Topical steroids are the topical forms of

corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are inv ...

s. Topical steroids are the most commonly prescribed

topical medication A topical medication is a medication that is applied to a particular place on or in the body. Most often topical medication means application to body surfaces such as the skin or mucous membranes to treat ailments via a large range of classes ...

s for the treatment of

rash A rash is a change of the human skin which affects its color, appearance, or texture. A rash may be localized in one part of the body, or affect all the skin. Rashes may cause the skin to change color, itch, become warm, bumpy, chapped, dry, c ...

eczema Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved c ...

, and

dermatitis Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved c ...

. Topical steroids have

anti-inflammatory Anti-inflammatory is the property of a substance or treatment that reduces inflammation or swelling. Anti-inflammatory drugs, also called anti-inflammatories, make up about half of analgesics. These drugs remedy pain by reducing inflammation as o ...

properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price. Side effects may occur from long-term topical steroid use.

Medical uses

Weaker topical steroids are utilized for thin- skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, and breast folds. Weaker steroids are used on the face, eyelids, diaper area,

perianal The anus ( Latin, 'ring' or 'circle') is an opening at the opposite end of an animal's digestive tract from the mouth. Its function is to control the expulsion of feces, the residual semi-solid waste that remains after food digestion, which, ...

skin, and

intertrigo Intertrigo refers to a type of inflammatory rash (dermatitis) of the superficial skin that occurs within a person's body folds. These areas are more susceptible to irritation and subsequent infection due to factors that promote skin breakdown such ...

of the groin or body folds. Moderate steroids are used for

atopic dermatitis Atopic dermatitis (AD), also known as atopic eczema, is a long-term type of inflammation of the skin ( dermatitis). It results in itchy, red, swollen, and cracked skin. Clear fluid may come from the affected areas, which often thickens over tim ...

, nummular eczema, xerotic eczema, lichen sclerosis et atrophicus of the

vulva The vulva (plural: vulvas or vulvae; derived from Latin for wrapper or covering) consists of the external female sex organs. The vulva includes the mons pubis (or mons veneris), labia majora, labia minora, clitoris, vestibular bulbs, vulv ...

scabies Scabies (; also sometimes known as the seven-year itch) is a contagious skin infestation by the mite ''Sarcoptes scabiei''. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the ski ...

(after scabiecide) and severe

. Strong steroids are used for

psoriasis Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to comple ...

lichen planus Lichen planus (LP) is a chronic inflammatory and immune-mediated disease that affects the skin, nails, hair, and mucous membranes. It is not an actual lichen, and is only named that because it looks like one. It is characterized by polygonal, fla ...

, discoid lupus, chapped feet,

lichen simplex chronicus Lichen simplex chronicus (LSC) is thick leathery skin with exaggerated skin markings caused by sudden itching and excessive rubbing and scratching. It generally results in small bumps, patches, scratch marks and scale. It typically affects the ...

, severe poison ivy exposure,

alopecia areata Alopecia areata, also known as spot baldness, is a condition in which hair is lost from some or all areas of the body. Often, it results in a few bald spots on the scalp, each about the size of a coin. Psychological stress and illness are pos ...

, nummular eczema, and severe

in adults. To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off. Long-term use of topical steroids can lead to secondary infection with

fungus A fungus ( : fungi or funguses) is any member of the group of eukaryotic organisms that includes microorganisms such as yeasts and molds, as well as the more familiar mushrooms. These organisms are classified as a kingdom, separately fr ...

bacteria Bacteria (; singular: bacterium) are ubiquitous, mostly free-living organisms often consisting of one biological cell. They constitute a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria were am ...

(see

tinea incognito Tinea incognita or Tinea incognito is a fungal infection of the skin masked and often exacerbated by application of a topical immunosuppressive agent. The usual agent is a topical corticosteroid. As the skin fungal infection has lost some of the ...

), skin atrophy,

telangiectasia Telangiectasias, also known as spider veins, are small dilated blood vessels that can occur near the surface of the skin or mucous membranes, measuring between 0.5 and 1 millimeter in diameter. These dilated blood vessels can develop anywhere on ...

(prominent blood vessels), skin bruising and fragility. The use of the

finger tip unit In medicine, a finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger of an adult.F ...

may be helpful in guiding how much topical steroid is required to cover different areas of the body.

Adverse effects

Hypothalamic–pituitary–adrenal axis The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three components: the hypothalamus (a part of the brain located below the thalamus), the pituitary gland (a ...

(HPA) suppression *

Cushing's syndrome Cushing's syndrome is a collection of signs and symptoms due to prolonged exposure to glucocorticoids such as cortisol. Signs and symptoms may include high blood pressure, abdominal obesity but with thin arms and legs, reddish stretch marks, a ...

Diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

Osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone a ...

