Topical Steroids

Topical steroids are safe and effective medications used as the mainstay for treatment of numerous skin conditions. They work to reduce inflammation within the skin and can drastically improve symptoms without absorption into the bloodstream (meaning no adverse effects on internal organs, etc). Nevertheless, it is important that these medications be used correctly, as improper or over-use can lead to skin reactions such as rash, redness, skin thinning, and stretch marks.

General Principles

  1. Use only asmuch (or as strong) as needed, exactly where it is needed, and for only as long as needed.
    • Refer to classes below for additional info on medication strength. 
  2. Try to use no longer than 2 weeks in a row followed by a 1 week break (“2 weeks on, 1 week off”).
    • Exception: areas of thick skin such as scalp and hands/feet (okay to use indefinitely).  
  3. Always apply before moisturizers or other topical agents, ideally after bathing while skin is damp and moist.

STRONGEST

(Clobetasol, Betamethasone, Desoximetasone)
  • Use for areas of thick skin (scalp, hands, feet, plaques) or sever/ stubborn flares only.
  • Never use on areas with thin skin (face, arm pits, groin) unless specifically instructed otherwise.
  • If rash or symptoms still not improving, talk to your dermatologist about wet wraps or plastic occlusion. 

MEDIUM

(Triamcinolone, Mometasone, Fluocinolone)
  • Use for typical flares over trunk and extremities. In general, this will be the strength used most often.
    • Often comes in largest size (“tub” or “jar”). 
  • Okay to use for severe flares of thin areas (face, arm pits, groin) but only for brief periods (~1 week max).

WEAKEST

(Desonide, Hydrocortisone, Clocortolone)
  • Use for typical flares of thin areas such as face, arm pits, and groin.
  • Use for mild flares over trunk and extremities. 
  • If having to use daily after 1-2 weeks, contact your dermatologist to discuss alternative options.

NON-STEROIDAL

(Tacrolimus, Pimecrolimus, Eucrisa, Opzelura)
  • Often used as an adjunct or add-on to topical steroids.
    • Okay to use daily, on all areas, with no risk of skin thinning, overuse, etc.
  • Can be applied immediately after steroids, or alternatively, by itself for mild flares and thinner skin.