 1986

Fluori- Frc-nated qucncy

No bid-qidNo prn

Current topical corticosteroid preparations 87

Vehicle

Alcohol, propylene glycol, benzyl alcoholA cooling, soothing emollient skin-cream base

No

No

Yes

bid-qid

bid-qid

Stearyl alcohol, cetyl alcohol, isopropyl palmitate, citric acid, polyoxyethylene 40stearate, dibasic sodium phosphate, propylene glycol, water, sorbic acid

Propylene glycol, stearyl alcohol, mineral oil, cetyl alcohol, sorbitan monostearate,polysorbate 60, citric acid, purified water

Stearic acid, propylene glycol, sorbitan monostearate and monooleate, polysorbate 60,purified water, citric acid, methylparaben, propylparaben

Yes bid-qidYes bid-qid

Yes bid-qid

Yes bid-qid

No bid-qid

Yes bid

Yes bid

Yes bid

Yes bid

No bid-qid·

No bid-qidYes bid-qid

Yes bid-qid

Yes bid-qid

Yes bid-qid

Yes bid-qid

Yes bid-qid

White petrolatumPropylene glycol with citric acid

Methylparaben and propylparabens, stearyl alcohol, cetyl alcohol, mineral oil, propyl­ene glycol, sorbitan monostearate, polysorbate 60, purified water, citric acid

Stearyl alcohol, cetyl alcohol, mineral oil, propylene glycol, sorbitan monostearate,polysorbate 60, purified water, citric acid

Alcohol, propylene glycol, polysorbate 20, benzalkonium chloride, water

Isopropyl myristate, cetylstearyl alcohol, white petrolatum, mineral oil, lanolin alco­hol, water

Isopropyl myristate, cetylstearyl alcohol, white petrolatum, mineral oil, lanolin alco­hol, edetate disodium, lactic acid, water

Purified water, SD alcohol 40, isopropyl myristate, carbomer 940, trolamine, edetatedisodium, docusate sodium

Propylene glycol, sorbitan sesquioleate, fatty alcohol citrate, fatty acid, pentaerythritolester, beeswax, aluminum stearate, citric acid, butylated hydroxyanisole, white pet­rolatum

Glycerin, sodium lauryl sulfate, aluminum sulfate, calcium acetate, dextrin, purifiedwater, cetyl stearyl alcohol, synthetic beeswax, white petrOlatum, light mineral oil,methylparaben

White petrolatumEmulsifying wax, cetyl alcohol, isopropyl palmitate, glycerin, lactic acid, benzoyl al­

cohol, water

White petrolatum, mineral oil

Cetyl alcohol, glyceryl stearate, light mineral oil, propylene glycol, disodium mono­oleamidosulfosuccinate, citric acid, purified water

Alcohol, carboxyvinyl polymer, propylene glycol, di-isopropanolamine, purified water,disodium edetate

Propylparaben, butylparaben, methylparaben cetyl alcohol, stearyl alcohol, propyleneglycol, sodium lauryl sulfate, purified water

Light mineral oil, glyceryl stearate, propylene glycol, sodium lauryl sulfate, polyethyl­ene, food starch modified

colltinued

88 Tan et al

Table I. Cant'd

Journal of theAmerican Academy of

Dermatology

DosageProduct Manufacturer form % Size Active ingredients

Valisone Schering Cream 0.1 15 gm, 45 gm, Betamethasone valerate110 gm, 430 gm

0.01 15 gm, 60 gmValisone Schering Ointment 0.1 15 gm, 45 gm Betamethasone valerateValisone Schering Lotion 0.1 20 ml, 60 ml Betamethasone valerateWestcort Westwood Pharma- Cream 0.2 15 gm, 45 gm, 60 gm, Hydrocortisone valerate

ceuticals, Inc., 120 gmBuffalo, NY14213

Westcort Westwood Ointment 0.2 15 gm, 45 gm, 60 gm Hydrocortisone valerate

Table II. Topical steroid combinations (anti-inflammatory)

IDosage

I IProduct Manufacturer form % Size Active ingredients

Alphaderm Norwich-Eaton Phar- Cream 30 gm, 100 gm Hydrocortisone and ureamaceuticals, Inc., (10%)Norwich, NY13815

Barseb HC Barnes-Hind Scalp 52 ml Hydrocortisone and sali-cylic acid (0.5%)

