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What is a topical steroid?

Topical steroids are medications such as creams, ointments, aerosols, gels and lotions that can be applied directly to the skin or scalp to treat various types of conditions. For instance alleviate redness, swelling and allergic reactions affecting the skin. This type of medications are also used for mosquito bites, irritation, rash, eczema and itching. Some steroids can be obtained over the counter without a prescription from a doctor and others require a prescription.

 

Topical steroids are different from anabolic steroids

Topical steroids should not be confused with anabolic steroids, which are commonly used by to increase muscle mass.

 

Medication available

Topical steroids are normally sold in the form of creams, solutions, lotions, powders, gels, ointments and aerosols and in different sizes. The topical steroid potency is denoted from high potency (class 1) to low potency (class 7), with class one been the strongest and class seven the weakest.

 

Types of steroids

 

There are a variety of routes in which steroids can be used, for example topical steroids are those steroids that are required to be applied directly on the affected area unlike oral or parental steroids that are used to treat certain conditions systemically (those conditions require other routes of administration other than applying the medication directly to the affected area).

 

What are the most popular topical steroids?

Below is a list of the most popular topical steroids, outlining their class indicating their potency, generic name/active ingredient and in brackets the brand name.

 

Class 1

Class 2

Class 3

Class 4

Class 5

Class 6

Class 7

Clobetasol propionate 0.05% (Dermovate)

Desoximetasone 0.25% (Topicort)

Mometasone furoate 0.1% (Elocon, Elocom ointment)

Mometasone furoate 0.1% (Elocon cream, lotion)

Fluticasone propionate 0.05% (Cortate, Cutivate cream)

Alclometasone dipropionate 0.05% (Aclovate cream, ointment)

Hydrocortisone 2.5% (Hydroval, Hyderm, Hytone cream, lotion, ointment)

Betamethasone dipropionate 0.25% (Diprolene)

Amcinonide 0.05% (Cyclocort)

Triamcinolone acetonide 0.5% (Kenalog, Aristocort cream)

Fluocinolone acetonide 0.01-0.2% (Derma-Smooth, Synalar, Synemol, Fluonid)

Fluocinolone acetonide 0.025% (Synalar, Synemol cream)

Fluocinolone acetonide 0.01% (Capex shampoo, Dermasmooth)

Hydrocortisone 1% (Many over-the-counter brands)

 

What do they treat?

 

They are often used for various conditions form redness, swelling to itching. Weaker topical steroids are often used for more sensitive areas in the body such as face, armpit, eyelids etc. while moderate topical steroids are used quite often for scabies, severe dermatitis, sclerosis and eczema and finally strong topical steroids are used for the treatment of psoriasis, severe atopic dermatitis, and nummular eczema etc.

 

To prevent a reduction in effectiveness (tachyphylaxis) of topical steroids, they are often required to be used on a week on and off routine, some doctors may require you to use it differently too. The use of topical steroids long term can lead to secondary infections with bacteria and fungus.

 

 

Do you need a prescription or can you buy them over the counter (otc)?

Some of this topical agents are mostly obtained with a prescription from a doctor while some can be obtained over the counter because they are weaker.

Brand

Generic

Prescription or over the counter

Dermovate

Clobetasol propionate 0.05%

Prescription

Topicort

Desoximetasone 0.25%

Prescription

Cutivate cream

Fluticasone propionate 0.05%

Prescription

Derma-Smooth, Synalar, Synemol cream

Fluocinolone acetonide 0.025%

Prescription

Hytone, Cortate

Hydrocortisone 1%

OTC

 

 

Safety information

 

Side effects

Some of the side effects involved with the use of topical steroids may include the following:

  • Hypothalamic pituitary adrenal axis (HPA) suppression
  • Cushing's syndrome
  • Diabetes mellitus
  • Osteoporosis
  • Topical steroid addiction
  • Allergic contact dermatitis
  • Steroid atrophy
  • Perioral dermatitis: sudden appearance of rash on the eye and mouth as a result of topical steroid use.
  • Folliculitis
  • Miliaria
  • Genital ulcers
  • Long-term use could lead to Norwegian scabies and Kaposi's sarcoma

 

Contraindications

The use of any topical steroid agent is contraindicated in any one who is hypersensitive to any of the active ingredients or any ingredients used in the formulation.

 

Warnings and precautions

 

  • Should not be recommended to patients that are allergic to these drugs or any of its chemical components
  • Topical steroids are not recommended for the treatment of diaper rash.
  • It is not recommended to wear tight fitting diapers or plastic pants on the infected part of the skin when undergoing treatment with topical steroids as this will allow more of the medication to enter the body.
  • Topical steroids should be applied on cuts or bruised/damaged skin.
  • Topical steroids should not be used on bacterial, virus or parasitic infection of the skin.

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