Six Safe Tips from a Dermatologist to Use Topical Steroids Safely

Topical steroids are widely used as a treatment for several skin conditions such as psoriasis, eczema, vitiligo, bullous pemphigoid, and many others. Multiple studies have shown that steroids are both safe and effective at reducing inflammation.^[1,2] However, there are still many lingering fears and concerns about steroid use.^[3-7] Steroids are part of a healthy treatment regimen but they need to be used correctly to reduce the possibility of side effects. Here are some tips in which steroids can be used more safely:

1) Topical Steroids Are Not All Created Equal

Steroids come in different strengths and are differently used based on where they are applied to the body. For example, weaker steroids are used on the face and areas where there is skin-on-skin contact like the armpits and groin. Likewise, stronger steroids are used on the back, chest, abdomen, arms, hands, legs, and feet.  A chart of steroid strength and classes is listed in Table 1.

2) The Percentage of Steroid in the Cream Does Not Represent Strength

If your doctor prescribes hydrocortisone 2.5% ointment and clobetasol 0.05% ointment, you may think that the hydrocortisone 2.5% is a stronger ointment since it has a higher amount of the medication in the prescription (2.5% vs 0.05%). However, this is not how steroids work. The amount of medication is only part of the story. Each steroid has an inherent strength to it and clobetasol is much more powerful than hydrocortisone. A 0.05% preparation of clobetasol is much stronger than a 2.5% preparation of hydrocortisone. Please refer back to Table 1 for details on the steroid strengths. 

3) Steroids Are to Be Used Temporarily as Needed to Reduce Inflammation

Steroids are best used to temporarily reduce inflammation but should not be used for long-term treatment. Depending on the disease, topical steroids are frequently transitioned to other topical medications to reduce steroid exposure. Here are some examples of how steroids are transitioned with other diseases:

In chronic conditions such as psoriasis, atopic dermatitis, and, seborrheic dermatitis, the diseases can wax and wane, and sometimes the conditions can worsen, requiring the use of topical steroids to gain control. 

4) Patient-Doctor Communication About Steroids

Patients and their physicians should feel empowered to honestly discuss any fears about steroids. While many people seek alternatives to steroids, it’s important to realize that steroids are effective in treating many skin conditions and are safe when used appropriately. Studies that have looked for steroid alternatives have typically compared the alternative to lower strengths of steroids, such as low potency hydrocortisone,^[8-10] which is much weaker than mid or high potency steroids. 

Mid-potency and stronger steroids are uniquely strong in their ability to reduce inflammation. Patients and doctors should consider discussing the following questions when discussing steroid use:

• How long do the steroids need to be used?
• Are there other medications that will help reduce steroid usage?
• Which steroids should be used and where should they be applied?

5) Commit When Using Topical Steroids

The point of using steroids is to reduce inflammation and they are most effective when used regularly. Skipping days or using an ultra-thin layer may keep the steroids from working effectively. As a result, the skin condition or skin inflammation will last longer, leading to more discomfort. Typically, the goal is to use a strong steroid for a short amount of time so that it works more quickly and can be transitioned to a steroid alternative over a quicker time period.

6) Steroid Treatment Plans Will be Customized by a Doctor

There are no absolute hard and fast rules when it comes to using steroids. The points raised in this article provide a general framework for how steroids are built into a treatment plan. When providing care, doctors will have unique approaches to how they may use steroids with each individual. For example, in rare cases, a doctor or dermatologist may use a strong steroid on the face, armpits, or groin if it is needed for a more severe skin condition.

Steroids are effective and can be used safely. The key is good communication between patients and doctors about how and why steroids are being used.^[11]