Barseb Barnes-Hind Spray 0.6 84 gm Hydrocortisone and sali-Thera- cylic acid (0.48%)Spray

Carmol HC Syntex Cream loz Hydrocortisone acetate andurea (10%)

Table III. Topical steroid combinations (anti-infectives)

DosageProduct Manufacturer form % Size Active ingredients

Cordran-N Dista Cream 0.05 15 gm, 30 gm, 60 gm Fluandrenolide (0.05%),neomycin sulfate (5 mg/gm)

Cordran-N Dista Ointment 0.50 15 gm, 30 gm, 60 gm Fluandrenolide (0.05%),neomycin sulfate (5 mg/gm)

Cortisporin Burroughs Wellcome Cream 0.5 7.5 gm Hydrocortisone acetate,Co., polymyxin B sulfate,Research Triangle neomycin sulfate, grami-Park, NC 27709 cidin

Cortisporin Burroughs Wellcome Ointment Y20Z Hydrocortisone, polymyxinB sulfate, neomycin sul-fate, and bacitracin zinc

Volume 14Number 1January, 1986

Fluori- Fre-nated quency

Yes bid-tid

Yes bid-tidYes bid-gidNo bid-tid

Current topical corticosteroid preparations 89

Vehicle

Mineral oil, white petrolatum, polyethylene glycol 1000 monocetyl ether, cetearyl al­cohol, monobasic sodium phosphate, phosphoric acid, chlorocresol, propylene gly­col

Mineral oil, white petrolatum, hydrogenated lanolinIsopropyl alcohol, water, carboxyvinyl polymer, NaOHWhite petrolatum, stearyl alcohol, propylene glycol, amphoteric-9, carbomer 940, so­

dium phosphate, sodium lauryl sulfate, sorbic acid, water

No

Fluori­nated

No

No

No

No

bid-tid

Fre­quency

bid-gid

gd-bid

qd

bid-qid

White petrolatum, stearyl alcohol, propylene glycol, sorbic acid, sodium lauryl sulfate,carbomer 934, dried sodium phosphate, mineral oil, steareth-2, steareth-lOO, water

Vehicle

Purified water, sorbitol, polyoxyethylene fatty gluceride, starch, white petrolatum, tri­glycerides of saturated fatty acids, isopropyl myristate, sorbitan monolaurate

Isopropyl alcohol, propylene glycol, isopropyl myristate, ascorbic acid, citric acid

Alcohol with propylene glycol, isopropyl myristate, benzalkonium chloride, propellant(butane)

Purified water, stearic acid, isopropyl myristate, PPG-26 oleate, isopropyl palmitate,propylene glycol, trolamine, cetyl alcohol, carbomer 940, sodium bisulfite, sodiumlaureth sulfate, edetate disodium, xanthan gum, hypoallergenic perfuo:e

Fluori- Fre·nated quency

Yes bid-tid

Yes bid-tid

No bid-qid

Vehicle

Stearic acid, cetyl alcohol, mineral oil, polyoxyl 40 stearate, glycerin, purified water,ethylparaben

White wax, cetyl alcohol, sorbitan sesquioleate, white petrolatum

Liquid petrolatum, white petrolatum, propylene glycol, polyoxyethy1ene, polyoxypro­pylene compound, emulsifying wax, purified water

No bid-qid Special white petrolatum

continued

90 Tan et al

Table III. Cont'd

Journal of theAmerican Academy of

Dermatology

Product

Lotrisone

Mycolog

Mycolog

Mytrex.

Manufacturer

Schering

Squibb

Squibb

Savage

Size Active ingredients

Cream 0.05 15 gm, 4S gm Betamethasone dipropionateand clotrimazole (l%)

Cream 0.1 15 gm, 30 gm, 60 gm, Triamcinolone acetonide,120 gm nystatin

Ointment 0.1 15 gm, 30 gm, 60 gm, Triamcinolone acetonide,120 gm nystatin

Cream 0.1 15 gm, 30 gm, 60 gm, Triamcinolone acetonide120 gm nystatin, neomycin sulfate,

gramicidin

Mytrex Savage Ointment 0.1 15 gm, 30 gm, 60 gm Triamcinolone acetonidenystatin, neomycin sul-fate, gramicidin

Neo-Synalar Syntex Cream 0.025 15 gm, 30 gm, 60 gm Fluocinolone acetonide,neomycin sulfate

