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Steroid creams and ointments

Also known as topical steroids

Key points about topical steroids

Steroid creams and ointments (topical steroids) are used to reduce inflammation and itchiness in skin conditions such as eczema or dermatitis.
There are many types and brands of topical steroids available in Aotearoa New Zealand.
Find out how to apply them safely and possible side effects.

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Topical steroids are used to reduce inflammation and itchiness in skin conditions such as eczema, dermatitis or psoriasis.

They are also known as topical corticosteroids, glucocorticosteroids and cortisone.
Topical steroids work by reducing inflammation which may ease symptoms such as itchiness and redness.
They are applied to your skin in the form of creams, ointments, lotions or solutions.
For skin conditions associated with dryness, such as eczema, other treatments such as emollients and moisturisers may also be needed.
If an emollient and a topical corticosteroid are both prescribed, applying an emollient 20 to 30 minutes before using a topical steroid can help your skin absorb the steroid more effectively.
Topical steroids should not be used on rosacea or acne.

There are many types and brands of topical steroids available in Aotearoa New Zealand.

Topical steroids have varying potency (strength) and are generally grouped into 4 categories depending on their strength:
- mild
- moderately potent
- potent
- very potent.
Your healthcare provider will decide on the correct strength for you depending on your condition, age and the area of your body being treated.
Stronger products are more likely to cause side effects, so it’s important to use potent steroids for the shortest possible period.
Topical steroids are absorbed at different rates from different parts of the body. There's much greater absorption where your skin is thin (eg, eyelids, genitals and skin creases) compared to thicker skinned areas (eg, palms of your hands and soles of your feet).

Description	Example
Mild steroids These are usually used to treat mild skin conditions such as inflammation (redness) associated with nappy rash(external link) or mild atopic eczema(external link) in children. These steroids are also available as combined products with an antibiotic or an antifungal such as Micreme H®. These can be purchased from the pharmacy without a prescription, but it's best to talk to a pharmacist to make sure it's the best option for you.	Hydrocortisone 0.5% Hydrocortisone 1% DermAid® DermAid Soft® DermAssist®
Moderate steroids Moderate topical steroids are 2 to 25 times as potent as hydrocortisone.	Clobetasone butyrate Eumovate® Triamcinolone acetonide Aristocort®
Potent steroids Potent topical steroids are 100 to 150 times as potent as hydrocortisone. These are used for severe inflammation. These steroids are available as combined products with an antibiotic such as Viaderm KC®, Fucicort®.	Betamethasone valerate Beta® Betnovate® Betamethasone dipropionate Diprosone® Hydrocortisone 17-butyrate Locoid® Mometasone furoate Elocon® Methylprednisolone aceponate Advantan®
Very potent steroids Very potent topical steroids are up to 600 times as potent as hydrocortisone.	Clobetasol propionate Dermol® Betamethasone dipropionate Diprosone OV®

Topical steroids are available in different preparations, eg, creams, ointments, lotions, solutions or gels.

The correct one to use depends on the type of skin lesion, location on your body and potential for irritation (stinging) or allergy.
- Creams are usually best to treat moist or weeping areas of skin, and they rub into the skin well.
- Ointments tend to be greasy and are usually best to treat areas of skin that are dry or thickened. They have the lowest chance of burning and stinging with application.
- Lotions are easy to apply and may be useful to treat hairy areas such as the scalp.
Topical steroids are usually only applied once or twice a day.

Use topical steroids as instructed by your healthcare provider, who will explain where, how frequently and for how long to apply the medicine.

Creams or ointments are rubbed gently into the affected skin until they have disappeared.
The amount of topical steroid you should apply is measured in fingertip units (FTUs). One FTU is the amount of topical steroid that's squeezed out from the tube along an adult's fingertip (the distance from the tip of the adult index finger to the first crease) as shown in the image below.

Image credit: DermNet, NZ

1 FTU is enough product to cover an area the same size as 2 adult handprints (palms and fingers).
You'll need to use enough topical steroid to get a response then you can use a less potent product to control the condition.
If you’re using a topical steroid and not getting a response after 7 days, instead of using more or using it for a long time, talk to your healthcare provider. A short course of a stronger topical steroid can be safer than using a lower strength one for a long time.
Your healthcare provider may ask you to cover treated areas. Covering the treated area after applying a topical steroid increases the absorption of the steroid, but may also increase side effects.
If you have frequent skin flare-ups you may be advised by your healthcare provider to use treatment for short durations to prevent flare-ups. This is also called ‘pulse dosing’ or ‘weekend treatment’ where you apply the topical steroid for 2 days a week during remission (between flares).

The diagram below gives some guidance on how many fingertip units of steroid cream are required for adults.

Image credit: Healthify He Puna Waiora

For guidance on how many fingertip units to use in children, read more about fingertip units when applying topical steroids to children(external link).

Video: How to use topical steroids

(Guy's and St Thomas' NHS Foundation Trust, UK, 2017)

Like all medicines, topical steroids can cause side effects, although not everyone gets them.

Side effects	What should I do?
Burning or stinging feeling	This is common and may happen when you first start applying the treatment. It usually improves as your skin gets used to the treatment. Tell your doctor if this feeling continues.
Thinning of the skin	This isn't common and occurs with the potent or very potent topical steroids, if a covering is used after treatment or if steroids are used often on a large area or long term. It's less likely to occur with mild or moderate topical steroids or if steroids are only used for a short course. If it does occur, it often goes away when the treatment is stopped. Tell your doctor.
Permanent stretch marks Bruising Discolouration Thin spidery veins	These aren't common and may occur with long-term use of topical steroids. Tell your doctor if these bother you.

Withdrawal side effects

If you use strong topical steroids every day for over a year and then suddenly stop using them, you may get a withdrawal reaction. The side effects of stopping treatment after a long time can include changes in skin colour, burning, stinging, itching or peeling skin. Talk to your doctor about stopping treatment gradually to avoid these withdrawal side effects.

Eczema | Mate harehare
Dermatitis
Psoriasis | Mate tongatonga uri