10 Things You Should Know About Topical Steroids (Corticosteroids)
Key takeaways:
Topical corticosteroids (“steroids”) are safe and effective treatment options for many skin conditions.
Topical steroids come in many formulations, like steroid creams and ointments. Some are available over-the-counter (OTC), while others are only available with a prescription.
Applying a medication topically doesn't mean it's side effect-free. Topical steroids have the potential to cause side effects — especially if you use too much or apply them for too long.
There are ways to save on topical steroid medications. Many options are available as lower-cost generics or have copay savings opportunities. GoodRx can help make your prescription more affordable.
Table of contents
You may have noticed many corticosteroid (“steroid”) creams, ointments, and lotions on your last visit to the pharmacy. You may even have a tube or two in your medicine cabinet at home in the case of an itchy rash.
If so, you’re in good company. Topical steroids are among the most prescribed medications in the world of skin health. Yet, there’s a lot of misinformation about what topical steroids are and how to use them safely.
Here, we’ll separate fact from fiction. We’ll review the differences between topical steroids, what conditions they treat, and why you should always use them as directed.
1. Topical steroids treat many different health conditions
Topical steroids are first-choice treatments for many common skin conditions. Children and adults can use them to treat conditions like eczema, psoriasis, or seborrheic dermatitis.
Some other health conditions that topical steroids treat are:
Radiation burns after receiving radiation treatment
Lichen planus, a type of inflammation that affects your skin or mouth
Discoid lupus rash, which is a red or dark rash that people with lupus may experience after being in the sun
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If you get a mild case of poison ivy, hydrocortisone is also a great option to help relieve itchiness. For more severe cases, your healthcare provider may prescribe stronger topical steroids, like triamcinolone or clobetasol. If you have it on areas with thin skin, your healthcare provider may prescribe you a lower potency steroid, like desonide. Areas with thin skin include your eyelids, underarms, and genitals.
2. Hydrocortisone, a topical steroid, is available over the counter
In the U.S., hydrocortisone is the only topical steroid available over the counter (OTC). Lower dosages, ranging from 0.5% to 1%, are available to purchase OTC. Higher doses of hydrocortisone require a prescription.
In order to get the best results, you should apply hydrocortisone after bathing or showering. And make sure you follow the directions on the package. Apply it to the affected area once or twice a day. But you shouldn’t use it more than 4 times a day or for longer than 7 days. If you do, there’s a greater risk of experiencing side effects.
3. Most topical corticosteroids are only available with a prescription
You’ll need a prescription for most topical steroids. These products come in many different formulations and dosages. Some examples are:
Hydrocortisone (depending on the formulation and concentration)
Hydrocortisone (when combined with other topical medications)
You should only apply the prescribed amount of medication with every dose. But, sometimes the written directions aren’t entirely clear. One method to help figure out how much product to use is the fingertip unit (FTU) method. One FTU is the amount of cream or ointment you squeeze from the top of your index finger to its first crease.
It’s common to only need one FTU for many medications. But you may need a different amount of product depending on the area of affected skin. Make sure to ask your healthcare provider or your pharmacist how much to apply to avoid using too much.
4. Topical steroids reduce inflammation
Topical steroids work in several ways to manage skin conditions. For instance:
They are anti-inflammatory. Products that have anti-inflammatory properties block substances that cause inflammation. By doing so, topical steroids help reduce swelling.
They are antimitotic. This means they slow down the production of new skin cells. This can help manage skin lesions and remove scales in conditions like psoriasis.
They have an immunosuppressive effect. This means they lower the immune response in your body. This is useful in conditions like eczema when the immune system goes into overdrive.
5. Topical steroids vary in potency
Topical steroids are divided into several groups based on how strong (potent) they are. The potency depends on different factors, such as formulation and the active ingredient.
Group 1 topical steroids are the most potent. They include drugs like augmented betamethasone gel and any form of clobetasol. Groups 6 and 7 topical steroids are the least potent. They include steroids like alclometasone and hydrocortisone.
In general, low potency steroids are the safest to use. Your healthcare provider may prescribe or recommend them if you need to use a topical steroid for a long time or on a large surface area. But if you have more severe symptoms, your healthcare provider will likely prescribe a more potent topical steroid.
6. There are different types of topical corticosteroids
Topical steroids come in different formulations, such as creams, lotions, or ointments. You can also find them in foams or shampoos. Depending on the condition you’re treating, one formulation may be better than the others.
More information is available about common topical formulations in another GoodRx Health article.
7. Common topical steroid side effects include redness and skin changes
Topical steroids are generally safe when used as directed. But they can still cause side effects. Local side effects are the most common side effects you may experience while using topical steroids. These are side effects that occur on the area of skin where you apply them.
Common topical steroid side effects are redness, minor changes in skin color, and skin thinning. Other local side effects include bruising easily, rosacea, and sensitive skin.
8. Topical steroids also have rare but serious side effects
More serious side effects may also happen — especially if you use potent steroids for a long time on thinner areas of skin. This makes it more likely for a steroid to absorb through your skin and into your bloodstream.
Although very rare, serious side effects can include:
High blood glucose (sugar)
Certain eye problems, like glaucoma, cataracts, or high pressure in your eye
Growth delay in children
To help avoid serious side effects, make sure to use only the prescribed or directed quantity. Also, tell your healthcare provider if your medication isn’t helping. They can suggest different, non-steroid therapies that may be right for you.
9. You could also experience topical steroid withdrawal
In rare cases, you may experience a condition called topical steroid withdrawal (TSW). This can happen when you stop using a topical steroid after using it for a very long time. Symptoms of TSW include stinging, burning, and/or red skin. You may also have swollen skin or bumps.
If you’re experiencing symptoms of TSW, you should contact your healthcare provider. They may ask you to restart your topical steroid or try other management techniques, such as applying cold compresses.
10. There are ways to save on topical steroids
There are many ways to save on topical steroids. GoodRx can help you navigate your options, which may include GoodRx discounts, copay savings cards, and patient assistance programs.
You can find topical steroid prices for as low as $12 with a free GoodRx discount. Here are some specific examples.
Triamcinolone 0.1% cream (15 g): As low as $74.80
Hydrocortisone 2.5% cream (30 g): As low as $11.02
Clobetasol 0.05% cream (15 g): As low as $19.39
Mometasone 0.1% cream (15 g): As low as $41.44
Betamethasone augmented 0.05% cream (15 g): As low as $14.85
The bottom line
Topical steroids are a convenient and affordable treatment option for many health conditions. Some are available OTC, and others require a prescription. They’re safe and effective under the care of a licensed healthcare provider and when used as directed. However, like all medications, they can cause side effects — especially when they’re used for too long. Make sure to ask your healthcare provider about how long you should use them for.
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References
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Das, A., et al. (2017). Use of topical corticosteroids in dermatology: An evidence-based approach. Indian Journal of Dermatology.
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Kimyon, R. S., et al. (2019). Prescription-strength topical corticosteroids available over the counter: Cross-sectional study of 80 stores in 13 United States cities. Journal of the American Academy of Dermatology.
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National Eczema Association. (2017). Give topical steroids the fingertip.
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