Vioforrn-Hy- Ciba Cream 1 5 gm, 20 gm Hydrocortisone, iodochlor-drocorti- hydroxyquin (3%)sone

Vioform-Hy- Ciba Ointment 1 20 gm Hydrocortisone, iodochlor-drocorti- hydroxyquin (3%)sone

Vioforrn-Hy- Ciba Lotion 1 15 ml Hydrocortisone, iodochlor-drocorti- hydroxyquin (3%)sone

VoSol HC Wallace Laborato- Solution 1 10 ml Hydrocortisone (1 %) andries, (otic) acetic acid (2%)Cranbury, NJ08512

Vytone Dermik Cream 0.5 loz Hydrocortisone, iodoquinol1 loz

Table IV. Topical steroid combinations (anti-pruritics)

\

DosageProduct Manufacturer form '0 Size Active ingredients

Corticaine

Derma Med­icone-HC

G1axo Inc.,Research TrianglePark, NC 27709

Medicone Co.,New York, NY10014

Cream 0.5

Ointment

10z

7 gm, 20 gm

Hydrocortisone acetate, di­bucaine (0.5%)

Hydrocortisone acetate,benzocaine, 8-hy­droxyquinoline sulfate,ephedrine HCl, menthol,ichthammol, zinc oxide

Volume 14Number 1January, 1986

Current topical corticosteroid preparations 91

Yes bid-tid

Yes bid-qid

No tid-qidNo

No tid-gid

No tid-qid

No tid-qid

Fluori­nated

Yes

Yes

Yes

Yes

No

Fre­quency

bid

bid-tid

bid-tid

bid-tid

tid-qid

Vehicle

Water, mineral oil, white petrolatum, cetearyl alcohol, ceteth 20, propylene glycol, so­dium phosphate monobasic, phosphoric acid, benzyl alcohol

Methylparaben, propylparaben, ethylene diamine Hel, white petrolatum, cetearyl alco­hol, cetearth 20, sorbital solution, polysorbate 60, alcohol, aluminum hydroxideconcentrated wet gel, titanium dioxide, glyceryl monostearate, polyethylene glycolmonostearate, simethicone, sorbic acid, propylene glycol

Plastibase, polyethylene and mineral oil gel base

Polysorbate 60 NF, alcohol USP, aluminum hydroxide compressed gel, titanium diox­ide USP, glyceryl monostearate, methylparaben, propylparaben, polyethylene glycolmonostearate 400, simethicone

Sorbic acid NF, propylene glycol, ethylenediamine USP, hydrochloric acid NF, whitepetrolatum USP, purified water USP

Polyethylene and mineral oil USP base

Methylparaben, propylparaben, stearic acid, propylene glycol, sorbitan monostearateand monooleate, polysorbate 60, purified water

Stearyl alcohol, cetyl alcohol, stearic acid, petrolatum, sodium lauryl sulfate, glycerinin water

Petrolatum

Stearic acid, cetyl alcohol, lanolin, propylene glycol, sorbitan trioleate, polysorbate60, triethanolamine, methylparaben, propylparaben, perfume flavor in water

Propylene glycol, diacetate, citric acid, benzethonium chloride, sodium acetate

Purified water, propylene glycol, glyceryl monostearate SE, cholesterol and relatedsterols, isopropyl myristate, polysorbate 60, cetyl alcohol, sorbitan monostearate,polyoxyl 40 stearate, sorbic acid, polysorbate 20

Fluori- Fre-nated quency

No A.M-

P.M.

No bid-gid

Vehicle

Esters of mixed saturated fatty acids, stearyl alcohol, glycerin, polysorbate 40, BHA,BHT, disodium EDTA, purified water, methylparaben, propylparaben

Petrolatum, lanolin, perfume

continued

92 Tan et al

Table IV. Cont'd

Journal of theAmerican Academy of

Dermatology

Product

F-E-P Creme

Mantadil

Pramosone

Pramosone

Pramosone

Zone-A

Dosage

I I IManufacturer form % Size Active ingredients

Boots Pharmaceuti- Cream 15 gm Hydrocortisone acetate,cals, Inc., pramoxine HCl (l%)Shreveport, LA71106

Burroughs Wellcome Cream 0.5 Hydrocortisone acetate,chlorcyclizine HCI (2%)

Ferndale Labs, Inc., Cream 0.5, 1 I oz, 1 Ib Hydrocortisone acetate,Ferndale, MI pramoxine HCI (l%)48220

