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Topical steroids factsheet

Topical corticosteroids are the most common treatment for inflammation in eczema. In order for
them to be successful, they need to form part of a programme of treatments. A good skin care
routine must be in place, involving the use of emollients to moisturise the skin and soap substitutes
to cleanse it. Contact with substances that may dry or irritate the skin further should be reduced as
far as possible. For some people with eczema, the regular use of emollient preparations is all that
is needed to keep their condition under control. However, for many people there will be a time
when a steroid preparation is required as part of their treatment.

What are topical steroids? A registered pharmacy can sell hydrocortisone and Eumovate
as pharmacy (P) medicines; a prescription is not required, but
‘Topical’ means applied directly to the skin. ‘Steroids’ are a
they must be supplied under the supervision of a pharmacist
group of natural hormones, produced in the body by a
for treating mild to moderate eczema as well as allergic and
variety of different glands. They are also produced
irritant contact dermatitis and insect bites. When topical
synthetically as medicines, and given as injections, in tablet
steroids are supplied in this way (i.e. without prescription),
form or topically (i.e. applied to the skin). Topical steroids are
they should NOT be used on the eyes or face, on broken or
used in the treatment of eczema, and their main value is
infected skin, on the anal or genital areas, in pregnancy, or by
that they reduce inflammation and speed up the healing of
anyone under the age of 10 years (hydrocortisone) and 12 years
the skin. They also help to make the skin less red, hot, itchy
(Eumovate) – usage of this kind requires the guidance of a
and sore. They are not, however, a cure for eczema.
health care professional. Hydrocortisone and Eumovate can
Topical steroid preparations are available as creams, only be bought in small tubes – enough to treat small areas of
ointments, lotions, foams, gel, mousses, shampoos and eczema.
tape, and come in different strengths or potencies. The one
(or ones) you are prescribed will depend on the severity of Topical steroid potencies
your eczema, your age, the part of your body that is affected In the UK topical steroid preparations are divided into four
and any other treatments used. categories according to how strong or potent they are. The
terms used are ‘mild’, ‘moderately potent’, ‘potent’ and ‘very
When your eczema is very dry, it is likely that your doctor
potent’. The potency of topical steroids is determined by the
will prescribe an ointment-based preparation, whereas
amount of vasoconstriction (narrowing of the blood vessels)
creams, which are light and cooling, may be used to treat
they produce. It also relates to the degree to which the topical
moist, weepy or ‘wet’ eczema. Lotions are easiest to apply on
steroid inhibits inflammation and its potential for causing side
the hairy areas of the body.
effects. It can be difficult for the person with eczema or the
There are two types of topical steroids that can be bought parent of a child with eczema to work out the potency of a
over the counter from a pharmacy without a prescription: 1% product, since the labelled percentage of steroid on the
hydrocortisone cream, a mildly potent topical steroid, and packaging does not relate to the potency and may sometimes
Eumovate (clobetasone butyrate 0.05%), a moderately imply a less potent product. The potency of the topical steroid
potent topical steroid cream (see Table 1 ). may be stated in the patient information leaflet (PIL) inside the
packaging.

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Topical steroids factsheet

One way of understanding the strength of different steroid • • Body site: Areas of thick skin, such as the feet and the
preparations is to note that moderate is 2 times more potent hands, can be treated with potent preparations. For thinner
than hydrocortisone 1%, potent is 10 times more potent, and skin, such as the face and genital areas, mild and
very potent is 50 times more potent. If you are not sure of moderately potent preparations are commonly prescribed;
the potency of a steroid preparation, ask your pharmacist. A a potent steroid will only be used for severe, unresponsive
list is provided later in this factsheet but new preparations eczema in these areas, usually for a limited period. If the
may not be included. steroid is applied a to the body folds, the occlusive effect
increases its potency so milder preparation should be
The potency of the steroid you are given will be based on
used.
several factors:

• Age: Babies and children with mild to moderate eczema • • Size of the affected area: A weaker strength might be
prescribed when a large area of skin requires treatment.
are usually prescribed mild topical steroids. Sometimes,
when eczema is more severe or there is no response to a
• Other treatments: If bandaging forms part of the treatment,
mild steroid, moderate to potent topical steroids may be
• a weaker steroid may be chosen because bandaging
prescribed for short periods and under medical
increases the potency of the steroid.
supervision.
NB. You may be given more than one topical steroid to treat
• Severity of the eczema: A mild or moderately potent steroid
eczema in different areas of the body. Make sure that you
may be replaced by a stronger potency if the eczema flares
are clear which preparation to use where. If in doubt, talk to
up, with very potent prescribed by specialists for very
your pharmacist or contact your
severe flares.
doctor/nurse.

