What are topical steroids?
Topical steroids are effective anti-inflammatory preparations used to control eczema/dermatitis and many other skin conditions. They are also called topical corticosteroids, glucocorticosteroids, and
cortisone. They were first marketed in the 1950s.
Like all medications, topical (cortico)steroids are associated with potential adverse effects (side effects), especially if they are used incorrectly.
The topical steroids can be divided up into four groups according to their strength. As a general rule, use the weakest possible steroid that will do the job. However, sometimes it is appropriate to use a potent preparation for a short time to make sure the skin condition clears completely.
Topical steroids are also available in combination with other agents for example antibacterial and antifungal agents.
Topical steroids available in New Zealand
Topical steroids are prescription medicines regulated by Health Authorities. The products listed here are the generic (and trade) names of those available in New Zealand currently (February 2014 ). The products available in other countries may be different. For example, in the USA, the classification of topical steroids places them in seven potency classes. Seek the advice of a pharmacist or your own medical practitioner if you require more information.
Very potent or superpotent (up to 600 times as potent as hydrocortisone)
Potent (100-150 times as potent as hydrocortisone)
Moderate (2-25 times as potent as hydrocortisone)
Skin absorption of topical steroids
Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. But a potent steroid used for the palm may cause side effects if applied to the face. There is much greater absorption where the skin is thin, for example eyelids, genitals and skin creases, compared to thicker skinned areas, such as palms and soles.
Absorption also depends on the vehicle in which the topical steroid is delivered. Higher absorption, eg by ointment or gel, increases the potency of the product compared to lower absorption vehicles, eg cream or lotion.
Which vehicle is best for me?
The most suitable vehicle in a topical steroid product depends on the type of skin lesion, location on the body, and potential for irritation (stinging or contact irritant dermatitis) or allergy (allergic contact dermatitis to topical steroids).
- Lotions are easy to apply.
- Creams rub in well.
- Ointments may be most effective for dry lesions.
- Gels and solutions are useful in hairy areas or for a drying effect.
- Potent and very potent topical steroids are best avoided on the face because of potential for side effects.
What are the side effects of topical steroids?
Internal side effects
If more than 50 g of clobetasol propionate, or 500 g of hydrocortisone is used per week, sufficient steroid may be absorbed through the skin to result in adrenal gland suppression and/or eventually Cushing syndrome. Refer to DermNet NZ's page on systemic steroids.
- Adrenal gland suppression – Topical steroids can suppress the production of natural steroids, which are essential for healthy living. Stopping the steroids suddenly may then result in illness.
- Cushing syndrome – If large amounts of steroid are absorbed through the skin, fluid retention, raised blood pressure, diabetes and many other side effects may result.
Skin side effects
Local side effects of topical steroids include:
- Skin thinning (atrophy) and stretch marks (striae).
- Easy bruising and tearing of the skin.
- Perioral dermatitis (rash around the mouth).
- Enlarged blood vessels (telangiectasia).
- Susceptibility to skin infections, eg impetigo, herpes simplex, malassezia folliculitis and molluscum contagiosum.
- Disguising skin infection, eg tinea incognito.
- Allergy to the steroid cream.
- Delaying diagnosis and treatment of skin cancer, because of the anti-inflammatory action of topical steroid. Topical steroids do not have an anti-tumour effect.
- Aggravating certain inflammatory skin conditions, particularly pustular psoriasis, steroid acne and steroid rosacea.
The risk of these side effects depends on the strength and specific steroid, the length of application, the site treated, whether it is occluded, and the nature of the skin problem.
Localised pustular psoriasis
How to use topical steroids
Ask for specific instructions how to use your topical steroid(s). See DermNet's information about fingertip units. Which one, to what site(s), when, how often, and for how many days? Cream, ointment or lotion? This is particularly important if:
- You are using potent steroids over large areas of your body.
- You have been asked to use plastic to cover treated areas (occlusion).
- Your skin condition persists for more than two or three weeks.
- You are a child.
Topical steroids are very effective medications. They work by reducing inflammation, and when used correctly are very safe. They should not be used as bleaching creams.
Apply topical steroids only to the areas affected by the skin disease, and generally only once or twice daily for 2 to 4 weeks or less. If your skin is dry, apply an emollient frequently. Emollients can be applied before or after application of topical corticosteroid; the optimal order and timing of the combination is unknown.
- MIMS Online accessed 22 February 2014
- Can topical steroids be applied at the same time as emollients? Medicines Q&As. NHS
- Corticosteroids (Ch. 25). In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Bolognia Textbook of Dermatology. 2nd ed. Mosby Elsevier publishing; 2008.
On DermNet NZ:
- Topical Corticosteroids Medical Education (UK)
- Consumer medicine information and data sheets – Medsafe
- Drugs, Herbs and Supplements – MedlinePlus
- Topical corticosteroids PDF – A quick guide to potency, structural class and cross-reactivity, from Connetics.
- International Topical Steroid Awareness Network
Books about skin diseases:
See the DermNet NZ bookstore
New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check individual New Zealand datasheets on the Medsafe website.