Ferndale Ointment 1 oz, 4 OZ, I lb Hydrocortisone acetate,pramoxine HCl (1 %)

Ferndale Lotion 0.5, l, 2.5 1Y4 OZ, 4 OZ, 8 Hydrocortisone acetate,OZ, 20z pramoxine Hel (I %)

UAD Laboratories, Lotion 20z Hydrocortisone acetate,Inc., pramoxine HCl (1 %)Jackson, MS39209

Table V. Topical steroid combinations (acne)

DosageProduct Manufacturer form % Size Active ingredients

Komed HC Barnes-Hind Lotion 0.5 52.5 rol Hydrocortisone acetate, so-dium thiosulfate (8%),salicylic acid (2%), men-thol, camphor

Vanoxide- Dennik Lotion 0.5 40z Hydrocortisone, benzoylHC peroxide (5%)

At attempt has been made to separate the prep­arations into tables containing single-ingredientcorticosteroids (Table I), topical corticosteroidcombinations primarily used for anti-inflammatorypurposes (Table II), those combinations containinganti-infectives (Table III), those containing anti-

pruritics (Table IV), and those used in the treat­ment of acne (Table V).

REFERENCES1. Sulzberger MB, Witten HH: The effect of topical1y applied

Compound F in selective dermatoses. J Invest Dermatol19:101-102, 1952.

Volume 14Number IJanuary, 1986

Current topical corticosteroid preparations 93

Fluori­nated

No

Fre­quency

tid-qid

Vehicle

Stearic acid, cetyl alcohol, aquaphor, isopropyl palmitate, polyoxyl 40 stearate, pro­pylene glycol, potassium sorbate, sorbic acid, triethanolamine lauryl sulfate, water

No bid-qid

No tid-qid

No tid-qid

No tid-qid

No tid-qid

Liquid petrolatum, petrolatum emulsifying wax, water, methylparaben

Stearic acid, cetyl alcohol, aquaphor, isopropyl palmitate, polyoxyl 40 stearate, pro­pylene glycol, potassium sorbate, sorbic acid, triethanolamine lauryl sulfate, water

Sorbitan sesquioleate, water, aquaphor, white petrolatum

Forlan-L, cetyl alcohol, stearic acid, di-isopropyl adipate, polyoxyl 40 stearate, sili­con, triethanolamine, glycerin, polyvinyl pyrrolidone, potassium sorbate, sorbicacid, water

Stearic acid, cetyl alcohol, forlan-L glycerin, triethanolamine, Myrj-52, di-isopropyladipate, polyvinyl pyrrolidone, silicone, potassium sorbate, sorbic acid, water

Fluori­nated

No

No

Fre­quency

bid

tid

Vehicle

Isopropyl alcohol (25%), edetate disodium, colloidal alumina, purified water

Propyl gallate, sodium hydroxide, simethicone, BHT, BHA, monoglyceride citrate,vegetable oil, cyclohexanediamine tetraacetic acid, tetrasodium EDTA, methylpara­ben, propylparaben, purified water, calcium phosphate, propylene glycol, caprylic/capric triglyceride, propylene glycol monostearate, laneth-lO acetate, decyloleate,polysorbate 20, cetyl alcohol, mineral oil, lanolin alcohol, sodium phosphate, so­dium phosphate, sodium biphosphate, stearyl heptanoate, hydroxyethylcellulose,FD&C colors

2. Akers WA: Risks of unoccluded topical steroids in clinicaltrials. Arch DermatoI116:786-788, 1980.

3. Alani MD, A1ani SP: Allergic contact dermatitis to cor­ticosterone. Ann Allergy 30:181-185, 1972.

4. Comaish S: A case of hypersensitivity to corticosteroids.Br J DermatoI81:919-925, 1969.

5. Coskey RJ: Contact dermatitis due to multiple corticoste­roid creams. Arch DermatoI1l4:1l5-117, 1978.

6. Fisher AA, Pascher F, Kanof NB: Allergic contact der­matitis due to ingredients of vehicles. Arch Dermatol104:286-290, 1971.

7. Shore RN, Shelley WB: Contact dermatitis from stearylalcohol and propylene glycol in f1uocinonide cream, ArchDermatol 109:397-399, 1974.

8. Epstein S: Parahen sensitivity: Subtle trouble. Ann Allergy26:185-189,1968.