Table 1 shows topical steroids listed alphabetically by trade name according to their strength.

Table 1: Topical steroids

Trade name Generic name Strength
This is the name chosen by the manufacturer This is the official name of the steroid Potency – this is not indicated on
– it is in big print on the tube. – it is usually written in smaller print the tube but may be stated in the
The following are examples of trade names, on the tube. PIL inside the packaging.
but this is not a complete list. You will also
find that some topical steroids do not have a
trade name – only a generic name.

Dermacort ®
Hydrocortisone 0.1% Mild
(available only over the counter)
®
Dioderm Hydrocortisone 0.1% Mild
®
Hc45
Hydrocortisone 1% Mild
(available only over the counter)
Hydrocortisone 0.5% Hydrocortisone 0.5% Mild
Hydrocortisone 1% Hydrocortisone 1% Mild
Hydrocortisone 2.5% Hydrocortisone 2.5% Mild
®
Mildison Lipocream Hydrocortisone 1% Mild
®
Synalar 1 in 10 Fluocinolone acetonide 0.0025% Mild
Zenoxone ® cream Hydrocortisone 1% Mild

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Topical steroids factsheet

Table 1: Topical steroids continued

Trade name Generic name Strength
This is the name chosen by the manufacturer This is the official name of the steroid Potency – this is not indicated
– it is in big print on the tube. – it is usually written in smaller print on the tube but may be stated in
The following are examples of trade names, on the tube. the PIL inside the packaging.
but this is not a complete list. You will also
find that some topical steroids do not have a
trade name – only a generic name.

Alphaderm ® Hydrocortisone 1%, urea 10% Moderate

®
Betnovate-RD Betamethasone valerate 0.025% Moderate
Clobavate ® Clobetasone butyrate 0.05% Moderate
®
Eumovate Clobetasone butyrate 0.05% Moderate
®
Haelan
Fludroxycortide 0.0125% Moderate
(available as cream, ointment and tape)
Modrasone ® Alclometasone dipropionate 0.05% Moderate
Synalar 1 in 4 ® Fluocinolone acetonide 0.00625% Moderate
®
Ultralanum Plain Fluocortolone hexanoate 0.25% Potent
Betacap ®
Betamethasone valerate 0.1% Potent
(scalp application)
Beclometasone dipropionate Beclometasone dipropionate 0.025% Potent
®
Betnovate Betamethasone valerate 0.1% Potent
®
Bettamousse Contains 1.2 mg betamethasone
Potent
(scalp application) valerate 0.1%, per gram
Cutivate ® ointment Fluticasone propionate 0.005% Potent
Cutivate ® cream Fluticasone propionate 0.05% Potent
®
Diprosalic
Betamethasone dipropionate 0.05% Potent
(ointment and scalp preparation)
Diprosone ® Betamethasone dipropionate 0.05% Potent
Elocon ® Mometasone furoate 0.1% Potent
®
Locoid
(available as scalp application Hydrocortisone butyrate 0.1% Potent
and lotion ‘Locid Crelo’)
Metosyn ® Fluocinonide 0.05% Potent
Nerisone ® Diflucortolone valerate 0.1% Potent
®
Synalar Fluocinolone acetonide 0.025% Potent
Clarelux ®
Clobetasol propionate 0.05% Very potent
(scalp application)
Dermovate ® Clobetasol propionate 0.05% Very potent
®
Etrivex
Clobetasol propionate 0.05% Very potent
(shampoo)
Nerisone Forte ® Diflucortolone valerate 0.3% Very potent

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Topical steroids factsheet

If the doctor feels that your eczema could be infected, you may be prescribed a combination preparation that contains
ingredients aimed at fighting the infection (see Table 2 below).

Table 2: Topical steroids with antimicrobial effects

Trade name Generic name Main Added Strength
This is the name chosen This is the official name of the anti-microbial antimicrobials Potency –
by the manufacturer steroid – it is usually written in effect
this is not
– it is in big print on the smaller print on the tube. Which type of
indicated on
tube. infection it is
the tube but
used for.
The following are may be stated
examples of trade in the PIL
names, but this is not a inside the
complete list. You will packaging.
also find that some
topical steroids do not
have a trade name –
only a generic name.

