Topical steroids
What are Topical steroids?
Topical steroids are aerosols, creams, gels, lotions, solutions, and tapes that contain corticosteroids (often abbreviated to steroids) which are designed to be applied externally to the scalp or the skin, depending on the condition being treated.
Corticosteroids control inflammation by mimicking naturally occurring corticosteroid hormones produced by our adrenal glands, which are two small glands that sit on top of our kidneys. In addition to reducing inflammation (redness and swelling) in the area that they are applied, topical corticosteroids also suppress the immune response, reduce cell turnover, and constrict (narrow) blood vessels.
What are topical steroids used for?
Topical steroids of low to medium potency may be used for the treatment of various skin disorders that respond to corticosteroids such as:
- atopic dermatitis (mild-to-moderate)
- contact dermatitis
- discoid lupus erythematosus of the face and skin folds (intertriginous areas)
- dry skin
- insect bites
- intertrigo
- itching confined to small areas of skin
- itching of the anogenital regions
- lichen planus of the face and intertriginous areas
- nummular dermatitis
- polymorphous light eruption
- psoriasis of the face and intertriginous areas
- seborrheic dermatitis of the face and intertriginous areas.
More potent topical corticosteroids may be used for the treatment of:
- Alopecia areata
- Atopic dermatitis (resistant)
- Discoid lupus erythematosus
- Lichen planus
- Granuloma annulare
- Psoriatic plaques and psoriasis that affects the palms, soles, elbows, or knees
- Severe hand eczema
- Severe poison ivy.
Generally, the weakest effective steroid should be used; however, some doctors may choose to use a more potent topical steroid initially for the first few days.
Are there any differences between topical steroids?
Topical steroids come in various potencies (strengths), ranging from very high potency (Class 1) to low potency (Class 7).
In some instances, absorption of different formulations containing the same active ingredient can vary (for example, betamethasone ointment is absorbed better than betamethasone cream) which can also affect potency.
Skin thickness also affects absorption.
- The skin of the eyelids, genitals, and skin creases is thin and potent topical steroids should be avoided.
- The skin of the palms and soles is thick and mild topical steroids are usually ineffective.
Absorption (and potency) is greatly enhanced by occlusion (covering the area with impermeable or semi-impermeable dressings).
Topical steroids are sometimes combined with other ingredients, such as antifungal or antibacterial agents. Combination antibacterial/corticosteroid preparations should only be used short-term (for less than one week) to reduce the risk of antimicrobial resistance developing.
Augmented preparations are those that have been modified so that they are absorbed through the skin faster.
Very high potency (Class 1)
These topical corticosteroids are up to 600 times more potent than topical hydrocortisone.
| Generic name | Brand name examples |
|---|---|
| Augmented betamethasone dipropionate gel and ointment 0.05% | Generic only |
| clobetasol propionate 0.05% | Cormax cream/solution, Clobex lotion/spray/shampoo, Olux foam, Olux E foam, Temovate cream/ointment/solution |
| diflorasone diacetate 0.05% | Apexicon ointment |
| fluocinonide 0.1% | Vanos cream |
| flurandrenolide 4mcg/m2 | Cordran Tape |
| halobetasol 0.05% | Ultravate cream/ointment/lotion |
Potent (Class 2)
These topical corticosteroids are 100-150 times more potent than topical hydrocortisone.
| Generic name | Brand name examples |
|---|---|
| amcinonide ointment 0.1% | Cyclocort |
| Augmented betamethasone dipropionate lotion and cream (0.05%), regular betamethasone dipropionate ointment (0.05%) | Generic betamethasone dipropionate cream AF, Diprolene lotion, Diprosone ointment |
| desoximetasone | Topicort cream/ointment (0.25%), Topicort gel (0.05%) |
| diflorasone diacetate 0.05% | Apexicon E cream |
| fluocinonide 0.05% | Generic fluocinonide |
| halcinonide 0.1% | Halog ointment/cream/solution |
Upper medium potency (Class 3)
These topical corticosteroids are up to 25 times more potent than topical hydrocortisone.
| Generic name | Brand name examples |
|---|---|
| amcinonide 0.1% | Cyclocort cream |
| Regular betamethasone dipropionate cream 0.05% | Generic |
| fluticasone propionate 0.005% | Cutivate ointment |
| triamcinolone acetonide 0.5% | Cinolar cream/ointment |
Medium potency (Class 4 and 5)
These topical corticosteroids are between 2 and 25 times more potent than topical hydrocortisone.
