Why are steroid creams called topical corticosteroids?
Topical corticosteroids are steroids that are applied directly to the body through the skin, eyes, nose, mouth or ears. They include topical steroid creams, ointments, suppositories, gels, sprays, lotions and drops.
Steroid creams are often used to treat inflammation, irritation and itching caused by skin conditions such as psoriasis and eczema.
The steroids you’re given by a doctor are man-made versions of the natural hormones your body produces. However, not all steroid treatments are ‘topical’.
Read on to discover which conditions your steroid cream or ointment treats, how long it takes to work and its possible side effects.
Which conditions do steroid creams and ointments treat?
Steroid creams, ointments, gels and lotions are applied directly to the area of skin that’s itchy or sore, to reduce inflammation. They are designed to improve pain and soreness, but they don’t usually treat the underlying cause of your symptoms, such as an infection.
They can help to treat inflammatory skin conditions such as:
- atopic eczema
- contact dermatitis
- prickly heat rash
- discoid eczema
- discoid lupus erythematosus
- tight foreskin (phimosis and paraphimosis)
Steroid ointments and creams can also be used for other conditions not directly related to the skin, such as certain eye conditions and piles (haemorrhoids).
Which conditions do topical steroids creams not treat?
In general, topical steroid creams only reduce inflammation in the area where they’re applied. Other steroid treatments – known as ‘systemic’ treatments – deal with inflammation that affects the whole body. Systemic treatments include steroid injections and steroid tablets.
What are the different types of topical steroid creams?
Topical steroid creams, ointments and lotions can be used alone or in combination with other types of treatments to reduce inflammation in a specific area of your body.
They can include:
skin creams, ointments and lotions – these are prescribed in the form of hydrocortisone, clobetasone or betamethasone for conditions such as eczema, contact dermatitis and psoriasis
eye ointments and drops – these are often used to reduce inflammation after operations to the eye or for eye conditions such as uveitis. They usually come in the form of betamethasone and dexamethasone. Steroids can also be used as eye drops
anal ointments and suppositories – hydrocortisone cream can be used around your bottom (anus) or inserted inside as a suppository to help treat piles. Other steroids, such as prednisolone or budesonide, can also be used around or inside the anus in foam or suppository forms
How long do topical steroid creams take to work?
It depends on the condition being treated. For example, topical corticosteroids can be used for a short time to treat a condition such as eczema, or for a few months if you’re using a steroid cream for psoriasis.
It can be personal to you. Your doctor will advise how long a steroid cream or ointment should be used based on your condition, the strength of your prescription and where on your body you need to use it.
Your dose or treatment can be adjusted over time. You shouldn't use topical steroids for any longer than directed by your doctor or pharmacist. If you’re not getting results, talk to a healthcare professional. If you’re needing to use a steroid cream frequently, your doctor may prescribe a different medication that’s more suited to long-term use. Likewise, a different medication may be better for certain conditions, such as eczema on your face.
What are the different strengths of steroid creams and ointments?
Topical corticosteroids come in 4 strengths.
mild – usually bought in pharmacies, but varies from country to country
moderate, potent and very potent – stronger types, such as betamethasone cream, usually need to be prescribed by your doctor
How to get the best from your steroid cream or ointment
use them right:
- if you’re using emollients as well, put those on first and wait about 30 minutes before applying the steroid cream or ointment
- smooth a thin layer of the steroid cream onto your skin in the same direction as the hair grows
- use fingertip units (FTU) to measure the amount of cream you apply. A FTU is about 500mg and is the amount of cream you need to squeeze a line from the tip of your finger to the first crease on that finger. Your doctor will advise you how many FTUs you need depending on the part of the body you need to treat
for fungal infections such as ringworm, never use steroid creams without an antifungal cream. On their own, they can make it seem like the infection is improving, but the rash will then get worse. You can usually buy combination steroid and antifungal creams from pharmacies.
Always tell your doctor or pharmacist if you have acne, rosacea or open sores (ulcers) as you should not use steroids with these conditions.
Don’t use steroids on infected skin or eyes unless your doctor advises you to do so - you don’t want to spread the infection.
If you’re trying for a baby, pregnant or breastfeeding talk to your doctor before using any steroid creams. Some are safe during this time (though you need to wash any cream off your breast before breastfeeding), others are only suitable for very specific issues under supervision from a dermatologist.
If you’ve ever had an allergic reaction to steroids, tell your doctor or pharmacist.
What are the side effects of steroid creams?
Like all medications, steroid creams may cause side effects, but they are rarely serious. Here’s what you need to know:
weaker steroid creams usually have fewer side effects – weaker steroid creams like 1% hydrocortisone usually have fewer side effects. Stronger forms of topical corticosteroids are usually more effective at reducing inflammation, but there is a greater risk of side effects.Only use them as advised by your doctor or pharmacist
the most common side effect (up to 1 in 10 people will get it) is burning, pain, irritation or itching where the cream is applied. Remember that means most people (around 9 out of 10) will not experience any side effects. So to get the benefits and tackle your symptoms it’s important to use the creams as you’ve been advised. If you do get this side effect, talk to your pharmacist or GP to see what alternative they can offer you
there are some rare side effects which fewer than 1 in 10,000 people will experience. That means 9,999 out of every 100,000 people won’t experience them, and will use the medicines to get relief from their symptoms. Side effects are more likely if you're using a more potent corticosteroid and using it for a very long time, or over a large area (for example, to treat a skin condition such as psoriasis). These may include:
- stinging skin for a few days
- thinning of the skin
- permanent stretch marks
- allergic contact dermatitis
- hair growth where you applied the cream
- spreading of a skin infection you already have
- inflamed hair follicles (folliculitis)
- changes in skin colour
When to see a doctor if you’ve used topical steroid creams
if you’re using higher doses of steroids over a long period of time your doctor will usually monitor you. Make sure you go and check in, to help ensure you get the benefits without the side effects – serious side effects for topical steroids are very rare but are more likely if you’re using a high dose or if you’ve been using your steroid cream over a large area of your body for a long time
in rare instances, high doses of topical steroids can cause side effects similar to side effects of oral steroids. You should see a doctor if you think you have any of these side effects
You should also see a doctor if:
- your symptoms don’t get better, get worse or come back after treatment
- you develop symptoms you didn’t expect, or you feel generally unwell or worried
Your health questions answered
Which is the strongest steroid cream available without a prescription?
Answered by: the Healthily medical team
“Steroid creams vary in strength. Some low-potency creams are available to buy from a pharmacy without a prescription. What you can buy will depend on what you need it for and where you live. In the UK, you can buy both clobetasone and hydrocortisone up to 1% strength for conditions such as eczema without a prescription. However, you may need a prescription if you want to use it on your face. Stronger creams, such as hydrocortisone butyrate or mometasone, may only be available with a prescription from your doctor. If you do buy a steroid cream from a pharmacy, always discuss its use with the pharmacist and don’t use it for more than 1 week without speaking to your doctor.”
How do I stop using a topical steroid cream?
Answered by: the Healthily medical team
“Most people only need to use mild steroid creams for 1 or 2 weeks to treat conditions such as contact eczema. After this time, you should be able to stop using it without noticing any side effects.However, if your doctor prescribed a stronger steroid cream for a longer period of time to treat psoriasis or eczema, you may be advised to gradually reduce the amount you use over a few weeks. If you stop applying it suddenly, this may cause your symptoms to get worse or come back. If you’re unsure, speak to your doctor.”