Topical Steroid Selection Quiz
Quick Take
- Temovate (clobetasol propionate) is the strongest prescription steroid available in the UK.
- It’s ideal for short‑term control of severe psoriasis, eczema and lichenoid disorders.
- Common alternatives include betamethasone dipropionate, halobetasol, fluocinonide and mometasone furoate.
- All high‑potency steroids share similar side‑effects - skin atrophy, stretch marks, and possible adrenal suppression.
- Choosing the right steroid hinges on disease severity, body‑site sensitivity, treatment duration and patient risk factors.
When a dermatologist orders Temovate vs alternatives, the goal is to match the drug’s potency with the skin condition while minimizing harm. This guide walks you through the science, the practicalities, and the decision‑making steps you need to feel confident prescribing or using a high‑potency topical steroid.
Temovate is a super‑high‑potency topical corticosteroid (clobetasol propionate 0.05%) approved for short‑term treatment of severe inflammatory skin disorders. It works by binding to glucocorticoid receptors, dampening the inflammatory cascade, and shrinking swollen, reddened tissue within days.How Temovate Fits Into the Potency Landscape
The WHO classifies topical steroids into four groups. Temovate sits in GroupIV - the super‑high‑potency tier, alongside only a handful of other agents. Its vasoconstriction test score (the standard measure of potency) is around 5.5, making it roughly 10‑15 times stronger than a mid‑potency steroid like mometasone.
Typical Indications for Temovate
Because of its strength, Temovate is reserved for conditions that have failed milder therapies:
- Plantar and palmar psoriasis
- Severe plaque psoriasis on the scalp
- Exfoliative or erythrodermic psoriasis
- Chronic hand eczema unresponsive to lower‑potency steroids
- Lichen planus, especially hypertrophic variants
Guidelines from the British Association of Dermatologists advise a maximum continuous use of twoweeks on any body site, followed by a taper or a switch to a lower‑potency steroid.
Safety Profile and Common Side‑Effects
With great power comes a higher risk of adverse events. The most frequently reported issues are:
- Skin atrophy - thinning of the epidermis after prolonged use.
- Striae (stretch marks) - especially on thin skin like the thighs or abdomen.
- telangiectasia - visible blood vessels after chronic application.
- Local infection - opportunistic bacterial or fungal overgrowth if the barrier is compromised.
- Systemic absorption - rare but can suppress the hypothalamic‑pituitary‑adrenal (HPA) axis, especially when applied under occlusion or on large surface areas.
Patients should be warned to avoid using plaster dressings unless explicitly directed, and to report any unexplained fatigue, nausea, or dizziness that might signal systemic effects.
Alternative High‑Potency Topical Steroids
When Temovate isn’t available, or when a clinician wants a slightly less aggressive option, several alternatives are commonly considered.
Betamethasone dipropionate is a high‑potency (GroupIII) steroid often formulated as a cream or ointment at 0.05% concentration. It is effective for plaque psoriasis, severe eczema, and inflammatory dermatoses, but carries a marginally lower risk of atrophy than Temovate. Halobetasol propionate is a super‑high‑potency (GroupIV) steroid, typically sold as a 0.05% lotion or foam. FDA‑approved for plaque psoriasis, it shares Temovate’s potency but is formulated for easier spread on large surfaces like the trunk. Fluocinonide falls into GroupIII‑IV, marketed at 0.05% in cream, ointment, or scalp solution. It is a workhorse for chronic hand eczema and seborrheic dermatitis, offering a balance between strength and tolerability. Mometasone furoate is a high‑potency (GroupIII) steroid, available as a 0.1% cream or ointment. While less aggressive than Temovate, it is prized for its low‑oil formulation, making it popular on the face and intertriginous zones.