| Generic name | Brand name examples |
|---|---|
| betamethasone valerate foam 0.12% | Luxiq foam |
| betamethasone dipropionate spray 0.05% | Sernivo spray |
| desoximetasone 0.05% | Topicort LP cream |
| hydrocortisone 17-butyrate 0.1% | Locoid ointment |
| hydrocortisone probutate 0.1% | Pandel cream |
| hydrocortisone valerate 0.2% | Generic hydrocortisone valerate cream/ointment |
| fluocinolone acetonide 0.025% | Synalar cream/ointment |
| fluticasone propionate 0.05% | Cutivate cream |
| mometasone furoate 0.1% | Elocon cream |
| triamcinolone acetonide 0.025% | Kenalog cream/spray |
| triamcinolone acetonide 0.1% | Triderm cream/lotion/ointment |
Mild (Class 6)
These topical corticosteroids are slightly more potent than topical hydrocortisone.
| Generic name | Brand name examples |
|---|---|
| alclometasone dipropionate 0.05% | Generic alclometasone dipropionate cream/ointment |
| desonide 0.05% | Desonate gel, DesOwen cream/ointment |
| fluocinolone acetonide 0.01% | Derma-Smoothe |
| hydrocortisone 17-butyrate 0.1% | Locoid cream |
Least potent (Class 7)
Hydrocortisone is the least potent topical corticosteroid.
| Generic name | Brand name examples |
|---|---|
| hydrocortisone 1%, 2.5% | Generic hydrocortisone, Ala-Cort |
Note that potency charts vary depending on the source. This grouping of potencies is based on the best effort accumulation of data.
Are topical steroids safe?
Serious side effects are uncommon or rare when topical corticosteroids are used exactly as directed and for the time intended, but may include:
- Cushing syndrome: Rare, but the risk is higher if large quantities of a topical corticosteroid (>50g/week of clobetasol propionate or >500g/week of hydrocortisone) are used long-term
- Glaucoma or cataracts caused by excessive use of topical steroids near the eye.
Topical steroids should not be confused with anabolic steroids often abused by body-builders to increase muscle mass.
For a complete list of severe side effects, please refer to the individual drug monographs.
What are the side effects of topical steroids?
Common side effects reported with topical steroids include:
- Easy bruising and tearing of the skin
- Enlarged blood vessels (telangiectasia)
- Folliculitis (inflammation of the hair follicles) and miliaria (sweat rash): ointments
- Increased hair thickness and length in the area of application (hypertrichosis)
- Skin thinning
- Stinging or inflamed skin: creams
- Stretch marks (striae) especially in the armpits or groin.
Side effects associated with more potent topical steroid use include:
- Perioral dermatitis (also called “Muzzle rash”). Consists of small, red, pus-filled bumps and mild peeling around the mouth
- Steroid rosacea: A rosacea-like condition near the middle of the face. Can worsen when the topical steroid is discontinued
- Pustular psoriasis: Clearly defined raised bumps filled with pus
- Topical corticosteroid withdrawal: Symptoms include red burning skin, swelling, or pimples after discontinuation of the topical corticosteroid.
Topical corticosteroids can also mask the symptoms of infections caused by bacteria, fungi, or viruses.
Note that some potent topical steroids have been found illegally in some cosmetic products purchased over-the-counter or via the internet, resulting in steroid-dependent dermatitis and rosacea.
For a complete list of side effects, please refer to the individual drug monographs.
