Topical steroids: What they are and how they work
Topical steroids, also called topical corticosteroids, are used to treat a variety of inflammatory skin conditions such as rashes, insect bites, eczema, psoriasis, and more.
While these medications can be very effective in relieving inflammation, irritation, and redness, long-term use can cause serious side effects.
It is important to understand when and how to best use topical steroid creams to get the benefits and minimize the side effects.
Steroid creams are typically used for short-term relief of redness, itching, and swelling.
Long-term use of topical steroids can cause side effects such as thinning of the skin, dry skin, perioral dermatitis, and withdrawal symptoms.
Talk to your doctor or dermatologist about the proper use of topical steroids to minimize side effects.
What are topical steroids?
Topical steroids are medications that are applied to the skin to relieve inflammation, redness, and itching.
They mimic cortisol, a hormone that the body produces naturally in response to inflammation.
By mimicking the anti-inflammatory properties of cortisol, topical steroids can help calm an overactive immune response in the skin and reduce redness, swelling, itching, and discomfort.
These medications are applied directly to the skin and work locally, rather than affecting the entire body like oral steroids.
Topical steroids vary in effectiveness, from mild (like 1% hydrocortisone) to very strong (like clobetasol propionate), and come in a variety of formulations, including creams, ointments, and gels.
Common topical steroids
There are many types of topical steroids, but the most commonly used include:
Hydrocortisone. A mild corticosteroid that is often used to temporarily relieve itching and inflammation caused by minor skin irritations, such as rashes and insect bites.
Hydrocortisone is available over the counter, but stronger hydrocortisone requires a prescription.
Dexamethasone. A mild corticosteroid that is often used to treat sensitive areas, such as the face or groin.
Dexamethasone is often used to treat mild to moderate eczema, dermatitis, or allergic reactions.
Fluocinolone acetonide. A low- to medium-strength corticosteroid used to treat conditions such as eczema, psoriasis, and seborrheic dermatitis.
Betamethasone. A medium- to high-potency corticosteroid used to treat conditions such as psoriasis, eczema, and lichen planus.
Betamethasone is often used to treat moderate skin conditions that don’t respond to milder steroids.
Clobetasol. Clobetasol is one of the most potent topical steroids and is used to treat more severe psoriasis, lichen planus, and lupus.
What are topical steroids used for?
Topical steroids can be used to treat a variety of inflammatory skin conditions. However, they are not usually used as a long-term treatment because they can have side effects.
In the short term, steroid creams can help relieve inflammation-related symptoms such as redness, swelling, and itching.
Skin conditions that topical steroids can help treat include:
Eczema (atopic dermatitis)
Psoriasis
Contact dermatitis
Seborrheic dermatitis
Lichen planus
Vitiligo
How do topical steroids work?
Topical steroids specifically target inflammation of the skin, which is the cause of the redness, swelling, and itching seen in many skin conditions.
These medications penetrate the outer layer of the skin and reach deeper into the skin, reducing the release of pro-inflammatory substances such as cytokines and prostaglandins that cause swelling and irritation.
Topical steroids not only modulate the immune system, but they also constrict the small blood vessels in the skin, which reduces blood flow to the inflamed area.
This helps to relieve the redness and warmth that often accompanies skin inflammation.
In conditions such as psoriasis, topical steroids can also slow the overproduction of skin cells, which prevents the formation of the thick, scaly patches that are characteristic of the disease (3).
Side effects of topical steroids
While effective, topical steroids can have side effects, especially if used incorrectly. These include:
Thinning of the skin.
Long-term use of steroid creams can make the skin thinner and more sensitive because the drugs impair collagen production and the skin’s ability to retain moisture.
Stretch marks. Prolonged use in certain areas, such as the thighs or armpits, can lead to a loss of skin elasticity and thickness, which can cause stretch marks.
Perioral dermatitis. Excessive use of steroid creams in the oral area can disrupt the skin barrier and cause inflammation, leading to a red, pinpoint rash called perioral dermatitis.
Topical steroid withdrawal (TSW). Sudden discontinuation of topical steroid use after long-term use can trigger what is known as topical steroid withdrawal symptoms.
Redness, irritation, and other symptoms of inflammation may return or even worsen.
Increased susceptibility to infection. Steroids can suppress the skin’s immune system, which can promote the growth of bacteria and fungi.
Using topical steroids
Proper use of topical steroids is essential to maximize their benefits and minimize potential side effects. Always taper your dose of a potent steroid gradually rather than stopping it abruptly.
Your doctor can help you avoid withdrawal symptoms.
If possible, avoid long-term use of topical steroids to minimize side effects.
Mild steroids, such as hydrocortisone, can usually be used for 1 to 2 weeks without side effects, while stronger steroids, such as clobetasol, are usually only used for short periods of time unless otherwise prescribed by your doctor.
Apply steroid creams as directed by your doctor, or 1 to 2 times daily if you are using an over-the-counter cream or ointment.
To determine the correct amount of product to use, use the fingertip rule (FTU): Apply enough cream or ointment to the skin to reach from the tip of your index finger to the first joint.
This amount is enough for two palm-sized areas.
Also, be sure to maintain your daily skin care routine while using topical steroids, unless otherwise directed by your doctor.
A skin barrier repair moisturizer can help maintain the strength and integrity of the skin barrier while using a steroid cream.
Alternatives to topical steroids
If your doctor has prescribed topical steroids for a specific purpose, use them.
However, if you’re looking for an alternative to steroids to relieve minor symptoms of skin inflammation without the side effects of long-term steroid use, consider these anti-inflammatory skin care products.
Summary: Are topical steroids good or bad?
Topical steroids can be very helpful if prescribed and used correctly. They can quickly relieve symptoms of conditions like eczema and psoriasis, making life more pleasant.
However, they’re not usually suitable for long-term use or as a one-size-fits-all solution.
If you’ve been prescribed topical steroids, be sure to follow your doctor’s instructions to minimize side effects like thinning skin or withdrawal symptoms.
While these medications can relieve symptoms, they are not a cure for inflammatory skin conditions and should be used as part of a more comprehensive skin care plan tailored to your skin’s specific needs.
