Topical corticosteroids are medicines used on the skin to treat skin conditions. The type of steroid found in these medicines is similar to those produced naturally in the body. They work by reducing inflammation within the skin, making it less red and itchy. This information describes the different types of steroids, how to use them safely and any side effects to be aware of. If you have any questions or concerns, please speak to a doctor or nurse caring for you.
What are the different strengths of topical corticosteroids?
Topical steroids come in a number of different strengths. This means it is very important that you follow the advice of your doctor or specialist nurse and apply the correct strength of steroid to the affected area of your body. The strengths of the most commonly prescribed topical steroids in the UK are listed as follows.
Hydrocortisone 0.5%, 1.0%, 2.5% (Hydrocortisone Dioderm®, Efcortelan®, Mildison®)
Betamethasone valerate 0.025% (Betnovate-RD®)
Clobetasone butyrate 0.05% (Eumovate®, Clobavate®)
Fluocinolone acetonide 0.001% (Synalar 1 in 4 dilution®)
Fluocortolone 0.25% (Ultralanum Plain®)
Fludroxycortide 0.0125% (Haelan® tape)
Betamethasone valerate 0.1% (Betnovate®)
Diflucortolone valerate 0.1% (Nerisone®)
Fluocinolone acetonide 0.025% (Synalar®)
Fluticasone propionate 0.05% (Cutivate®)
Hydrocortisone butyrate 0.1% (Locoid®)
Mometasone furoate 0.1% (Elocon®)
Clobetasol propionate 0.1% (Dermovate®, Clarelux®)
Diflucortolone valerate 0.3% (Nerisone Forte®)
In adults, stronger steroids are generally used on the body, and mild or moderate steroids are used on the face and skin folds (under and in between the breasts, armpits, groin and genitals). In infants and small children, mild or moderate steroids are normally used, although stronger steroids may be needed to treat severe skin conditions. Stronger steroids can sometimes be used on the face and skin folds to treat certain skin conditions for short periods of time.
What are the different preparations of topical corticosteroids?
- Ointments have the highest oil content and are therefore usually preferred for dry skin conditions.
- Creams are less greasy than ointments but have less moisturising effect. Creams are sometimes preferred for the face and hands or if the skin condition is weeping.
- Lotions are less thick than creams and may be used to treat large areas or hairy skin.
- Solutions and scalp applications can be water or alcohol based and are the thinnest topical steroid preparations. Alcohol based preparations may sting when applied to inflamed skin.
- Tapes often used to treat inflamed areas on the hands and feet.
How should I apply topical steroids?
Applying topical steroids correctly will increase how well they work and reduce the risk of side effects. Please follow these simple steps when applying them:
- Start by washing your hands
- Squeeze the topical steroid in a line from the last finger crease to the finger tip. This is a ‘finger tip unit’ and is enough steroid to cover the same area of skin as two hands laid flat with the fingers together.
- Apply the treatment in downward motions in the direction of hair growth. Do not rub the treatment in. Topical steroids are usually only applied to affected areas of skin (red, rough or thickened areas) but follow the advice of your doctor or specialist nurse.
- Wash your hands thoroughly after applying topical corticosteroids.
How much topical steroid should I apply?
As a general guide, topical steroids should be applied to affected areas of skin to give a thin glistening layer. The finger tip unit (FTU) is a useful guide to estimate how much topical steroid to use and represents approximately 0.5g of cream or ointment. This can be measured by squeezing the steroid in a line from the last finger crease to the tip of the finger. Fingertip units for children are measured on an adult finger and are used differently according to the age of the child.
1 FTU for the front and back of one hand
2.5 FTU for the face and neck
3 FTU for the scalp
4 FTU for one arm and hand
8 FTU for one leg and a foot
8 FTU for the front of the body
8 FTU for the back
For children aged 3-12 months
1 FTU for face and neck
1 FTU for arm and hand
1 FTU for front of chest and stomach
1.5 FTU for leg and foot
1.5 FTU for back including bottom
For children aged 1-2 years
1.5 FTU for face and neck
1.5 FTU for arm and hand
2 FTU for front of chest and stomach
2 FTU for leg and foot
3 FTU for back including bottom
For children aged 3-5 years
1.5 FTU for face and neck
2 FTU for arm and hand
3 FTU for front of chest and stomach
3 FTU for leg and foot
3.5 FTU for back including bottom
For children aged 6-10 years
2 FTU for face and neck
2.5 FTU for arm and hand
3.5 FTU for front of chest and stomach
4.5 FTU for leg and foot
5 FTU for back including bottom
Should I apply topical steroids with moisturisers?
You should avoid applying the topical steroid at the same time as a moisturiser as this will dilute its strength. When both treatments are to be used and where practical, the emollient should be applied 30 minutes before application of the topical steroid.
How long should I use topical steroids for?
The length of treatment will depend on the severity of your skin condition, the strength of topical steroid and where it is applied. Usually, the risk of side effects increases after 1 to 2 months of continuous use. If topical steroids are used for longer than this, a treatment-free period or a change in frequency of use can reduce the risk of side effects. However, suddenly stopping treatment can sometimes cause the underlying skin condition to flare. The length of treatment and how it is stopped will vary between people and must therefore be decided by your doctor or specialist nurse.
What are the side effects of topical steroids?
When used correctly, the risk of side effects from topical steroid use is very low. Side effects that can happen are:
- Temporary stinging or burning. This is common, especially if the skin is inflamed. It usually settles within a few days.
- Thinning of the skin. This is rare if topical steroids are used correctly. The risk of skin thinning increases if strong steroids are used for long periods, on the face or skin folds, or under bandages or plasters. Most skin thinning will resolve on stopping treatment.
- Stretch marks. This is uncommon and generally only occurs after prolonged use of strong topical steroids.
- Mild lightening of the skin.
- Allergic reactions to the steroid or other ingredients within the preparation.
- Acne like rash. This can happen if strong steroids are applied to the face.
A small amount of the topical steroid is absorbed into the body from the skin. If topical steroids are used in large quantities over a long time, this can cause weight gain and the symptoms of steroid excess (Cushing’s syndrome), or it can affect the body’s production of natural hormonal steroids (adrenal suppression). If topical steroids are used as prescribed, the risk of these complications is very low.
Can I use topical steroids if I am pregnant or breastfeeding?
As with many medications, there is limited information about the safety of topical steroid use in pregnancy and during breastfeeding. However, topical steroids have been used by a large number of pregnant and breastfeeding women without any evidence of harmful effects.
Any use should always be discussed with your doctor or specialist nurse to make sure the benefits outweigh the risks. To avoid transfer to the infant only weak topical steroids should be used on the breast and around the nipple, and these should be washed off before breastfeeding.
When should I avoid using topical steroids?
Topical corticosteroids can worsen skin infections. If you have a bacterial, viral or fungal skin infection they should therefore be avoided, unless they are applied with an anti-infective agent or you are started on tablet medication to treat the infection.
Ref number: 4398/VER2
Date published: Jul 2017 | Review date: Apr 2020
© 2020 Guy’s and St Thomas’ NHS Foundation Trust
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