Side‑by‑Side Comparison
| Agent | WHO Potency Group | Typical Formulations | Common Indications | Maximum Daily Dose (%w/w) | Typical Side‑Effect Profile |
|---|---|---|---|---|---|
| Temovate (clobetasol propionate) | IV (super‑high) | Cream, ointment, scalp lotion | Severe psoriasis, chronic hand eczema, lichen planus | 0.05% (max 30g/week) | Higher risk of atrophy, striae, HPA suppression |
| Betamethasone dipropionate | III (high) | Cream, ointment | Plaque psoriasis, eczema, dermatitis | 0.05% (max 40g/week) | Moderate atrophy risk, milder systemic effects |
| Halobetasol propionate | IV (super‑high) | Lotion, foam | Psoriasis, extensive dermatitis | 0.05% (max 30g/week) | Similar to Temovate; foams improve compliance |
| Fluocinonide | III‑IV (high‑to‑super) | Cream, ointment, scalp solution | Hand eczema, seborrheic dermatitis, scalp psoriasis | 0.05% (max 40g/week) | Balanced efficacy; lower atrophy than Temovate |
| Mometasone furoate | III (high) | Cream, ointment | Facial eczema, intertriginous rash, mild‑moderate psoriasis | 0.1% (max 50g/week) | Least atrophy; suitable for sensitive sites |
Choosing the Right Steroid: A Practical Decision Guide
Think of steroid selection as a three‑step filter:
- Assess severity and location. Super‑high potency (Temovate, Halobetasol) is best for thick‑skinned, resistant areas like palms, soles, scalp, or for acute flares of psoriasis. For the face, intertriginous zones, or children, opt for a high‑potency but gentler agent like mometasone.
- Consider treatment duration. If you anticipate longer than twoweeks of therapy, start with a slightly lower‑potency steroid to reduce cumulative atrophy. Switch to a milder topical (e.g., hydrocortisone 1% or a calcineurin inhibitor) for maintenance.
- Evaluate patient‑specific risk factors. Diabetes, hypertension, or a history of steroid‑induced skin thinning pushes you toward the least aggressive option that still controls the disease.
Use the table above as a quick reference while you “talk” through these steps with the patient.
Practical Tips for Safe Use
- Apply a thin layer - about the size of a grain of rice per square inch.
- Limit occlusion; only use a waterproof dressing if the dermatologist explicitly orders it.
- Schedule a follow‑up after 7‑10days to reassess skin response and taper if improving.
- For large‑area treatment (e.g., >10% of BSA), split the course into two‑week blocks with a 1‑week drug‑free interval.
- Monitor morning cortisol in patients on >4weeks of super‑high‑potency steroids, especially children.
Related Concepts and Adjunct Therapies
High‑potency steroids rarely stand alone. In practice, they are combined with:
- Topical calcineurin inhibitors (tacrolimus 0.1%, pimecrolimus 1%) - useful for steroid‑sparing on the face or neck. \n
- VitaminD analogues (calcipotriene 0.005%) - enhance psoriasis control when paired with a steroid.
- Phototherapy (narrow-band UVB) - reduces the need for prolonged high‑potency steroid use.
- Emollient therapy - restores barrier function, allowing lower steroid doses.
Understanding these connections helps you craft a holistic regimen that minimizes side‑effects while keeping the disease in check.
Next Steps for Clinicians and Patients
If you’re a prescriber, download the quick‑reference chart (not included here) and integrate it into your electronic health record templates. For patients, keep a diary of the area treated, amount applied, and any skin changes - this makes the follow‑up visit smoother.
Frequently Asked Questions
What makes Temovate stronger than other steroids?
Temovate contains clobetasol propionate 0.05%, the most potent glucocorticoid approved for topical use in the UK. Its molecular structure maximises receptor affinity, delivering about ten‑fold more anti‑inflammatory power than high‑potency agents like betamethasone.
Can I use Temovate on my face?
Generally no. The facial skin is thin and absorbs steroids quickly, raising the risk of atrophy. Prefer a high‑potency but gentler option such as mometasone furoate or a calcineurin inhibitor for facial eruptions.
How long is it safe to stay on Temovate?
Guidelines suggest a maximum of twoweeks of continuous use on any single body site, followed by a taper or a switch to a lower‑potency steroid. Longer courses increase the chances of skin thinning and systemic effects.
Is it okay to combine Temovate with a vitamin D cream?
Yes. Vitamin D analogues (e.g., calcipotriene) work through a different pathway and can boost psoriasis control while allowing you to shorten the steroid course.
What signs indicate I should stop using Temovate?
Watch for skin thinning, new stretch marks, easy bruising, or signs of systemic glucocorticoid exposure (fatigue, nausea, dizziness). If any appear, discontinue the medication and consult your doctor.
How does Halobetasol differ from Temovate?
Both are super‑high‑potency steroids, but Halobetasol is formulated as a lotion or foam, which spreads easier over large, hairy areas. Its absorption profile is similar, so the safety considerations are alike.