Canesten HC ® Hydrocortisone 1% Antifungal Clotrimazole Mild

®
Daktacort Hydrocortisone 1% Antifungal Miconazole nitrate Mild
Fucidin H ® Hydrocortisone 1% Antibacterial Fusidic acid Mild
Antibacterial Chlorhexidine
Nystaform HC ® Hydrocortisone 0.5% Mild
Antifungal Nystatin
Terra-Cortril ® Hydrocortisone 1% Antibacterial Oxytetracycline Mild
Antibacterial Benzalkonium
Timodine ® Hydrocortisone 0.5% chloride Mild
Antifungal Nystatin
Antibacterial Oxytetracycline
Trimovate ® Clobetasone butyrate 0.05% Moderate
Antifungal Nystatin
Chlortetracycline
Aureocort ® Triamcinolone acetonide 0.1% Antibacterial Potent
hydrochloride
Betamathasone Antibacterial Clioquinol
Betamethasone valerate 0.1% Potent
and clioquinol
Betamethasone Antibacterial Neomycin sulphate
Betamethasone valerate 0.1% Potent
and neomycin
Fucibet ® Betamethasone valerate 0.1% Antibacterial Fucidic acid Potent
Betamethasone dipropionate Antifungal Clotrimazole
Lotriderm ® Potent
0.064%
Synalar C ® Fluocinolone acetonide 0.025% Antibacterial Clioquinol Potent
Synalar N ®
Fluocinolone acetonide 0.025% Antifungal Neomycin sulphate Potent

Clobetasol with Antibacterial Neomycin

Clobetasol propionate 0.05% Very potent
neomycin and nystatin Antifungal Nystatin

These topical steroids are sometimes used for short bursts if infection is suspected. They are not usually used for continuous
long-term eczema treatment.

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Topical steroids factsheet

Application However, whichever order you choose, it is important that you

leave a gap of around 30 minutes between the two treatments.
It is important to use the correct amount of topical steroid for
The reason for this is to avoid diluting the topical steroid with the
your eczema, as instructed by your health care
emollient and spreading it to areas that don’t need it.
professional. NICE recommends that topical steroids are
applied once a day for children under 12 years. Older Topical steroids should be applied with clean hands so that the
children and adults will generally be instructed to apply a skin just glistens. It can sometimes be difficult to judge how
topical steroid 1–2 times a day for short bursts of treatment, much steroid to use and there are now guidelines on the
and then stop or step down use when the eczema flare amount required to cover body areas that are affected by
settles. (If used over long periods of time, treatment with eczema. These are based on the Finger Tip Unit (FTU), which is
potent topical steroids is unlikely to be stopped abruptly the amount of cream or ointment that just covers the end of an
and people will be ‘stepped down’ back to lower potency adult finger from the tip to the crease of the first joint when
preparations until their eczema flare settles.) Some people squeezed from an ordinary tube nozzle (see Figure 1). One FTU
with more severe eczema whose eczema flares very is enough to cover an area of skin the size of two adult hands
frequently are prescribed topical steroids to apply on 2 with the fingers together. Different parts of the body require
consecutive days a week on the areas where their eczema different amounts of topical steroid. For example, in an adult
usually flares. This is known as ‘weekend therapy’ and can one arm will need 3 FTUs whilst a 4-year old child will require 1
help to prevent the almost continuous flare cycle, meaning FTU for an arm and hand (see Figures 2 and 3). Adjustments will
that in the long run less topical steroid would be needed to be required if the whole area is not covered by eczema. Further
control the eczema than if each flare were treated as it information is often provided in the leaflet supplied with your
occurred. It may be necessary to restart a longer use and treatment. Any unused steroid cream or ointment should be
reduce to weekend therapy for significant flares. discarded and the hand rewashed (unless there is eczema on
the fingers).
Any further use of the steroid beyond that advised by your
health care professional will not be of benefit in controlling All steroids will be marked with a use-by-date and should not
your eczema and could be harmful to the skin on a long- be used after the time stated. You will usually be given a set
term basis. Conversely, not using enough topical steroid or period of time in which to use the preparation. Any steroid that
using very small amounts continuously often results in it not remains at the end of a treatment should not be passed on for
working so well and perhaps more being used in the long use by anyone else.
term.
Repeat prescriptions are not generally advised in cases of
There are no standard rules regarding whether to apply a eczema since the condition can alter and it is important for
steroid preparation after or before using an emollient. the doctor to examine the skin to reassess the suitability of the
Some people are happiest using an emollient first to treatment.
prepare the skin, followed by the steroid.

