Topical Steroids: What They Are & How They Work

Topical steroids, also called topical corticosteroids, are used to treat inflammatory skin conditions like rashes, bug bites, eczema, psoriasis, and many others. While these medications can be very effective at reducing inflammation, irritation, and redness, long-term use can result in some notable side effects. The key is to understand when and how to best use topical steroid creams to get the benefits they can offer while minimizing side effects.

Steroid creams are commonly used for short-term relief from redness, itching, and swelling.

Long-term use of topical steroids can lead to side effects like skin thinning, dry skin, perioral dermatitis, and withdrawal symptoms.

Work with your doctor or dermatologist to properly use topical steroids and minimize side effects.

What Are Topical Steroids?

Topical steroids are medications applied to the skin to reduce inflammation, redness, and itching. They mimic cortisol, a hormone that your body naturally produces as part of its inflammatory response system. By mimicking cortisol’s anti-inflammatory properties, topical steroids can help to calm overactive immune responses in the skin, reducing redness, swelling, itching, and discomfort.

These medications are applied directly to the skin and work locally, rather than affecting your entire body like oral steroids would.

Topical steroids vary in potency, from mild (like 1% hydrocortisone) to very strong formulations (like clobetasol propionate) and come in a variety of different formulations, including creams, ointments, and gels.

Common Topical Steroids

There are many different topical steroids, but some of the most commonly used include:

Hydrocortisone. A mild corticosteroid often used for temporary relief of itchiness and inflammation caused by minor skin irritations like rashes and bug bites. Hydrocortisone is available over the counter and by prescription in stronger forms.

Desonide. A low-potency corticosteroid often used to treat sensitive areas like the face or groin. Desonide is commonly prescribed for mild to moderate eczema, dermatitis, or allergic reactions.

Fluocinolone acetonide. A low- to medium-strength corticosteroid used to treat conditions like eczema, psoriasis, and seborrheic dermatitis.

Betamethasone. A medium- to high-strength corticosteroid that is used to treat conditions like psoriasis, eczema, and lichen planus. Betamethasone is often used for moderate skin conditions that don’t respond to milder steroids.

Clobetasol. One of the strongest topical steroids available, clobetasol is used for more severe cases of psoriasis, lichen planus, and lupus.

What Do Topical Steroids Treat?

Topical steroids can be used to treat a wide range of inflammatory skin conditions. However, they are typically not intended as a long-term treatment for these conditions, as they can come with side effects. In the short-term, steroid creams can help to manage symptoms associated with inflammation, like redness, swelling, and itching.

Some skin conditions that topical steroids can help with include:

Eczema (atopic dermatitis)

Psoriasis

Contact dermatitis

Seborrheic dermatitis

Lichen planus

Vitiligo

How Do Topical Steroids Work?

Topical steroids work by targeting inflammation in the skin, which is the root cause of redness, swelling, and itching in many skin conditions. These medications penetrate the outer layers of skin and are able to reach the deeper layers, where they can reduce the release of pro-inflammatory substances like cytokines and prostaglandins that cause swelling and irritation.

In addition to modulating the immune system, topical steroids constrict small blood vessels in the skin, reducing blood flow to the inflamed area. This helps to decrease the redness and heat that often accompanies skin inflammation. For conditions like psoriasis, topical steroids also slow down the excessive production of skin cells, preventing the thick, scaly patches characteristic of the disease (3).

Side Effects of Topical Steroids

While effective, topical steroids can cause side effects, especially when used improperly. These include:

Skin thinning. Long-term use of steroid creams can cause the skin to thin and become more fragile because the medication interferes with collagen production and your skin’s ability to retain moisture.

Stretch marks. Prolonged use on certain areas like thighs or underarms can cause stretch marks due to reduced skin elasticity and thickness.

Perioral dermatitis. Overuse of steroid creams around the mouth can disrupt the skin barrier and cause inflammation, causing a red, bumpy rash called perioral dermatitis.

Topical steroid withdrawal (TSW). Abruptly stopping topical steroids after prolonged use can cause what’s known as topical steroid withdrawal, where redness, irritation, and other signs of inflammation can come back and may be even worse than before.

Increased susceptibility to infections. Steroids can suppress your skin’s immune defenses, making it easier for bacteria or fungi to grow.

How to Use Topical Steroids

Proper use of topical steroids is crucial to maximize their benefits while minimizing potential side effects. Always gradually taper off strong steroids rather than stopping abruptly. Your doctor will be able to help you do this properly to avoid withdrawal symptoms.

Whenever possible, avoid prolonged use of topical steroids to minimize side effects. Mild steroids like hydrocortisone can often be used for 1 to 2 weeks without negative effects, while stronger steroids like clobetasol are typically limited to short courses unless instructed otherwise by a doctor.

Apply steroid creams as directed by your doctor or 1 to 2 times daily if using an over-the-counter cream or ointment. To know how much product to apply, use the fingertip unit (FTU) rule: squeeze enough cream or ointment to cover from the tip of your index finger to the first joint. This amount is enough to cover an area about the size of two adult palms.

Finally, make sure you maintain your regular skin care regimen while using topical steroids, unless instructed otherwise by your doctor. Barrier repair moisturizers can help to maintain your skin’s barrier strength and integrity while using steroid creams.

