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Corticosteroids (topical)

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Corticosteroids (topical)



Introduction

Topical corticosteroids, or topical steroids, are creams, gels or ointments containing corticosteroids.

Corticosteroids are hormones that can reduce inflammation (redness and swelling), suppress the immune system and narrow the blood vessels in the skin. Their main purpose is to reduce skin inflammation and irritation.

Conditions widely treated with topical corticosteroids include:



eczema



seborrhoeic dermatitis – a condition that causes the skin to become flaky, leading to symptoms such as dandruff



psoriasis



nappy rash



lichen planus – a condition that causes an itchy, non-infectious rash



discoid lupus erythematosus – a type of lupus that usually only affects the skin



skin irritation caused by insect bites or stings



Topical corticosteroids can't cure these conditions, but can help relieve the symptoms.

See the separate topic on corticosteroids for information about oral (tablets and capsules), inhaled and injected corticosteroids.

 

Types of topical corticosteroids

Topical corticosteroids are available in different strengths, which are determined by the amount of corticosteroid they contain. They can be:



mild – such as hydrocortisone



moderate – such as clobetasone butyrate



potent – such as betamethasone dipropionate



very potent – such as clobetasol propionate



Mild corticosteroids can often be bought over the counter from pharmacies, while stronger types are only available on prescription. You will usually be prescribed the lowest strength necessary to control your symptoms.

Topical corticosteroids are also available in several different forms, including:



solutions – water- or alcohol-based liquids that are non-greasy and easy to apply, but they can sometimes dry out the skin 



lotions – similar to solutions but thicker; they are often recommended to treat larger areas of skin or hairy areas 



creams – thicker than lotions and often recommended when the affected skin has become moist or is weeping



ointments – liquids containing high levels of oil, which can make them greasy; they are usually recommended to treat skin that has become dry and scaly



gels – more solidified, jelly-like substances, often used to treat areas of the body that are very hairy, such as the scalp



mousses – foam-like substances that are also often used to treat the scalp



Some topical corticosteroids are available combined with other substances, such as antibiotics or antifungals to treat infected areas of skin.

 

Using topical corticosteroids

Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with your medication. This will give details of how much to apply and how often.

Topical corticosteroids usually only need to be used once or twice a day for a few days or weeks at a time and should only be applied directly to the affected areas of skin.

Occasionally, your doctor may suggest using a topical corticosteroid less frequently but over a longer period of time, to help prevent periods where your symptoms worsen.

 

Safety and side effects

If used as directed, topical corticosteroids are a very safe treatment. The most common side effect is a burning or stinging sensation when the medication is applied, but this usually improves as your skin gets used to the treatment.

Serious side effects, such as thinning of the skin and changes in skin colour, usually only occur if too much potent or very potent topical corticosteroids are used for a long period.

Topical corticosteroids are safe for most people to use, but there are some circumstances where they are not recommended. For example, very potent topical corticosteroids should be avoided if you are pregnant or breastfeeding and shouldn't be used to treat young children.

 

Corticosteroids and anabolic steroids


The steroids contained in topical corticosteroids shouldn't be confused with the type of steroids sometimes used (illegally) by bodybuilders and athletes. These are called anabolic steroids.

Anabolic steroids contain a type of hormone that helps stimulate tissue growth, particularly muscle tissue. If used correctly, topical corticosteroids don't have any effect on muscle growth or development.

 

Things to consider when using topical corticosteroids 

Most people can use topical corticosteroids safely, but there are situations when they aren't recommended.

 

Skin infections

Topical corticosteroids shouldn't usually be used on infected skin, as they could make the infection worse.

However, they can be used to treat infected skin on the advice of your doctor if you use a topical corticosteroid that has been combined with medication to specifically treat the infection, such as an antibiotic.

 

Certain skin conditions

Certain skin conditions including rosacea, acne and skin ulcers (open sores) can be made worse by topical corticosteroids, so they should be avoided.

 

Pregnancy

Most topical corticosteroids are considered safe to use during pregnancy. However, using very potent topical corticosteroids is not usually recommended during pregnancy, because research has found they may increase the risk of giving birth to a baby with a low birthweight.

 

Breastfeeding

Mild, moderate and potent topical corticosteroids are also considered safe to use when breastfeeding. However, you should wash off any steroid cream applied to your breasts before feeding your baby.

As a precaution, very potent topical corticosteroids are not recommended to use while breastfeeding because their safety is uncertain.

 

Young children

Children can safely use mild to moderate topical corticosteroids. Potent and very potent topical corticosteroids are not usually recommended, particularly in very young children, because they carry a greater risk of causing side effects than in adults.