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Topical steroids factsheet

Figure 1 Measuring an FTU Figure 2 Number of FTUs for different

parts of an adult’s body

Figure 3 Number of FTUs for different parts of a child’s body

Are topical steroids a safe potent topical steroid.

treatment?
If used over long periods of time, topical steroid can thin the
Topical steroids, used appropriately and under supervision, skin, making it appear transparent, fragile and susceptible
are a safe and effective treatment for eczema. The likelihood to bruising; blood vessels may become more prominent, and
of side effects occurring is directly related to the potency of the skin can lose its elasticity, developing ‘stretch marks’.
the preparation, where it is being used, the condition of the Other possible side effects include increased hair growth of
skin on which it is used and the age of the person very fine hair and perioral dermatitis (i.e. a spotty rash
concerned. Pregnant women should consult their doctor around the mouth). However, it should be stressed that these
regarding the advisability of continued use of their usual effects usually only occur when potent steroids have been
topical steroid preparation. All these factors will be taken into applied for a long period of time, either to the face or to
consideration when a prescription is given to treat eczema. covered parts of the body such as the flexures. Skin thinning
can also occur when steroids have been applied under
Hydrocortisone 0.05%, 0.1%, 0.5% or 1% is extremely
occlusion (e.g. to the hands with plastic gloves). For this
unlikely to cause adverse effects and can be used as
reason, this type of treatment is limited to short periods of
prescribed on the face and in young children. Be careful not
time under the supervision of a doctor or nurse.
to confuse this with hydrocortisone butyrate, which is a

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Topical steroids factsheet

It is important to bear in mind that these effects take several Summary

weeks to develop and will be avoided if potent preparations
Under the supervision of a doctor, and used properly and
are limited in use and replaced by less potent preparations
sensibly in combination with good skincare as part of an
once they have brought a ‘flare up’ of eczema under control.
overall management routine, topical steroids are a valuable
Keeping up a good daily routine of using complete emollient
treatment for eczema.
therapy for washing, bathing and moisturising to constantly
repair the skin barrier and prevent dry skin has been shown Topical steroids have been in widespread use for over 50
to reduce the amount of topical steroids required for some years and although side effects can occur, this is usually
people. because treatment has been used incorrectly.

There is also a small risk from topical steroids being The use of a stronger topical steroid for a short period of
absorbed into the blood through the skin. Again, the time, decreasing the strength as the condition improves,
likelihood of this occurring is directly linked to the amount of will bring most flare-ups of eczema under control. If it does
steroid used and the age of the person involved. The main not, it is likely that other problems, such as infection, dryness
problem relating to the absorption of steroids is a slowing of the skin or regular contact with a known allergen, have
down of growth in children by the suppression of adrenal been ignored.
glands. It is for this reason that strong steroids will only be
Most packs of ointments and creams contain instructions
prescribed for short periods of time for young children, and
on how to use the topical steroid properly; if you are ever in
if required over long periods, only under the supervision of,
doubt about how to use your treatment, do not hesitate to
and monitoring by, a hospital specialist.
ask either your doctor or the pharmacist who supplied it.
Allergy to the steroid itself or to the base of the preparation
Finally, it is important not to forget that emollients need to
can sometimes occur. If the eczema gets worse after using
become an accepted part of the daily skincare routine. They
a particular steroid, let your doctor know. Also be aware
soothe, moisturise and protect the skin, thus providing the
that topical steroids can suppress the symptoms of skin
basis for everyday management of eczema and help to
infection, so always check with your doctor if in doubt.
reduce the need for topical steroid preparations.
Fear of side effects can make people under-treat their
eczema by stopping a treatment too soon or not using the
steroid they have been given. This can be detrimental to
the overall management of the condition and may mean
that a stronger preparation has to be used to bring the
eczema under control again.

DISCLAIMER
Our publications contain information and general advice about eczema. They are written and reviewed by dermatology experts, with input from people with
eczema. We hope you find the information helpful, although it should not be relied upon as a substitute for personalised advice from a qualified healthcare professional.
While we strive to ensure the information is accurate and up-to-date, National Eczema Society does not accept any liability arising from its use. We welcome reader
feedback on our publications, please email us at [email protected]

Factsheet last reviewed September 2016.

© National Eczema Society, June 2019. All rights reserved. Except for personal use, no part of this work may be distributed, reproduced, downloaded, transmitted or
stored in any form without the written permission of National Eczema Society.

National Eczema Society is the UK charity for everyone affected by eczema. We help support
people with eczema, providing information and advice, which we deliver through our
website, social media, campaigns, publications and nurse-supported Helpline. We also
provide a voice for people with eczema, raising awareness of the condition, supporting
research into new treatments and campaigning for better medical care.

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