Topical Corticosteroids

This leaflet has been written to help you understand more about topical corticosteroids. It tells you what they are, how they work, how they are used to treat skin conditions, and where you can find out more about them. 

Steroids are naturally occurring chemicals produced by the body. There are different types of steroids, and the type most commonly used to treat skin problems is a corticosteroid. Corticosteroids treat skin conditions by suppressing inflammation and reducing the amount of collagen in the skin. 

Corticosteroids applied to the skin in the form of creams, ointments, lotions, mousses, shampoos, gels, or tapes are known as topical corticosteroids (TCS). 

TCS is available in different strengths, or potencies: mildly potent, moderately potent, potent, and very potent. Your doctor will decide on the correct strength for you based on your condition, age, and area of your body being treated.

TCS is used to treat a wide variety of inflammatory skin conditions and may also be used to treat excessive scar tissue.

TCS suppresses skin inflammation (which causes redness and itching) rather than treating the cause of the inflammation and so they do not usually cure the condition and instead just control it, although once controlled the condition may not necessarily recur.

You should use TCS as instructed by your doctor, who will explain where, how frequently, and for how long to apply the medication. TCS is usually applied only once (or sometimes twice) a day. It is essential not to under-use or over-use TCS. Use enough preparation to cover the area to be treated (see information on fingertip units at the end of this information leaflet). 

For hairy areas, apply in the direction of hair growth to minimize the build-up of TCS at the bases of hairs as this can cause inflammation of the hair follicles (folliculitis). Your doctor may prescribe more than one TCS, of different potencies, for you to apply to various body regions, as some places (e.g., the face (especially the eyelids), the groin, and under the arms or breasts) are more prone to side effects than others.

If you are uncertain how to use the TCS, ask your doctor for clarification. It is useful to complete the section at the end of this information leaflet to remember how frequently you should use it and for how long. Most people who are prescribed topical corticosteroids will also be prescribed an emollient (moisturizer). You can use both treatments at the same time of day but should wait twenty to thirty minutes between the two treatments to avoid diluting the topical steroid and reducing its effectiveness.

When used correctly, TCS rarely causes significant side effects. However, if TCS (particularly the potent and super-potent preparations) are used for excessive periods, they may cause changes to the treated skin, including thinning, bruising, stretch marks, folliculitis, and pimples, loss of skin pigment, and hair growth at the site of application. Burning or stinging is quite common in the first few days of treatment. However, this usually resolves after a few days.

If used as directed by your doctor, the risk of any absorption of TCS into your body is extremely low.

It is entirely acceptable to use TCS for prolonged periods as long as you know what strength to apply, how much, and how frequently to apply the treatment and for how long. 

TCS is safe to use in pregnancy and breastfeeding, and there is no age limit for their use. Using less than your doctor has advised can make your skin condition challenging to control and may mean that a stronger preparation is needed to control your condition. 

Occasionally, an allergy to the TCS or one of the other constituents of the topical preparation may develop and cause more inflammation.

If your TCS has been prescribed to treat some inflammatory skin diseases such as eczema or psoriasis, it is also beneficial to use emollients liberally and frequently, as these will increase the effectiveness of, and reduce the requirement for, the TCS. Be sure not to exceed the length of the course recommended by your doctor.

TCS should generally not be used on skin infections such as impetigo, cold sores, and fungal infections unless combined with an appropriate anti-infective agent, or advised by your doctor. TCS may worsen some non-infectious skin diseases such as acne, rosacea, or perioral dermatitis.

The most typical problem with TCS is under-use. If inadequate amounts of TCS are used, or if they are stopped too soon, this results in more frequent and severe flares, increasing the requirement for TCS.

In rare circumstances, the overuse of strong TCS can lead to thinning of the skin. If the steroids are overused on the face, this can sometimes trigger an acne-like problem causing a red face, which then flares up when the steroids are stopped. If this is not recognized, this can lead to people using increasingly potent steroids to control the acne and red-face problem, which worsens. This is a more common problem where potent steroids can be bought over the counter or when people lend strong steroid creams to friends or family. 

Severe eczema can require very potent TCS to control it. These should not be stopped suddenly without medical advice, or eczema may flare up again. It is usually recommended that these should be tailed off gradually as advised by a doctor or nurse.

A fingertip unit (FTU) is the amount of cream or ointment that just covers the end of an adult finger from the tip to the crease of the first joint when squeezed from an ordinary tube. This cream is enough to cover an area of skin the size of two hands with the fingers together. It helps to ensure you are using the correct amount of TCS – not too much and not too little.