List drug with Topical steroids
| Drug Name |
|---|
| Aclovate Generic name: Alclometasone Topical |
| Ala-Cort Generic name: Hydrocortisone Topical |
| Ala-Scalp Generic name: Hydrocortisone Topical |
| Ala-Scalp HP Generic name: Hydrocortisone |
| Alclometasone topical Generic name: Alclometasone Topical |
| Alphatrex Generic name: Betamethasone Dipropionate |
| Amcinonide Generic name: Amcinonide |
| Amcinonide topical Generic name: Amcinonide Topical |
| Anucort-HC cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Anusol-HC Generic name: Hydrocortisone Topical |
| Anusol-HC cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| ApexiCon Generic name: Diflorasone Topical |
| ApexiCon E Generic name: Diflorasone Topical |
| Aquanil HC Generic name: Hydrocortisone Topical |
| Aquaphor Itch Relief Generic name: Hydrocortisone Topical |
| Aquaphor Itch Relief Maximum Strength Generic name: Hydrocortisone Topical |
| Aristocort A Generic name: Triamcinolone |
| Avedana Hydrocortisone with Aloe Generic name: Hydrocortisone Topical |
| Clobetasol Generic name: Clobetasol Topical |
| Clobevate Generic name: Clobetasol |
| Clobex Generic name: Clobetasol Topical |
| Clocortolone Generic name: Clocortolone |
| Clocortolone topical Generic name: Clocortolone Topical |
| Clodan Generic name: Clobetasol Topical |
| Cloderm Generic name: Clocortolone Pivalate 0.1% |
| Cordran Generic name: Flurandrenolide |
| Cordran SP Generic name: Flurandrenolide Topical |
| Cordran Tape Generic name: Flurandrenolide |
| Cormax Generic name: Clobetasol |
| Cormax Scalp Application Generic name: Clobetasol |
| Cortaid Generic name: Hydrocortisone |
| Cortaid Intensive Therapy Generic name: Hydrocortisone Topical |
| Cortaid Maximum Strength Generic name: Hydrocortisone Topical |
| Cortaid with Aloe Generic name: Hydrocortisone Topical |
| CortiBalm Generic name: Hydrocortisone Topical |
| Corticaine Generic name: Hydrocortisone |
| Corticool Maximum Strength Generic name: Hydrocortisone |
| Cortizone-10 Generic name: Hydrocortisone Topical |
| Cortizone-10 Cooling Gel Generic name: Hydrocortisone Topical |
| Cortizone-10 Fast Itch Relief Generic name: Hydrocortisone Topical |
| Cortizone-10 Feminine Itch Relief Generic name: Hydrocortisone Topical |
| Cortizone-10 Intensive Healing Formula Generic name: Hydrocortisone Topical |
| Cortizone-10 Intensive Moisture Generic name: Hydrocortisone Topical |
| Cortizone-10 Maximum Strength Generic name: Hydrocortisone Topical |
| Cortizone-10 Overnight Generic name: Hydrocortisone Topical |
| Cortizone-10 Plus Generic name: Hydrocortisone Topical |
| Cortizone-10 Sensitive Skin Generic name: Hydrocortisone Topical |
| Cortizone-10 Ultra Soothing Generic name: Hydrocortisone Topical |
| Cortizone-5 Generic name: Hydrocortisone Topical |
| Cotacort Generic name: Hydrocortisone |
| Cutivate Generic name: Fluticasone Topical |
| Cyclocort Generic name: Amcinonide Topical |
| Mycin Scalp Generic name: Hydrocortisone |
| Beser Generic name: Fluticasone Topical |
| Beta HC Generic name: Hydrocortisone Topical |
| Beta-Val Generic name: Betamethasone Valerate |
| Betamethacot Generic name: Betamethasone Valerate |
| Betamethasone Generic name: Betamethasone Topical |
| Betamethasone dipropionate Generic name: Betamethasone Dipropionate |
| Betamethasone valerate Generic name: Betamethasone Valerate |
| Bryhali Generic name: Halobetasol Propionate 0.01% |
| Caldecort Generic name: Hydrocortisone Topical |
| Capex Generic name: Fluocinolone Topical |
| Cetacort Generic name: Hydrocortisone |
| Cinolar Generic name: Triamcinolone |
| Del-Beta Generic name: Betamethasone Dipropionate |
| Delacort Generic name: Hydrocortisone |
| Derma-Smoothe/FS Generic name: Fluocinolone |
| Derma-Smoothe/FS (Scalp) Generic name: Fluocinolone Topical Oil |
| Dermarest Generic name: Hydrocortisone |
| Dermarest Eczema Medicated Generic name: Hydrocortisone Topical |
| Dermarest Plus Anti-Itch Generic name: Hydrocortisone Topical |
| DermasilkRx SDS Pak Generic name: Triamcinolone Topical |
| Dermasorb HC Complete Kit Generic name: Hydrocortisone |
