Creams and lotions are general purpose and are the most popular formulations. Gel or solution. As a general rule, use the weakest possible steroid that will do the job. It is often appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. Topical steroid is sometimes combined with another active ingredient, including antibacterial, antifungal agent or calcipotriol. Topical steroids are medicines regulated by Health Authorities.
They are classified according to their strength. The products listed here are those available in New Zealand in November Side effects are uncommon or rare when topical steroids are used appropriately under medical supervision. Topical steroid may be falsely blamed for a sign when underlying disease or another condition is responsible for example, postinflammatory hypopigmentation or undertreated atopic eczema.
Cases of Cushing syndrome due to topical corticosteroids most often occur because of inappropriate prescribing or over the counter sales of corticosteroids in countries where that is permitted.
Local side effects may arise when a potent topical steroid is applied daily for long periods of time months. Most reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications. A topical steroid can cause, aggravate or mask skin infections such as impetigo , tinea , herpes simplex , malassezia folliculitis and molluscum contagiosum.
Note: topical steroid remains the first-line treatment for infected eczema. Stinging frequently occurs when a topical steroid is first applied, due to underlying inflammation and broken skin.
Contact allergy to steroid molecule, preservative or vehicle is uncommon but may occur after the first application of the product or after many years of its use. Adverse effects of topical steroids Bruising. Commonly used topical steroids corticosteroids include hydrocortisone, triamcinolone, fluocinonide, and clobetasol.
They work by preventing cells from producing inflammation-causing chemicals that are released in response to a variety of different triggers. Topical steroids come in different strengths, ranging from mild to moderate, potent and very potent.
Side effects are more common in high-potency prescription-strength steroid creams. Over-the-counter hydrocortisone is the lowest-potency steroid cream available, but could cause thinning of the skin if used daily for many consecutive weeks.
This is especially true if steroid cream is used on thin, sensitive skin such as the eyelids, genital areas, or the folds of the skin. For adults, a short course usually three days of a strong topical steroid may be an option to treat a mild-to-moderate flare-up of eczema. A strong topical steroid often works quicker than a mild one. This is in contrast to the traditional method of using the lowest strength wherever possible. However, studies have shown that using a high strength for a short period can be more convenient and is thought to be safe.
Some people have frequent flare-ups of eczema. For example, a flare-up may subside well with topical steroid therapy. Then, within a few weeks, a flare-up returns. In this situation, one option that might help is to apply steroid cream on the usual sites of flare-ups for two days every week.
This is often called weekend therapy. This aims to prevent a flare-up from occurring. In the long run, it can mean that the total amount of topical steroid used is less than if each flare-up were treated as and when it occurred. You may wish to discuss this option with your doctor. Topical steroids are usually applied once a day sometimes twice a day - your doctor will advise.
Gently rub a small amount see 'Getting the dose right - the fingertip unit', below on to areas of skin which are inflamed. This is different to moisturisers emollients which should be applied liberally all over. Gently rub the cream or ointment into the skin until it has disappeared. Then wash your hands unless your hands are the treated area. The amount of topical steroid that you should apply is commonly measured by fingertip units FTUs.
One FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult's fingertip. This assumes the tube has a standard 5 mm nozzle. A fingertip is from the very end of the finger to the first crease in the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together. Two FTUs are about the same as 1 g of topical steroid. For example, say you treat an area of skin the size of eight adult hands.
You will need four FTUs for each dose. This is 2 g per dose. So if the dose is once a day, a 30 g tube should last for about 15 days of treatment. An FTU of cream or ointment is measured on an adult index finger before being rubbed on to a child. Again, one FTU is used to treat an area of skin on a child equivalent to twice the size of the flat of an adult's hand with the fingers together. You can gauge the amount of topical steroid to use by using your adult hand to measure the amount of skin affected on the child.
From this you can work out the amount of topical steroid to use. Most people with eczema will also use emollients. Emollients are different to topical steroids and should be used and applied in a different way. When using the two treatments, apply the emollient first. The most common side effect of topical corticosteroids is a burning or stinging sensation when the medicine is applied.
However, this usually improves as your skin gets used to the treatment. If potent or very potent topical corticosteroids are used for a long time or over a large area, there's a risk of the medicine being absorbed into the bloodstream and causing internal side effects, such as:. This is not a full list of all the possible side effects.
For more information on side effects, see the leaflet that comes with the medicine. The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you're taking. See the Yellow Card Scheme for more information. Page last reviewed: 15 January Next review due: 15 January Topical corticosteroids. Topical corticosteroids are available in several different forms, including: creams lotions gels mousses ointments tapes and bandages solutions They're available in 4 different strengths potencies : mild moderate potent very potent Mild corticosteroids, such as clobetasone , hydrocortisone skin cream and hydrocortisone for piles and itchy bottom , can often be bought over the counter from pharmacies.
Conditions treated with topical corticosteroids Conditions widely treated with topical corticosteroids include: eczema — such as atopic eczema contact dermatitis — which causes symptoms such as dandruff and scaly patches on the skin psoriasis Topical corticosteroids cannot cure these conditions, but can help relieve the symptoms.
Who can use topical corticosteroids Most adults and children can use topical corticosteroids safely, but there are situations when they are not recommended.
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