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Topical Corticosteroids

Topical corticosteroids have been extensively used for over 30 years to treat various inflammatory skin conditions. There are a large number of topical steroids available. These quick-acting agents are the mainstay of therapy for eczema because they are effective for reducing inflammation and itch.

Topical steroids are available as creams, lotions, gels and ointments; selection of an appropriate product can also provide good moisturization of the skin. The wide spectrum of potencies and bases allows these mediations to be used both effectively and safely while under the care of an experienced physician.

During flares, over-the-counter moisturizing preparations that include a topical corticosteroid (such as clobetasone butyrate and hydrocortisone) are helpful to control inflammation and restore the skin barrier. The intensive use of emollient-based products can reduce the need for topical steroids.

Corticosteroid Selection Depends On Multiple Factors:

Topical Corticosteroid Strength

Type of Patient

Location and Description

Very Potent


Localized area, resistant thick lesions, palms, soles, scalp



Localized area, thick lesions, palms, soles, scalp

Moderately Potent

Adult, Child

Extensive area of skin

Weak/Mildly Potent

Adult, Child, Infant

Face, folds, genitals, extensive areas of skin

Potency Classification Of Topical Corticosteriods:

Very potent:

  • Betamethasone dipropionate 0.05% (Diprolene)
  • Clobetasol propionate 0.05% (Dermovate)
  • Halobetasol propionate (Ultravate)
  • Halcinonide 0.1% (Halog)


  • Amcinonide 0.1% (Cyclocort)
  • Betamethasone dipropionate 0.05% (Diprosone, generics)
  • Betamethasone valerate 0.05% (Betaderm, Celestoderm, Prevex)
  • Desoximetasone 0.25% (Desoxi, Topicort)
  • Diflucortolone valerate 0.1% (Nerisone)
  • Fluocinonlone acetonide 0.25% (Fluoderm, Synalar)
  • Fluocinonide 0.05% (Lidemol, Lidex, Lyderm, Tiamol, Topsyn)
  • Fluticasone propionate (Cutivate)
  • Halcinonide (Halog)
  • Mometasone furoate 0.1% (Elocom)

Moderately potent:

  • Betamethasone valerate (Betnovate, Betaderm, Celestoderm)
  • Clobetasone butyrate 0.05% (Spectro EczemaCare Medicated Cream)
    (for more information on this product click here)
  • Hydrocortisone acetate 1.0% (Cortef, Hyderm)
  • Hydrocortisone valerate 0.2% (Westcort, HydroVal)
  • Prednicarbate 0.1% (Dermatop)
  • Triamcinolone acetonide 0.1% (Kenalog, Triaderm)


  • Desonide 0.05% (Desocort)
  • Hydrocortisone 0.5% (Cortate, Cortoderm)
  • Hydrocortisone acetate 0.5% (Hyderm)

General Rules for Topical Corticosteroid Prescriptions:

Below are some general rules to remember when topical corticosteroids are prescribed:

Potential Side Effects Of Topical Corticosteroids:

  • Very responsive diseases require mild or moderately potent formulations, less responsive diseases require potent or very potent formulations
  • Mild formulations should only be used on the face, groin, axillae (armpit), genital and perianeal areas
  • Very potent formulations should be used for short periods of time (14-20 days) or intermittently to reduce side-effects
  • Potent or very potent formulations are usually required on the palms and soles, and for lichenified or hypertrophic dermatoses
  • Brief use of more potent steroids achieves faster control of eczema and may result in less steroid use, as compared with longer use of inadequately potent preparations
  • Occlusion (covering the treated area with plastic wrap, such as Saran) is often needed on the palms and soles in order to improve the penetration of corticosteroids through the thicker skin in these areas
  • Corticosteroids should not be used on ulcerated (open sores) or atrophic skin
  • After prolonged used, sudden discontinuation should be avoided, in order to prevent a rebound phenomenon
  • When treating children, special guidelines should be followed to avoid the disadvantages of underuse or the occurrence of systemic or local adverse effects due to overuse
  • Laboratory tests for adrenal suppression may be required after long periods of therapy and/or treatment of large areas

Local skin effects:

  • Atrophy, striae (stretch marks), purpura (purple-colored patches of skin)
  • Acne, perioral dermatitis, rosacea-like rash
  • Increase hair growth
  • Hypopigmentation (lightened patches of skin)
  • Tinea incognito (masks the appearance of fungal infections)
  • Allergic contact dermatitis to corticosteroids
  • Tachyphylaxis (diminishing response to a drug after repeated exposure)
  • Glaucoma and cataracts when used around eyes

Systemic side effects:

  • Growth suppression
  • Adrenal suppression
  • Infants are most at risk
  • Increased risk when larger surfaces of skin area are treated

Side effects are dependent on the active molecule and are generally seen with repeated or prolonged use of potent and very potent topical corticosteroids. Prolonged use of mildly or moderately potent topical corticosteroids can also cause side effects.

Growth impairment can be a concern when large quantities of topical steroids are used, which has to be balanced against the growth inhibiting effect of long-term chronic inflammation, as seen in eczema.

Predictors Of Side Effects From Topical Corticosteroids:

Using moderate, potent or very potent steroids:

  • Too long
  • Too often
  • Too much
  • Under occlusion
  • On face, skin folds of the genitals inner thighs
  • Too young and too old (patient's age)
  • Too extensive an area

Tips For Minimizing Side Effects Of Topical Corticosteroids:

Use moderate, potent or very potent steroids only:

  • Limit use on thick lesions only
  • Limit duration of use to 2-3 weeks
  • Limit use to once a day application
  • Best effect if used in the early evening
  • If maintenance therapy is required, use on the weekends only
  • Maintain with weaker steroid or TIMs
  • Frequent moisturizing minimizes the need for topical steroids
  • Less steroids may be needed if secondary infections are treated

Corticosteroid Allergy:

An inadequate response to treatment may indicate an allergy to the prescribed corticosteroid. Patch testing would be required for identification.

Combination Therapy:

Topical steroids have been used extensively and found to be very effective for the treatment of eczema. Concerns about side effects, both on the skin and systemically, have increased the acceptance of newer steroid-free alternatives. The negative effects and decreased responsiveness from long-term corticosteroid treatment are potential risks. These effects may not occur with the topical immunomodulators, but longer term studies are still needed to confirm this.

Topical immunomodulators (TIMS) (also called calcineurin inhibitors) are used as steroid-sparing medications and they provide an important therapeutic option in the treatment of atopic eczema. There are discussions on whether these immunomodulatory agents should be used alone or in combination with other medications. Good evidence is available to show that using a potent topical corticosteroid only twice a week will reduce or even prevent eczema flares. Furthermore, it has been suggested that if this regimen was combined with the intermittent use of a TIM, further reductions in episodic flares may be possible. However, the effects of TIMs may reduce flares when used on their own.

Certain skin areas respond better to TIM treatment, such as the face, skin folds and anterior upper chest, Treatment is well tolerated and free of significant side effects, other than initial mild burning.

The following charts provide a simplified visual representation of common topical treatment combinations in the multi-layered approach for successful eczema management:

Maintenance options with anti-inflammatories when eczema is active, but under control

Maintenance options with anti-inflammatories when eczema is active, but under control

Eczema flare-up options with anti-inflammatories

Eczema flare-up options with anti-inflammatories

Steroids = topical corticosteroids
TIMS = topical immunomodulators [tacrolimus (Protopic) or pimecrolimus (Elidel)]

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