Topical steroid addiction Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids for 2 weeks or longer and then discontinue use. Symptoms affect the skin and include redness, a burning sen ...

* Allergic

contact dermatitis Contact dermatitis is a type of acute or chronic inflammation of the skin caused by exposure to chemical or physical agents. Symptoms of contact dermatitis can include itchy or dry skin, a red rash, bumps, blisters, or swelling. These rashes are ...

(see steroid allergy) *

Steroid atrophy Steroid-induced skin atrophy is thinning of the skin as a result of prolonged exposure to steroids. In people with psoriasis using topical steroids it occurs in up to 5% of people after a year of use. Skin atrophy can occur with both prescription ...

Perioral dermatitis Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and ...

: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids. * Ocular effects: Topical steroid drops are frequently used after

eye surgery Eye surgery, also known as ophthalmic or ocular surgery, is surgery performed on the eye or its adnexa, by an ophthalmologist or sometimes, an optometrist. Eye surgery is synonymous with ophthalmology. The eye is a very fragile organ, and requ ...

but can also raise

intraocular pressure Intraocular pressure (IOP) is the fluid pressure inside the eye. Tonometry is the method eye care professionals use to determine this. IOP is an important aspect in the evaluation of patients at risk of glaucoma. Most tonometers are calibrated t ...

(IOP) and increase the risk of

glaucoma Glaucoma is a group of eye diseases that result in damage to the optic nerve (or retina) and cause vision loss. The most common type is open-angle (wide angle, chronic simple) glaucoma, in which the drainage angle for aqueous humor, fluid withi ...

cataract A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colors, blurry or double vision, halos around light, trouble ...

retinopathy Retinopathy is any damage to the retina of the eyes, which may cause vision impairment. Retinopathy often refers to retinal vascular disease, or damage to the retina caused by abnormal blood flow. Age-related macular degeneration is technically inc ...

as well as systemic adverse effects. * Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days' rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy. * Delivery-related adverse effects *Other local adverse effects: These include facial

hypertrichosis Hypertrichosis is an abnormal amount of hair growth over the body. The two distinct types of hypertrichosis are generalized hypertrichosis, which occurs over the entire body, and localized hypertrichosis, which is restricted to a certain area. ...

folliculitis Folliculitis is the infection and inflammation of one or more hair follicles. The condition may occur anywhere on hair-covered skin. The rash may appear as pimples that come to white tips on the face, chest, back, arms, legs, buttocks, or head. A ...

miliaria Miliaria, also called heat rash, sweat rash, or prickly heat, is a skin disease marked by small, itchy rashes due to sweat trapped under the skin by clogged sweat-gland ducts. Miliaria is a common ailment in hot and humid conditions, such as in ...

genital ulcer A genital ulcer is an open sore located on the genital area, which includes the vulva, penis, perianal region, or anus. Genital ulcers are most commonly caused by infectious agents (fungal infections, secondary bacterial infections, or sexually t ...

s, and granuloma gluteale infantum. Long-term use has resulted in Norwegian

, Kaposi's sarcoma, and other unusual dermatosis.

Safety in pregnancy

A 2015 meta-analysis of observational studies of pregnancies found no association between mothers' use of topical steroids and type of delivery, APGAR score, birth defects, or prematurity.

Classification systems

Seven-class System

The U.S. utilizes 7 classes, which are classified by their ability to constrict

capillaries A capillary is a small blood vessel from 5 to 10 micrometres (μm) in diameter. Capillaries are composed of only the tunica intima, consisting of a thin wall of simple squamous endothelial cells. They are the smallest blood vessels in the body: ...

and cause skin blanching. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.

Class I

Very potent: up to 600 times stronger than

hydrocortisone Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthm ...

* Clobetasol propionate 0.05% (Dermovate) *

Betamethasone dipropionate Betamethasone dipropionate is a glucocorticoid steroid with anti-inflammatory and immunosuppressant, immunosuppressive abilities. It is applied as a topical cream, ointment, lotion or gel (Diprolene) to treat pruritus, itching and other skin cond ...

0.25% (Diprolene) * Halobetasol propionate 0.05% (Ultravate, Halox) *

Diflorasone diacetate Diflorasone diacetate is a topical steroid that comes in the form of a cream. It is manufactured by E. Fougera & Co. and is used as an anti-inflammatory and anti-itching agent, like other topical corticosteroids. It is prescribed for psoriasis a ...

0.05% (Psorcon)

Class II

Fluocinonide Fluocinonide (sold under various brand names) is a potent glucocorticoid used topically as an anti-inflammatory agent for the treatment of skin disorders such as eczema and seborrhoeic dermatitis. It relieves itching, redness, dryness, crusti ...

