Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price. Side effects may occur from sudden discontinuation and prolonged, continuous use can lead to skin thinning. Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning.

Medical uses

Weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, and breast folds. Weaker steroids are used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds. Moderate steroids are used for atopic dermatitis, nummular eczema, xerotic eczema, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide) and severe dermatitis. Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy exposure, alopecia areata, nummular eczema, and severe atopic dermatitis in adults. For treating atopic dermatitis, newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. They are also generally safe and do not cause skin thinning when used intermittently to treat atopic dermatitis flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment). Applying once daily is enough as it is as effective as twice or more daily application. To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off. Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility. The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.

Adverse effects

Safety in pregnancy

Using topical steroids as intended during pregnancy is safe and does not cause miscarriage, birth defects or any pregnancy-related problems.

Classification systems

Seven-class System

The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.

Class I

Very potent: up to 600 times stronger than hydrocortisone

Class II

Class III

Class IV

Class V

Class VI

Class VII

The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well.

Five-class System

Japan rates topical steroids from 1 to 5, with 1 being strongest.

Four-class System

Many countries, such as the United Kingdom, Germany, the Netherlands, New Zealand, recognize 4 classes. In the United Kingdom and New Zealand I is the strongest, while in Continental Europe, class IV is regarded as the strongest.

Class IV (UK/NZ: class I)

Very potent (up to 600 times as potent as hydrocortisone)

Class III (UK/NZ: class II)

Potent (50–100 times as potent as hydrocortisone)

Class II (UK/NZ: class III)

Moderate (2–25 times as potent as hydrocortisone)

Class I (UK/NZ: class IV)

Mild

Allergy associations

The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids. When one is allergic to one group, one is allergic to all steroids in that group.

Group A

Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and prednisone

Group B

Triamcinolone acetonide, triamcinolone alcohol, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide

Group C

Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate, and fluocortolone

Group D

Hydrocortisone 17-butyrate, hydrocortisone-17-valerate, alclometasone dipropionate, betamethasone valerate, betamethasone dipropionate, prednicarbate, clobetasone-17-butyrate, Clobetasol-17 propionate, fluocortolone caproate, fluocortolone pivalate, fluprednidene acetate, and mometasone furoate

History

Corticosteroids were first made available for general use around 1950.