However, exceptions can be made if your child has severe symptoms and it is felt that the benefit of treatment outweighs the risks of side effects. For example, potent topical corticosteroids are sometimes recommended for treating cases of severe atopic eczema, usually under the supervision of a dermatologist (skin care specialist).

 

How to use topical corticosteroids  

Unless instructed otherwise by your doctor, follow the directions that come with your topical corticosteroid medication. This will give details of how much to apply and how often.

Most people only need to use the medication once or twice a day for a week or two, although occasionally your doctor may suggest using it less frequently over a longer period of time.

The medication should only be applied to affected areas of skin. Gently smooth it into your skin in the direction the hair grows.

 

Fingertip units (FTUs)

Sometimes, the amount of medication you are advised to use will be given in fingertip units (FTUs).



An FTU is the amount of medication needed to squeeze a line from the tip of an adult finger to the first crease of the finger.

An FTU is about 500mg. It should be enough to treat an area of skin double the size  of the flat of your hand with your fingers together.

The recommended dosage in terms of FTUs will depend on what part of the body is being treated. This is because the skin is thinner in certain parts of the body and more sensitive to the effects of corticosteroids.

For adults, the recommended FTUs to be applied in one single dose are:



0.5 FTU for genitalia



1 FTU for hands, elbows and knees



1.5 FTUs for the feet, including the soles



2.5 FTUs for the face and neck



3 FTUs for the scalp



4 FTUs for a hand and arm together, or the buttocks 



8 FTUs for the legs and front or back of the trunk (the main section of the body, excluding the arms, legs and head)



For children, the recommended FTUs will depend on their age. Your GP can advise you on this.

 

Using topical corticosteroids and emollients

Some people using topical corticosteroids also need to use emollients regularly. These are creams and lotions designed to prevent the skin becoming dry, scaly and itchy.

If you are using both topical corticosteroids and emollients, you should apply the emollient first. Then wait about 30 minutes before applying the topical corticosteroid.

 

Side effects of topical corticosteroids 

Topical corticosteroids rarely cause serious side effects if they are used as instructed.

Things that increase your risk of experiencing side effects include:



the potency (strength) of the topical corticosteroid 



the length and frequency of treatment – you are more likely to have side effects if you use a topical corticosteroid frequently over a long period of time



the area of skin being treated – the larger the area you are treating with a topical corticosteroid, the greater the risk; certain areas of skin, such as the face, groin and armpits, are also more sensitive to the medication



your age – young children and elderly people are at a greater risk because their skin tends to be thinner



 

Types of side effects

Side effects can affect the patch of skin being treated, known as local side effects or, less often, they can have a wider effect on the body, known as systemic side effects.

 

Local side effects

Local side effects are the main side effects associated with topical corticosteroids. They usually affect the face, folds of skin and areas that have been treated many times during the past months or years.

Local side effects can include:



burning or stinging of the skin – this is a common side effect that usually occurs when you start treatment; it tends to improve after a few days as your skin gets used to the medication



worsening of a pre-existing skin infection



folliculitis – inflamed hair follicles



thinning of the skin – this can make the affected skin more vulnerable to damage; for example, you may bruise more easily 



stretch marks



contact dermatitis – skin irritation caused by a mild allergic reaction to the substances in a particular topical corticosteroid



acne, or worsening of existing acne 



rosacea – a condition that causes the face to become red and flushed



changes in skin colour – this is usually more noticeable in people with dark skin



excessive hair growth on the area of skin being treated 



Besides a burning or stinging sensation, most of these side effects are uncommon and should disappear after you stop using the medication. Stretch marks are likely to be permanent, although they will probably become less noticeable over time.

 

Systemic side effects

Systemic side effects are rare and usually occur only if you do not apply topical corticosteroids as instructed.

They can occur if the medication is absorbed into the bloodstream and affects other parts of the body, such as the adrenal gland (a gland that produces many of the body’s natural steroids).

Possible systemic side effects include decreased growth in children and a rare condition called Cushing’s syndrome that is caused by having high levels of steroid hormones in your blood. Symptoms of Cushing's syndrome include rapid weight gain, changes to the skin (such as skin thinning) and mood changes (such as feeling depressed).

For information on the side effects of the particular topical corticosteroid you are using, check the information leaflet that comes with it or search for your medication in the medicines A-Z.


 

Reporting side effects

The Yellow Card Scheme allows you to report suspected side effects from any type of medicine that you are taking. It is run by the medicines safety watchdog called the Medicines and Healthcare products Regulatory Agency (MHRA).