0.05% (Lidex) *

Halcinonide Halcinonide is a high potency corticosteroid, in group II (second most potent group) under US classification. It is used topical A topical medication is a medication that is applied to a particular place on or in the body. Most often topica ...

0.05% (Halog) *

Amcinonide Amcinonide (trade name Cyclocort) is a topical glucocorticoid used to treat itching, redness and swelling associated with several dermatologic conditions such as atopic dermatitis and allergic contact dermatitis. Amcinonide can also be classifie ...

0.05% (Cyclocort) *

Desoximetasone Desoximetasone is a medication belonging to the family of medications known as topical corticosteroids. It is used for the relief of various skin conditions, including rashes. It helps to reduce redness, itching, and irritation. Desoximetasone i ...

0.25% (Topicort)

Class III

* Triamcinolone acetonide 0.5% (Kenalog, Aristocort cream) * Mometasone furoate 0.1% (Elocon, Elocom ointment) * Fluticasone propionate 0.005% (Cutivate) *

0.05% (Diprosone) * Halometasone 0.05%

Class IV

Fluocinolone acetonide Fluocinolone acetonide is a corticosteroid primarily used in dermatology to reduce skin inflammation and relieve itching. It is a synthetic hydrocortisone derivative. The fluorine substitution at position 9 in the steroid nucleus greatly enhances ...

0.01-0.2% (Synalar, Synemol, Fluonid) *

Hydrocortisone valerate Hydrocortisone valerate is a synthetic glucocorticoid corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main class ...

0.2% (Westcort) *

Hydrocortisone butyrate Hydrocortisone butyrate is a corticosteroid that comes in one of the following forms: * '' Hydrocortisone-17-butyrate'' — * '' Hydrocortisone-21-butyrate'' — It is a group IV corticosteroid under US classification. See also * Cortisol ...

0.1% (Locoid) * Flurandrenolide 0.05% (Cordran) * Triamcinolone acetonide 0.1% (Kenalog, Aristocort A ointment) * Mometasone furoate 0.1% (Elocon cream, lotion)

Class V

* Fluticasone propionate 0.05% (Cutivate cream) * Desonide 0.05% (Tridesilon, DesOwen ointment) *

0.025% (Synalar, Synemol cream) *

0.2% (Westcort cream)

Class VI

Alclometasone dipropionate Alclometasone dipropionate is a synthetic compound, synthetic glucocorticoid corticosteroid and a corticosteroid ester. References

Corticosteroid esters Glucocorticoids Propionate esters {{steroid-stub ...

0.05% (Aclovate cream, ointment) * Triamcinolone acetonide 0.025% (Aristocort A cream, Kenalog lotion) *

0.01% (Capex shampoo, Dermasmooth) * Desonide 0.05% (DesOwen cream, lotion)

Class VII

The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well. *

Hydrocortisone Hydrocortisone is the name for the hormone cortisol when supplied as a medication. Uses include conditions such as adrenocortical insufficiency, adrenogenital syndrome, high blood calcium, thyroiditis, rheumatoid arthritis, dermatitis, asthm ...

2.5% (Hytone cream, lotion, ointment) *

1% (Many over-the-counter brands)

Five-class System

Japan rates topical steroids from 1 to 5, with 1 being strongest.

Four-class System

Many countries, such as the

United Kingdom The United Kingdom of Great Britain and Northern Ireland, commonly known as the United Kingdom (UK) or Britain, is a country in Europe, off the north-western coast of the continental mainland. It comprises England, Scotland, Wales and ...

Germany Germany,, officially the Federal Republic of Germany, is a country in Central Europe. It is the second most populous country in Europe after Russia, and the most populous member state of the European Union. Germany is situated betwee ...

, the

Netherlands ) , anthem = ( en, "William of Nassau") , image_map = , map_caption = , subdivision_type = Sovereign state , subdivision_name = Kingdom of the Netherlands , established_title = Before independence , established_date = Spanish Netherl ...

New Zealand New Zealand ( mi, Aotearoa ) is an island country in the southwestern Pacific Ocean. It consists of two main landmasses—the North Island () and the South Island ()—and over 700 smaller islands. It is the sixth-largest island count ...

, recognize 4 classes. In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.

Class IV (UK/NZ: class I)

Very potent (up to 600 times as potent as hydrocortisone) * Clobetasol propionate (Dermovate Cream/Ointment, Exel Cream) *

(Diprosone OV Cream/Ointment, Diprovate Cream)

Class III (UK/NZ: class II)

Potent (50–100 times as potent as hydrocortisone) * Betamethasone valerate (Beta Cream/Ointment/Scalp Application, Betnovate Lotion/C Cream/C Ointment, Fucicort) *

(Diprosone Cream/Ointment, Diprovate Cream, Daivobet 50/500 Ointment) * Diflucortolone valerate (Nerisone C/Cream/Fatty Ointment/Ointment) * Hydrocortisone 17-butyrate (Locoid C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion) * Mometasone furoate (Elocon Cream/Lotion/Ointment) *

Methylprednisolone aceponate Methylprednisolone aceponate, or methylprednisolone acetate propionate, sold under the brand names Advantan and Avancort, is a glucocorticoid and a corticosteroid ester—specifically the C17α propionate and C21 acetate diester of methylpredn ...

