Corticosteroid Classification and Usage

Systemic Corticosteroids

The American Academy of Allergy, Asthma, and Immunology recommends prednisone and methylprednisolone, which are 4-5 times more potent than hydrocortisone, for the management of acute exacerbations and chronic inflammatory conditions 1, 2
The American College of Clinical Oncology suggests that dexamethasone, with a potency approximately 25 times greater than short-acting products, is particularly useful in situations requiring intense inflammatory suppression 2, 3
For clinical use in asthma, the recommended doses are methylprednisolone 0.25-2 mg/kg/day (pediatric) or 7.5-60 mg/day (adults), and prednisone/prednisolone in short courses of 1-2 mg/kg/day (maximum 30-60 mg/day) for 3-10 days 1, 3

The classification of topical corticosteroids into 7 classes based on skin vasoconstrictive activity is recommended, with Class 1 being the most potent and Classes 6-7 being the least potent 4
For face, intertriginous areas, and genitals, only Class 5-7 (low potency) corticosteroids should be used due to the increased risk of skin atrophy, with hydrocortisone 2.5% being the recommended option by the American Academy of Dermatology for facial use 4, 5
For trunk and extremities with thick and chronic plaques, consider Class 1-3 (high to ultra-high potency) corticosteroids, with clobetasol propionate 0.05% and halobetasol propionate 0.05% being examples of ultra-high potency options 4

The American Academy of Allergy, Asthma, and Immunology notes that systemic oral corticosteroids can cause adverse effects, including suppression of the hypothalamic-pituitary-adrenal axis, growth suppression, skin thinning, hypertension, diabetes, Cushing's syndrome, cataracts, muscle weakness, and altered immune function 1
The risk of skin atrophy with topical corticosteroids is dependent on potency and duration, with only 1% of 2,266 participants in 22 trials developing abnormal skin thinning, and 2 cases reported with moderate potency (Class 4) 4
Systemic corticosteroids significantly increase the risk of cardiovascular events, with current users having an odds ratio of 2.7 for atrial fibrillation, and high doses (≥7.5 mg equivalent of prednisone) having an odds ratio of 6.07 3