Patient education: Topical corticosteroid medicines (The Basics)

What are topical corticosteroids? — 

These are steroid medicines you put directly on your skin. They reduce redness, itching, and rash.

Topical corticosteroids come in many different forms, including creams, ointments, gels, lotions, shampoos, sprays, liquids (also called "solutions"), and foams. They also come in different strengths. Milder ones can often be bought without a prescription ("over-the-counter") from pharmacies. Stronger ones are available with a prescription. The right strength and form for you depends on what skin problem you have and which parts of your body are affected.

Other steroid medicines come as pills, shots, suppositories, eye drops, inhalers, and nose sprays. This article is only about topical corticosteroids that go on the skin.

What are some common topical corticosteroids? — 

Examples include:

●Hydrocortisone (sample brand name: Cortizone-10)

●Triamcinolone (sample brand name: Kenalog)

●Betamethasone (sample brand name: Diprolene)

There are many others, too.

What are topical corticosteroids used for? — 

They are used to treat many different skin conditions, including eczema, psoriasis, rash, and minor irritation such as from insect bites.

How do topical corticosteroids work? — 

Topical corticosteroids work by reducing inflammation in the skin. Inflammation means redness, swelling, and irritation.

How do I use a corticosteroid cream or ointment? — 

Your medicine will come with specific information and instructions. It's important to read these carefully.

Here are the general steps for using creams and ointments:

●Wash your hands with warm, soapy water.

●Wash the affected skin carefully, rinse away soap, and carefully pat dry. Do not rub the skin dry.

●To open the tube the first time, you might need to use the point on the cap to break the seal.

●Squeeze out a small amount that is just enough to thinly cover the affected skin (figure 1). A pea-sized amount is enough for minor skin irritation or an insect bite. If you have large area of affected skin, or several different areas, your doctor or nurse will tell you how much cream or ointment to use. They might explain the amount in terms of "fingertip units." This is a strip of cream or ointment the length of an adult fingertip (figure 2).

●Apply the cream or ointment evenly to the affected skin, in a thin layer.

●Gently massage the cream or ointment until it disappears.

●Wash your hands to remove any medicine that might still be on them. If your hand is the part that was treated, do not wash your hand.

The most important thing to remember is to use a small amount and apply it in a thin layer. This prevents too much of the medicine from being absorbed in your body, and lowers the chance of side effects.

There are also some things you should not do. For example:

●Do not use the cream or ointment more than once a day, unless your doctor or nurse tells you to.

●Do not use topical corticosteroids on your face, genitals, anus, or beneath your breasts, unless your doctor or nurse tells you to.

●Do not use topical corticosteroids on any raw or broken skin, or on skin that rubs against other skin.

●Do not cover the area with dressings such as bandages or gauze, unless your doctor or nurse tells you to.

If you are prescribed a steroid spray, gel, lotion, shampoo, liquid, or foam, your doctor, nurse, or pharmacist will tell you how to use it.

What are the side effects of topical steroids? — 

The most common side effect is a mild burning or stinging feeling when you first apply the medicine. This usually goes away after the first few uses.

Topical corticosteroids do not usually have serious side effects. If you use them for a long time or at high doses, side effects can include thin or red skin or acne in the treated areas. Thinning of the skin can make it easier for the skin to break, bruise, or stretch. Older people, young children, babies, and people with fragile skin are more likely to have these problems.

If you need to use topical corticosteroids for more than a few weeks, your doctor might have you take regular breaks from the medicine. This can help lower the risk of side effects.

What else should I know about topical steroids? — 

Read the information that comes with your medicine. In general:

●Topical steroids are used when a skin problem flares up. As the problem gets better, your doctor might have you decrease the topical corticosteroid treatments gradually, instead of stopping all at once. This makes it less likely your skin problem will come back once you are no longer using the medicine.

●Doctors usually recommend treating a flare for 1 to 2 weeks. For some skin problems, they might recommend longer treatment or repeating the treatment. In this case, you might need to see a doctor who is an expert in skin conditions.

●If you are pregnant or want to get pregnant, you might be able to use a small amount of topical corticosteroid occasionally. But it's important to talk to your doctor or nurse first, or if you have any questions.

For more detailed information about your medicines, ask your doctor or nurse for the patient drug information handout from UpToDate. Also, read the information that comes with your medicine. These leaflets explain how to use and store your medicines. They also list more possible side effects and warn you if your medicines should not be taken with certain other medicines or foods.

More on this topic

Patient education: How to use topical medicines (The Basics)
Patient education: Itchy skin (The Basics)
Patient education: Eczema (atopic dermatitis) (The Basics)
Patient education: Psoriasis (The Basics)
Patient education: Contact dermatitis (The Basics)
Patient education: Insect bites and stings (The Basics)
Patient education: Hemorrhoids (The Basics)
Patient education: Oral steroid medicines (The Basics)
Patient education: Inhaled corticosteroid medicines (The Basics)

Patient education: Eczema (atopic dermatitis) (Beyond the Basics)
Patient education: Psoriasis (Beyond the Basics)
Patient education: Contact dermatitis (including latex dermatitis) (Beyond the Basics)
Patient education: Hemorrhoids (Beyond the Basics)