Alternatives to Topical Steroids

If your doctor prescribed topical steroids for a specific purpose, use what you were prescribed. However, if you are looking for an alternative to steroids to help with milder signs of skin inflammation without the side effects of long-term steroid use, consider these anti-inflammatory skin care products.

Bottom Line: Are Topical Steroids Good or Bad?

Topical steroids can be very helpful when prescribed and used appropriately. They can provide quick relief for conditions like eczema and psoriasis, making life much more comfortable. However, they’re generally not meant for long-term use or as a one-size-fits-all solution.

If you are prescribed a topical steroid, always follow your doctor’s instructions to help minimize adverse effects like skin thinning or withdrawal symptoms. While these medications can help to manage symptoms, they are not cures for inflammatory skin conditions and should be used as part of a broader skin care plan custom-tailored to your skin’s specific needs.

DQH Can I use salicylic acid first and then vitamin C? It’s easy to create a skincare routine, but knowing how to use it is another thing entirely. In most cases, if you’re not getting the desired skin results, it could be due to the layering of conflicting ingredients. So, is it possible that salicylic acid and vitamin C are such ingredients? Or are these active ingredients the duo that’s been missing from your skincare routine? If you want answers, stick around because today we are going to explain the benefits of salicylic acid and vitamin C and how they can be used in your daily life. What are the benefits of salicylic acid for skin? Salicylic acid is one of the most commonly used beta hydroxy acids and is favored by many people with oily, acne-prone skin. This acid is derived from willow bark, and unlike its water-soluble relatives (called alpha-hydroxy acids), salicylic acid is oil-soluble, which means it can penetrate deeper into the lower layers of the skin. Once it reaches the lower layers, it can help unclog pores of excess sebum, dirt, bacteria, debris, and impurities. This results in clearer skin tones and greater definition. Not only does salicylic acid benefit the underlying layers, but the outer surface of the skin benefits as well. When applied to the skin, salicylic acid removes the buildup of dead skin cells. This is accomplished by breaking the bonds that hold dead cells to the surface. Over time, this can cause the complexion to look dull and prone to acne, blackheads, and other blemishes. If you’d like to learn more about salicylic acid and how it can improve your skin, check out this dedicated blog post from a beauty insider. What are the benefits of vitamin C for skin? Vitamin C is considered one of the most powerful antioxidants, which means it is very effective at fighting free radicals and preventing them from causing further skin damage. Examples of free radicals include pollution, central heating, UV rays and harsh climate. They attack proteins, fats and cell membranes as soon as they come into contact with the skin, causing signs of premature aging such as fine lines and wrinkles as well as hyperpigmentation, flaky patches of skin and loss of elasticity. Many people usually prefer to use vitamin C in their morning routine as this ingredient gives the complexion a radiant glow. You’ll also find that vitamin C can target areas of hyperpigmentation, plumping the skin and reducing the appearance of fine lines and wrinkles. The thing about vitamin C is that there are a lot of outdated studies going back to the 1950s that describe vitamin C as an unstable skin component. Thanks to improvements in modern technology, this is no longer the case as all products now contain a stable form of vitamin C. Visit The Beauty Insider to learn more about vitamin C. So please check out our blog post. Can I use salicylic acid first and then vitamin C? Yes, you absolutely can. In fact, it’s thought that using salicylic acid before using vitamin C ensures it penetrates faster and works faster. This is an efficient way to utilize two power sources, and the reason has to do with pH. For example, the skin’s natural pH is about 4.7, making it slightly acidic. Salicylic acid and vitamin C are also both acidic, and you’ll find that vitamin C is absorbed quickly into the skin. Therefore, using salicylic acid beforehand can increase the acidity of the skin and allow vitamin C to penetrate into the skin faster. While this is considered an effective way to combine two powerful ingredients, you need to be aware of your skin type and how it reacts to certain active ingredients. Even people with perfect, normal skin can experience skin sensitivity and irritation. Therefore, always consult a doctor or dermatologist before using any new products on your skin. It’s also important to follow skin application rules. In this case, you need to use the product correctly to ensure you get the best results for your skin. If you’re not sure what I mean, the basic rule for skin is to start with the thinnest consistency and work your way up to the thickest consistency. This prevents a barrier from forming on the surface, preventing other active ingredients from penetrating the skin. Can I use salicylic acid at night and vitamin C in the morning? Yes, absolutely, this is considered the most effective way to get returns without any adverse side effects. This is because there is enough time between applications to ensure that the skin’s pH levels return to balance. You’ll also find that Vitamin C is rich in antioxidants and is perfect for use in the morning to ensure your skin is protected and looking its healthiest. Due to the small size of salicylic acid molecules, it is an acid that is able to reach the deepest parts of the skin. While this is effective at keeping skin clear, it also increases the risk of irritation and photosensitivity. Therefore, many people prefer to use powerful BHAs in their evening routine without exposure to UV rays, pollution, or harsh weather. Warning: If you avoid using sunscreen every day, none of these ingredients will do what your skin needs. The combination of chemical peels and powerful ingredients increases the risk of further damage to the skin’s surface. Use SPF 50 every day to keep your skin protected and your lipid barrier healthy, even on cloudy days, keeping your skin in top condition.

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