logo

DermNet NZ

  

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Topical steroids

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

Note:

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 [1]). 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.

Class 1

Very potent or superpotent (up to 600 times as potent as hydrocortisone)

  • Clobetasol propionate (Dermol™ cream/ointment/scalp lotion)
  • Betamethasone dipropionate (Diprosone™ OV cream/ointment)
Class 2

Potent (100-150 times as potent as hydrocortisone)

  • Betamethasone valerate (Beta™ cream/ointment/scalp solution, Betnovate™ lotion/C cream/C ointment, Fucicort™ cream)
  • Betamethasone dipropionate (Diprosone™ cream/ointment, Daivobet® 50/500 ointment/gel)
  • Diflucortolone valerate (Nerisone™ cream/fatty ointment)
  • Hydrocortisone 17-butyrate (Locoid™ lipocream/ointment/scalp lotion/Crelo topical emulsion/)
  • Mometasone furoate (m-mometasone™ cream/ointment Elocon™ cream/lotion/ointment)
  • Methylprednisolone aceponate (Advantan™ cream/ointment)
Class 3

Moderate (2-25 times as potent as hydrocortisone)

  • Clobetasone butyrate (Eumovate™ cream)
  • Triamcinolone acetonide (Aristocort™ cream/ointment, Viaderm KC™ cream/ointment, Kenacomb™ ear drops)
Class 4

Mild

  • Hydrocortisone (DermAid™ cream/soft cream, DP™ lotion-HC 1%, Skincalm™, Lemnis™ Fatty Cream HC, Colifoam™ rectal foam 10%), Pimafucort™ cream/ointment, Daktacort™ cream, Micreme™ H cream, Resolve Plus™ 0.5%, 1% cream

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).

Topical steroids in differing vehicles
Topical steroids in differing vehicles

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.

Skin side effects

Local side effects of topical steroids include:

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.

Bruising due to topical steroids
Bruising
Skin thinning from topical steroids
Skin thinning
Tinea incognito due to application of topical steroid to fungal infection
Tinea incognito
Prominent capillaries due to topical steroids
Prominent capillaries
Stretch marks due to topical steroids
Stretch marks
Localised pustular psoriasis induced by superpotent topical steroid
Localised pustular psoriasis
Adverse effects of topical steroids

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:

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.[2]

Related information

References:

  1. MIMS Online accessed 22 February 2014
  2. Can topical steroids be applied at the same time as emollients? Medicines Q&As. NHS
  3. Corticosteroids (Ch. 25). In: Bolognia JL, Jorizzo JL, Rapini RP, editors. Bolognia Textbook of Dermatology. 2nd ed. Mosby Elsevier publishing; 2008.

On DermNet NZ:

Other websites:

Books about skin diseases:

See the DermNet NZ bookstore

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand. Updated 22 February 2014.

Note:

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.

DermNet NZ does not provide an online consultation service.
If you have any concerns with your skin or its treatment, see a dermatologist for advice.