| Dermasorb TA Generic name: Triamcinolone Topical |
| Dermasorb TA Complete Kit Generic name: Triamcinolone |
| Dermatop Generic name: Prednicarbate |
| Dermatop E Generic name: Prednicarbate |
| DermaWerx SDS Pak Generic name: Triamcinolone Topical |
| Dermtex HC Generic name: Hydrocortisone Topical |
| Desonate Generic name: Desonide Topical |
| Desonide Generic name: Desonide |
| Desonide topical Generic name: Desonide Topical |
| DesOwen Generic name: Desonide Topical |
| DesOwen Cream Kit Generic name: Desonide Topical |
| DesOwen Lotion 2 oz Kit Generic name: Desonide Topical |
| DesOwen Lotion 4 oz Kit Generic name: Desonide Topical |
| DesOwen Ointment Kit Generic name: Desonide Topical |
| Desoximetasone Generic name: Desoximetasone |
| Desoximetasone topical Generic name: Desoximetasone Topical |
| Diflorasone Generic name: Diflorasone |
| Diflorasone topical Generic name: Diflorasone Topical |
| Diprolene Generic name: Betamethasone Topical |
| Diprosone Generic name: Betamethasone Dipropionate |
| Elocon Generic name: Mometasone Topical |
| Embeline Generic name: Clobetasol |
| Embeline E Generic name: Clobetasol |
| Embeline Scalp Application Generic name: Clobetasol |
| Exederm for Eczema and Dermatitis Generic name: Hydrocortisone Topical |
| Fluocinolone (Topical application) Generic name: Fluocinolone |
| Fluocinolone Topical Generic name: Fluocinolone Topical |
| Fluocinolone topical oil Generic name: Fluocinolone Topical Oil |
| Fluocinonide Generic name: Fluocinonide Topical |
| Fluocinonide-E Generic name: Fluocinonide Topical |
| Fluovix Generic name: Fluocinonide Topical |
| Flurandrenolide Generic name: Flurandrenolide |
| Flurandrenolide topical Generic name: Flurandrenolide Topical |
| Fluticasone (Topical application) Generic name: Fluticasone |
| Fluticasone topical Generic name: Fluticasone Topical |
| Gly-Cort Generic name: Hydrocortisone |
| Gynecort Maximum Strength Generic name: Hydrocortisone Topical |
| Halcinonide Generic name: Halcinonide |
| Halcinonide topical Generic name: Halcinonide Topical |
| Halobetasol Generic name: Halobetasol Topical |
| Halog Generic name: Halcinonide 0.1% |
| Hemmorex-HC cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Hemril-30 cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Hydrocortisone (Topical application) Generic name: Hydrocortisone |
| Hydrocortisone butyrate Generic name: Hydrocortisone Butyrate |
| Hydrocortisone Butyrate (Eqv-Locoid Lipocream) Generic name: Hydrocortisone Topical |
| Hydrocortisone Butyrate (Eqv-Locoid) Generic name: Hydrocortisone Topical |
| Hydrocortisone probutate Generic name: Hydrocortisone Probutate |
| Hydrocortisone rectal cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Hydrocortisone topical Generic name: Hydrocortisone Topical |
| Hydrocortisone valerate Generic name: Hydrocortisone Valerate |
| Hydrocortisone with Aloe Generic name: Hydrocortisone Topical |
| Hydrozone Plus Generic name: Hydrocortisone |
| Hytone Generic name: Hydrocortisone |
| Impeklo Generic name: Clobetasol Propionate |
| Impoyz Generic name: Clobetasol Propionate 0.025% |
| Impoyz Cream Generic name: Clobetasol Propionate 0.025% |
| Instacort Generic name: Hydrocortisone Topical |
| Instacort-10 Generic name: Hydrocortisone |
| Itch-X Lotion Generic name: Hydrocortisone Topical |
| Ivy Soothe Generic name: Hydrocortisone |
| IvyStat Generic name: Hydrocortisone |
| Kenalog Generic name: Triamcinolone Topical |
| Keratol HC Generic name: Hydrocortisone |
| Kericort 10 Generic name: Hydrocortisone |
| Lacticare-HC Generic name: Hydrocortisone |
| Lexette Generic name: Halobetasol Propionate 0.05% |
| Lidex Generic name: Fluocinonide |
| Lidex-E Generic name: Fluocinonide |
| Locoid Generic name: Hydrocortisone Topical |
| Locoid (Hydrocortisone butyrate Topical application) Generic name: Hydrocortisone Butyrate |
| Locoid (Hydrocortisone Topical application) Generic name: Hydrocortisone |
| Locoid Lipocream Generic name: Hydrocortisone Topical |
| Locoid Lipocream (Hydrocortisone butyrate Topical application) Generic name: Hydrocortisone Butyrate |
