How to Safely Use Topical Steroids

Though topical steroids are generally a safe and effective treatment option, it's important to understand how to use them safely to avoid unwanted, sometimes significant side effects.

Typically, this means massaging a thin layer into the affected area one to four times a day as directed by your healthcare provider.

This article provides guidelines to help you get the most out of using a topical steroid while minimizing the risk of side effects.

Application

Topical steroid creams and ointments should be applied in a thin layer and gently rubbed into the affected area one to four times a day. For most skin conditions, this regimen should continue until the rash resolves.

However, due to the potential side effects of topical steroids, the treatment of some severe rashes or chronic conditions requires intermittent or tapered application of the medication. Chronic skin conditions that wax and wane, such as psoriasis or eczema, benefit from the intermittent application of a topical steroid to prevent recurrences.

Because topical steroids can cause side effects, the spacing of intermittent applications should be discussed with a healthcare provider before proceeding.

The Strength of Topical Steroids

Different surfaces of the skin absorb topical steroids differently. Therefore the strength of the steroid should correspond to the type of skin where it is to be applied. The lower the steroid group number, the greater the risk of side effects. The skin on the eyelids and face is thin and absorbs topical steroids rapidly. A group VI or VII steroid should be applied in these sensitive areas.

The skin on the palms of the hands and soles of the feet is tough and thick. It acts as a barrier that makes it more difficult for topical steroids to penetrate, so a more potent steroid is necessary. Parts of the body where skin touches skin—the groin, rectal area, armpits—absorb topical steroids rapidly, requiring a low-potency steroid. Infants and young children have skin that absorbs topical steroids more readily, also requiring a low-potency steroid.

Topical Steroids Under Occlusion

A topical steroid can be absorbed into the skin more quickly through a process known as occlusion. Occlusion involves applying the topical steroid to the affected area and wrapping it in plastic wrap or cloth and securing it with tape. The plastic wrap keeps perspiration close to the skin and hydrates the stratum corneum, the top layer of the epidermis. Hydrated skin is able to absorb topical medication much more efficiently than dry skin, providing faster relief.

Intermittent Dosing

A common side effect of topical steroid treatment is tachyphylaxis. Tachyphylaxis is essentially a tolerance to the vasoconstrictive action of a steroid. It is the rapid decrease in response to a topical steroid following its initial use. After repeated use of topical steroids, capillaries in the skin do not constrict as well, requiring higher doses and more frequent applications.

It is sometimes more useful to apply topical steroids in intermittent doses. If a topical steroid loses its effectiveness, it should be discontinued for 4 to 7 days, and then restarted.