Topical steroids

This page covers the following:

What are topical steroids?

Topical corticosteroids, usually called topical steroids, are creams, ointments, liquid suspensions, foams, etc that contain varying amounts of corticosteroid and are applied to a particular part of the skin or mucous membrane directly. You can read more about “corticosteroids” on the steroids page.

They can be used on their own or in conjunction with “systemic” drugs. Systemic means that the whole body is affected, and systemic drugs are taken in the form of tablets, liquids, infusions, etc and affect the whole-body system. Topical steroids, on the other hand, have a very targeted effect on the site where they are administered and are usually used for a short time to treat a particular area of the body.

Topical steroids are often the first line of treatment for blistering in pemphigus or pemphigoid because their side effects are less serious than most of the systemic alternatives and for localised disease as their speed of action can be reasonably fast.

The majority of information you can find on topical steroids is related to those used on the skin, but you can get preparations for use specifically on your mucous membranes such as mouth, nose, eyes and genital area.

Topical steroids will be prescribed by your doctor and come in various forms and various strengths. Some are quite mild, while others are very potent, but all need to be used with care. You can also buy some mild topical steroids from a pharmacy without a prescription: 1% hydrocortisone cream and Eumovate cream (clobetasone butyrate 0.05%), which is a little more potent.

Topical steroid preparations may come in many forms, such as creams, ointments, lotions, foams, gels, mousses, shampoos and tape. The specific topical steroid you are prescribed will depend on the severity of your disease, your age, the part of your body that is affected and other treatments you may be using.

When your skin is dry, it is likely that your healthcare professional will prescribe an ointment-based preparation. Creams, which are light and cooling, may be used to treat moist, weepy or ‘wet’ wounds. Lotions are easiest to apply on hairy areas of the body.

Topical steroids are often also used in conjunction with emollients to moisturise the skin and soap substitutes to cleanse it. These can also affect the action of the topical steroid on the skin. You can read about skin products on the skin page.

What do topical steroids do?

Topical steroids act on the skin and mucous membranes to reduce inflammation and speed up healing. They also help to make the skin less red, hot, itchy and sore.

What are the risks of using topical steroids?

Used correctly, topical corticosteroids have less serious side effects than the “systemic” alternatives. However, they do need to be used with care and the instructions accompanying your prescription should be followed carefully. Even so, topical corticosteroids can be absorbed through the skin and with prolonged use can have the same effect as systemic corticosteroids.

If you are older or using the topical steroid on a very young person, you should also be extra careful about the possible negative effects. Your doctor should have taken your age into consideration when prescribing the type of topical treatment.

The most common side effect is a burning or stinging sensation when the medicine is applied, but this usually improves as your skin gets used to the treatment.

You will also probably be warned that extensive use of topical steroids can result in thinning of the skin and a tendency to bruise more easily.

Using topical steroids over a prolonged period of time can create further possible problems, particularly if it is a stronger dose. You may even get withdrawal symptoms if you use your topical steroids for a long time (12 months or more).

When using topical corticosteroids in the mouth, you may also be prescribed an antifungal solution, as taking them regularly can result in oral thrush. Rinsing with a combined antifungal/steroid mouthwash can help avoid this particular side effect. For more information see the mouth page.

Some types of topical corticosteroid have other medications incorporated in the solution, such as antibiotics or antifungals.

How should I apply topical steroids?

Follow the directions you have been given very carefully. A lot depends on what sort of preparation you have been prescribed.

On the skin, a very small amount of cream or ointment is applied to the finger-tip - yours or the person administering the preparation - and applied to the affected area. The person applying the cream/ointment/gel should wear disposable gloves.

Lotions are also available to be used on the scalp and other hairy areas. Be careful to use a very small amount in skin creases as these sites are particularly vulnerable to skin thinning.

In the case of steroids applied to mucous membranes such as your mouth, they may be taken dissolved in a small amount of warm water and swished round the mouth. These soluble preparations can also be used to gargle with when the blistering is affecting the back of the mouth and throat. The remaining solution should be spat out, and definitely NOT swallowed. Occasionally, your health care professional will supply a mouth guard to keep the cream in place. Some also come as a paste which enables the preparation to stay on the affected part of the mouth. You can dry the area before applying the ointment with a dry tissue by dabbing gently on the affected area.

Topical steroids may also come as eye drops, but you are recommended not to use topical steroid creams or ointments in the eyes, the face or anal or genital areas, particularly if they are one of the potent types.

They should NOT be used on infected skin, on the anal or genital areas, in pregnancy, or by anyone under the age of 10 years and 12 years unless you have been told to do so by your doctor.

The Association Pemphigus Pemphigoïde France have a very good and detailed brochure on wound management that describes how to use steroidal preparations on the skin and mucous membranes.

What types of topical steroids are there?

Some topical corticosteroids are also combined with antibiotics or antifungals, to prevent or help treat infections.

In the UK, topical steroid preparations for the skin are divided into four categories according to how strong or potent they are. The terms used are ‘mild’, ‘moderately potent’, ‘potent’ and ‘very potent’. The potency of topical steroids is determined by the extent to which they narrow the blood vessels in the area they are applied to and by the degree to which they inhibit inflammation. The rating also takes into account the potential for causing side effects. Potency levels vary enormously from one category to the next.

It can be difficult to work out the steroid dose from the packaging as the details do not display the level of potency. You might find information about the preparation’s potency in the patient information leaflet (PIL) inside the packaging. If you are not sure how strong your steroid preparation is, ask your pharmacist. A list is provided in the link to potency tables below.

The choice of potency of the steroid you are given will be based on several factors:

Age: babies and children with mild to moderate eczema are usually prescribed mild topical steroids. Older people usually have thinner skin than younger patients
Severity of the blistering and erosions
The part of the body affected as your skin is different in various areas of the body. Make sure that you are clear where to use which preparation. If in doubt, talk to your pharmacist or contact your doctor/nurse
Other treatments: if bandaging forms part of the treatment, a weaker steroid may be chosen because bandaging will increase the potency of the steroid

How potent is the topical steroid I have been prescribed?

There are several tables of potency available. The guidelines from the National Institute for Health and Care Excellence (NICE) have very good information about topical corticosteroids and their comparative strength.

Other charities for patients with inflammatory skin conditions have further potency information. The National Eczema Society, for example, has useful information on potency, including a potency table for the more commonly prescribed topical preparations.

Where can I find out more information?

The British Association of Dermatologists have a patient information leaflet on the topical corticosteroids, and Patient Info also provide this page. You can also read about topical steroids on the NHS website.