| Locoid Lipocream (Hydrocortisone Topical application) Generic name: Hydrocortisone |
| Locoid Lotion Generic name: Hydrocortisone Topical |
| LoKara Generic name: Desonide Topical |
| Luxiq Generic name: Betamethasone Topical |
| Maxiflor Generic name: Diflorasone |
| Medi-Cortisone Maximum Strength Generic name: Hydrocortisone |
| Microcort Generic name: Hydrocortisone |
| Mometasone (Topical application) Generic name: Mometasone |
| Mometasone topical Generic name: Mometasone Topical |
| Monistat Care Instant Itch Relief Generic name: Hydrocortisone Topical |
| Neutrogena T/Scalp Generic name: Hydrocortisone |
| Nolix Generic name: Flurandrenolide Topical |
| NuCort Generic name: Hydrocortisone |
| NuCort with Aloe Generic name: Hydrocortisone Topical |
| Nupercainal HC Generic name: Hydrocortisone |
| Nutracort Generic name: Hydrocortisone |
| Olux Generic name: Clobetasol Topical |
| Olux-E Generic name: Clobetasol Topical |
| Olux/Olux-E Complete Pack Generic name: Clobetasol |
| Oralone Generic name: Triamcinolone Topical |
| Pandel Generic name: Hydrocortisone Topical |
| Pandel (Hydrocortisone probutate Topical application) Generic name: Hydrocortisone Probutate |
| Pandel (Hydrocortisone Topical application) Generic name: Hydrocortisone |
| Pediaderm HC Kit Generic name: Hydrocortisone |
| Pediaderm TA Generic name: Triamcinolone |
| Prednicarbate Generic name: Prednicarbate |
| Prednicarbate topical Generic name: Prednicarbate Topical |
| Preparation H Hydrocortisone Generic name: Hydrocortisone Topical |
| Procto-Med HC Generic name: Hydrocortisone Topical |
| Procto-Pak 1% Generic name: Hydrocortisone Topical |
| Proctocort Generic name: Hydrocortisone Topical |
| Proctocort cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Proctocream-HC Generic name: Hydrocortisone |
| Proctosol-HC Generic name: Hydrocortisone Topical |
| Proctosol-HC cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Proctozone HC cream, suppository Generic name: Hydrocortisone Rectal (cream, Suppository) |
| Proctozone-HC Generic name: Hydrocortisone Topical |
| Psorcon Generic name: Diflorasone Topical |
| Psorcon E Generic name: Diflorasone |
| Qualisone Generic name: Betamethasone Valerate |
| Recort Plus Generic name: Hydrocortisone |
| Sarnol-HC Generic name: Hydrocortisone Topical |
| Sarnol-HC Maximum Strength Generic name: Hydrocortisone |
| Scalacort Generic name: Hydrocortisone |
| Scalpcort Generic name: Hydrocortisone |
| Sernivo Generic name: Betamethasone Diproprionate 0.05% |
| Summer's Eve Specialcare Generic name: Hydrocortisone |
| Synalar Generic name: Fluocinolone Topical |
| Temovate Generic name: Clobetasol Topical |
| Temovate E Generic name: Clobetasol |
| Texacort Generic name: Hydrocortisone Topical |
| Therasoft Anti-Itch & Dermatitis Generic name: Hydrocortisone |
| Topicort Generic name: Desoximetasone Topical |
| Topicort LP Generic name: Desoximetasone Topical |
| Tovet Generic name: Clobetasol Topical |
| Triacet Generic name: Triamcinolone |
| Triamcinolone (Topical application) Generic name: Triamcinolone |
| Triamcinolone Acetonide in Absorbase Generic name: Triamcinolone Topical |
| Triamcinolone topical Generic name: Triamcinolone Topical |
| Triamcot (Triamcinolone Topical application) Generic name: Triamcinolone |
| Trianex Generic name: Triamcinolone Acetonide 0.05% |
| Triderm Generic name: Triamcinolone Topical |
| Tridesilon Generic name: Desonide Topical |
| U-Cort Generic name: Hydrocortisone Topical |
| Ultravate Generic name: Halobetasol Topical |
| Ultravate X Generic name: Halobetasol |
| Ultravate X Ointment Generic name: Halobetasol Topical |
| Valisone Generic name: Betamethasone Valerate |
| Vanicream HC Generic name: Hydrocortisone Topical |
| Vanos Generic name: Fluocinonide Topical |
| Verdeso Generic name: Desonide Topical |
| Westcort (Hydrocortisone Topical application) Generic name: Hydrocortisone |
| Westcort (Hydrocortisone valerate Topical application) Generic name: Hydrocortisone Valerate |
| Zytopic Generic name: Triamcinolone |
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