Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.

Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado.

Topical steroids, or topical corticosteroids, are medications that are applied directly to the skin. They are used to relieve skin conditions that cause skin inflammation and irritation. When used as directed by your healthcare provider, topical steroids are a safe and effective way to treat conditions such as eczema, psoriasis, and atopic dermatitis.

Topical steroids can be prescribed or purchased over-the-counter (OTC). They come in a variety of strengths and forms, such as creams or ointments.

This article will explore how topical steroids work, the way they are grouped based on strength, and examples of medications.

Topical steroids are medications that reduce inflammation in your skin.

Inflammation is a sign of an immune response. The treatment is applied to an affected area of skin to help reduce symptoms such as rashes, scaly patches, itching, pain, redness, or swelling.

For example, eczema, also known as atopic dermatitis, is a group of skin conditions that lead to itchy and inflamed skin with a scaly rash. Eczema is common in children. If you experience a flare-up of eczema, you can apply a cream to help you stop scratching the area and allow your skin to heal.

Topical steroids may be used for other skin conditions such as:

The skin has two main layers: an outer layer called the epidermis and the inner layer called the dermis.

The strength of a topical steroid is determined by a test that measures how much it can cause your blood vessels to constrict in the upper part of the dermis.

As blood vessels constrict, it can reduce swelling and discomfort.

Topical steroids constrict blood vessels to reduce inflammation. They may be prescribed for autoimmune disorders that affect the skin, allergic reactions, and conditions that result in rashes.

Topical steroids are usually applied in a thin layer and massaged into your skin anywhere from one to four times a day. They can come in different forms including:

Topical steroids come in both oily and non-greasy options. The type prescribed varies based on the area of skin where it will be applied.

Topical steroids come in a range of strengths and are divided into seven classes based on how strong they are. The strongest steroids are in Class I (class one) and the weakest steroids are in Class VII (class seven).

Class I topical steroids are approximately 600 to 1,000 times stronger than those in Class VII.

It is important to note that the percentages listed on a product label do not reflect the product's strength. For example, a 0.01% Class I topical steroid is far more potent than a 3% Class VII steroid.

The appropriate steroid strength, or potency, depends on a variety of factors.

For example, babies absorb topical steroids much faster than adults, so they may require a low-potency steroid.

Areas of the body where skin touches skin, such as the armpits or under the breasts, or sensitive areas of skin such as the eyelids, also absorb topical steroids quickly and may only need a low-potency formulation.

However, thick, rough skin on the palms of your hands and the soles of your feet usually absorbs topical steroids more slowly than other parts of the body, so those areas typically require a more potent steroid.

The greater the potency of a topical steroid, the greater the risk of side effects. Common side effects of topical steroids include:

It is possible to overuse topical steroids, which could result in withdrawal symptoms. This can happen if you use mid- to high-strength topical steroids frequently, for a long time, or on sensitive parts of your body like your face or genitals. 

Generally speaking, you should not use low-strength topical steroids for more than three months. High-strength topical steroids should not be used for more than three weeks.

Withdrawal symptoms occur when you stop using topical steroids but may take up to two weeks to appear. They may include:

If you think you are experiencing withdrawal symptoms, talk to your healthcare provider. It's possible to mistake eczema or other skin conditions for topical steroid withdrawal, so it's important to get a proper diagnosis and start an alternative treatment if appropriate.

Your healthcare provider can help you weigh the risks and benefits of using a topical steroid and to find a strength that may be best suited for your skin condition.

How long the drug should be used will also vary based on your condition.

Follow all instructions for using the drug properly and contact your provider if it isn't helping with your symptoms or it leads to more irritation. You may need a change in potency or formulation or you may need to stop using the medication.

There are many medications and formulations within each class of topical steroids.

The highest potency topical steroids include:

These topical steroids are considered highly potent:

These topical steroids are considered potent:

These topical steroids are considered moderately potent:

These topical steroids are considered somewhat potent:

These topical steroids are considered mild:

These topical steroids are considered the least potent:

There are seven classes of topical steroids based on strengths. As you go up in class and potency, the risk of side effects increases.

Topical steroids are medications applied to the skin to reduce inflammation and irritation.

They come in over-the-counter and prescription options with a range of strengths and formulations. Class VII steroids, which includes OTC hydrocortisone creams, are the mildest, while Class I are the strongest.

Your doctor can help you to decide if a topical steroid makes sense for treating your skin condition and what potency and length of treatment may be most helpful in your case.

Siegfried EC, Hebert AA. Diagnosis of atopic dermatitis: mimics, overlaps, and complications. J Clin Med. 2015;4(5):884-917. doi:10.3390/jcm4050884

Uva L, Miguel D, Pinheiro C, et al. Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. 2012;2012:561018. doi:10.1155/2012/561018

American Academy of Pediatrics. Eczema in babies and children.

Humbert P, Guichard A. The topical corticosteroid classification called into question: towards a new approach. Exp Dermatol. 2015;24(5):393-5. doi:10.1111/exd.12677

Gabros S, Zito PM. Topical corticosteroids. StatPearls Publishing.

American Osteopathic College of Dermatology. Steroids (topical).

Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. 2014;5(4):416-25. doi:10.4103/2229-5178.142483

Rathi SK, D'souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. 2012;57(4):251-9. doi:10.4103/0019-5154.97655

American Family Physician. Choosing topical corticosteroids.

National Eczema Association. Education announcement: use of topical steroids for eczema.

By Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years.

Thank you, {{form.email}}, for signing up.

There was an error. Please try again.

By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.