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Topical corticosteroid is a term refering to any sort of cream, gel or ointment containing corticosteroids. You may have heard them called ‘steroid creams’.
Their main purpose is to reduce skin inflammation and irritation. They cannot cure the conditions that trigger these symptoms, but they can provide temporary relief during a particularly bad flare-up of symptoms.
For information about steroid tablets and sprays, see our page on corticosteroids.
There are five main types of topical corticosteroids:
Topical corticosteroids are also available in different strengths. The strength is determined by the amount of steroids the medicine contains. They can be:
Read more about dosage of topical corticosteroids.
Your doctor will usually prescribe the lowest strength of corticosteroid necessary to control your symptoms. This reduces the risk of any adverse side effects, such as the skin:
Read more about the side effects of topical corticosteroids.
If used as directed, topical corticosteroids are a very safe treatment. Serious side effects usually only occur if excessive amounts of potent or very potent corticosteroids are applied.
However, there are some things to consider while taking topical corticosteroids.
High levels of potent topical corticosteroids can disrupt the hormonal balance in the body, leading to side effects, such as:
Topical corticosteroids are used to relieve the symptoms of skin inflammation, irritation and itching caused by inflammatory skin conditions.
Topical corticosteroids may be used to treat types of eczema, including:
Topical corticosteroids may also be prescribed to treat infected eczema, along with antibiotics.
Emollients are often prescribed to treat eczema and may be prescribed to use with topical corticosteroids if treating severe eczema.
Topical corticosteroids may also be used to treat:
Topical corticosteroids rarely cause serious side effects if they are used as instructed.
Things that increase your risk of getting side effects include:
Side effects can affect the patch of skin being treated, known as local side effects, or they can affect other parts of the body, known as systemic side effects.
Local side effects are the most common. They usually occur on the face, in folds of skin and in areas that have been treated many times during the past months or years.
Local side effects include:
These local side effects should disappear after you have finished your treatment with corticosteroids. However, if you have stretch marks, it is likely they will be permanent, though they will probably become less noticeable over time.
Systemic side effects are rare and usually occur only if you do not apply topical corticosteroids as instructed.
Systemic side effects occur because the steroids become absorbed into the blood stream and affect other parts of the body, such as the adrenal gland (a gland that produces many of the body’s natural steroids).
Systemic side effects are usually mild but can include:
Cushing’s syndrome is a rare condition caused by having high levels of steroid hormones in your blood. Symptoms of Cushing’s syndrome include:
Topical corticosteroids work by reducing inflammation and helping to control the symptoms of several skin conditions, such as atopic eczema and dermatitis.
To understand how topical corticosteroids work, it is useful to learn more about the biological processes that cause inflammation.
When a part of your body becomes infected, your immune system responds by flooding the area with infection-fighting antibodies. The antibodies limit the spread of infection and kill off the virus, bacteria or fungus responsible for the infection.
However, this process causes the affected area to become swollen, warm and, in the case of your skin, reddened. This is known as inflammation.
Inflammation is usually a helpful biological process. However, there are times when the immune system malfunctions and triggers inflammation even though there is no infection. This ‘misfiring’ of the immune system is the main cause of many common skin conditions, such as atopic eczema and psoriasis.
Topical corticosteroids are also split into four classes of potency and measured in finger tip units (FTUs).
The potency of a medication is a measurement of how powerful the effect of the medication will be.
The four classes of potency for topical corticosteroids are:
To reduce the risk of side effects, your doctor will prescribe the least potent corticosteroid necessary to relieve your symptoms.
An FTU is the amount of topical corticosteroid needed to squeeze a line from the tip of an adult finger to the first crease of the finger.
An FTU is about 500mg. It should be enough to treat an area of skin double the size of the flat of your hand with your fingers together.
The recommended dosage in terms of FTUs will depend on what part of the body is being treated. This is because the skin is thinner in certain parts of the body and more sensitive to the effects of corticosteroids.
For adults, the recommended FTUs to be applied in one single dose are:
For children, the recommended FTUs will depend on their age. Your doctor can advise you about this.
For most conditions, you will only need to apply topical corticosteroids once or twice a day.
The recommended length of treatment will depend on the condition being treated and the strength of the topical corticosteroid being used.
Mild to moderate topical corticosteroids can usually be used indefinitely to treat chronic (long-term) skin conditions, such as atopic eczema. However, most people only need treatment when they have a flare-up of symptoms. They will not need to use a topical corticosteroid every day.
Potent and very potent topical corticosteroids are often prescribed for a shorter period of time. If treatment is required for a long period of time, it is likely you will be referred to a dermatologist (skin care specialist).
There are several cautions to consider when using topical corticosteroids.
Topical corticosteroids should not be applied to infected skin. They could make the symptoms of the skin infection worse.
Mild or moderate topical corticosteroids are considered safe to use during pregnancy. However, using potent topical corticosteroids during pregnancy is not usually recommended. Research has found that they increase the risk of giving birth to a baby with a low birth weight.
Mild, moderate and potent topical corticosteroids are also considered safe to use when breastfeeding. However, you should wash off any steroid cream applied to your breasts before feeding your baby.
As a precaution, very potent topical corticosteroids are not recommended to use while breastfeeding because their safety is uncertain.
Children can safely use mild to moderate topical corticosteroids. Potent and very potent topical corticosteroids are not usually recommended, particularly in very young children, because they carry a greater risk of causing side effects than in adults.
However, exceptions can be made if your child has severe symptoms and it is felt that the benefit of treatment outweighs the risks of side effects. For example, potent topical corticosteroids are sometimes recommended for treating cases of severe atopic eczema, usually under the supervision of a dermatologist (skin care specialist).
Important: Our website provides useful information but is not a substitute for medical advice. You should always seek the advice of your doctor when making decisions about your health.