(Advantan Cream/Ointment) * Halometasone 0.05%

Class II (UK/NZ: class III)

Moderate (2–25 times as potent as hydrocortisone) *

Clobetasone butyrate Clobetasone butyrate is a synthetic glucocorticoid corticosteroid and a corticosteroid ester Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these h ...

(Eumovate Cream) * Triamcinolone acetonide (Aristocort Cream/Ointment, Viaderm KC Cream/Ointment, Kenacomb Ointment)

Class I (UK/NZ: class IV)

Mild *Hydrocortisone 0.5–2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

Allergy associations

The highlighted steroids are often used in the screening of

allergies Allergies, also known as allergic diseases, refer a number of conditions caused by the hypersensitivity of the immune system to typically harmless substances in the environment. These diseases include hay fever, food allergies, atopic dermat ...

to topical steroid and systemic steroids. When one is allergic to one group, one is allergic to all steroids in that group.

Group A

, hydrocortisone acetate, cortisone acetate, tixocortol pivalate,

prednisolone Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthr ...

methylprednisolone Methylprednisolone (Depo-Medrol, Medrol, Solu-Medrol) is a synthetic glucocorticoid, primarily prescribed for its anti-inflammatory and immunosuppressive effects. It is either used at low doses for chronic illnesses or used concomitantly at hig ...

, and

prednisone Prednisone is a glucocorticoid medication mostly used to suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium due to cancer and ad ...

Group B

Triamcinolone acetonide,

triamcinolone Triamcinolone is a glucocorticoid used to treat certain skin diseases, allergies, and rheumatic disorders among others. It is also used to prevent worsening of asthma and COPD. It can be taken in various ways including by mouth, injection i ...

alcohol, amcinonide,

budesonide Budesonide, sold under the brand name Pulmicort among others, is a medication of the corticosteroid type. It is available as an inhaler, nebulization solution, pill, nasal spray, and rectal forms. The inhaled form is used in the long-term mana ...

, desonide,

fluocinonide Fluocinonide (sold under various brand names) is a potent glucocorticoid used topically as an anti-inflammatory agent for the treatment of skin disorders such as eczema and seborrhoeic dermatitis. It relieves itching, redness, dryness, crusti ...

fluocinolone acetonide Fluocinolone acetonide is a corticosteroid primarily used in dermatology to reduce skin inflammation and relieve itching. It is a synthetic hydrocortisone derivative. The fluorine substitution at position 9 in the steroid nucleus greatly enhances ...

, and halcinonide

Group C

Betamethasone Betamethasone is a corticosteroid, steroid medication. It is used for a number of diseases including rheumatic disorders such as rheumatoid arthritis and systemic lupus erythematosus, skin diseases such as dermatitis and psoriasis, allergic con ...

, betamethasone sodium phosphate,

dexamethasone Dexamethasone is a glucocorticoid medication used to treat rheumatic problems, a number of skin diseases, severe allergies, asthma, chronic obstructive lung disease, croup, brain swelling, eye pain following eye surgery, superior vena ...

, dexamethasone sodium phosphate, and fluocortolone

Group D

Hydrocortisone 17-butyrate,

-17-valerate,

alclometasone dipropionate Alclometasone dipropionate is a synthetic compound, synthetic glucocorticoid corticosteroid and a corticosteroid ester. References

Corticosteroid esters Glucocorticoids Propionate esters {{steroid-stub ...

, betamethasone valerate, betamethasone dipropionate,

prednicarbate Prednicarbate is a relatively new topical corticosteroid drug. It is similar in potency to hydrocortisone. Corticosteroids have always been an important part of the pharmacological arsenal of dermatology Dermatology is the branch of medicine d ...

, clobetasone-17-butyrate, Clobetasol-17 propionate,

fluocortolone caproate Fluocortolone is a glucocorticoid used in the treatment of several conditions, including hemorrhoids. It is similar to fluocortin, but with one less keto group. See also * Corticosteroids Corticosteroids are a class of steroid hormones t ...

, fluocortolone pivalate, fluprednidene acetate, and

mometasone Mometasone, also known as mometasone y 3 s, is a steroid medication used to treat certain skin conditions, hay fever, and asthma. Specifically it is used to prevent rather than treat asthma attacks. It can be applied to the skin, inhaled, or use ...

furoate

History

Corticosteroids were first made available for general use around 1950.

References

{{Glucocorticoids Corticosteroids