Table of ContentsView AllTable of ContentsHow They HelpFormulationsHow to ApplyClassificationsSide Effects
Table of ContentsView All
View All
Table of Contents
How They Help
Formulations
How to Apply
Classifications
Side Effects
Topical corticosteroids come as creams, foams, gels, ointments, or solutions in a variety of strengths. Prescriptions commonly include clobetasol, triamcinolone, and hydrocortisone.
Unlike oral steroids that disseminate the active drug through the body, these medications penetrate the skin and go directly to the affected cells.
This article discusses steroidpsoriasis creams. It explains the different topical corticosteroids used to clear psoriasis and the potential side effects of these medications.
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How Corticosteroids Help Psoriasis
Psoriasis is an inflammatoryautoimmune diseasein which the immune system suddenly regards normal skin cells as harmful. In response to the perceived threat, the immune system will launch an inflammatory attack on the middle and upper layers of skin (known, respectively, as thedermisandepidermis).
The inflammation, in turn, will accelerate the production of skin cells, causing them to build up and form dry, scaly lesions known asplaques.
With consistent use, steroid creams are often enough to clear up a psoriasis flare. However, some people with psoriasis benefit from more aggressive treatments. These includeUV light therapy,retinoids, anddisease-modifying antirheumatic drugs (DMARDs).
What Are the Symptoms of Psoriasis?
Topical Steroid Formulations
Not all topical corticosteroids are the same. Your healthcare provider will prescribe the option best suited for you based on, among other things, the location of your plaques and the general state of your skin. There are several different formulations they can choose from:
Your healthcare provider will choose the option that delivers the appropriate amount of drug based not only on the drug concentration but the absorptive capacity of the skin.
Foams are especially effective in that they penetrate into the deeper layers of skin. Because of this, a less-potent corticosteroid may be sufficient when used in this form.
Plaque Psoriasis: Pictures and Symptoms of the Types You May See on Your Body
How to Apply Corticosteroids
Unless your healthcare provider tells you otherwise, never apply topical corticosteroids to the eyelids or under the eyes. Topical steroids should never be used internally or applied to cracked, bleeding, or infected skin.
Topical steroid treatment is typically used until the psoriatic rash clears up. For more severe outbreaks, your dermatologist may start you with a stronger topical medication. This can better penetrate thickened psoriasis plaques. Once the major scaling has been reduced, you may be switched to a milder steroid cream.
Some corticosteroids are used on an intermittent basis wheneversigns of a psoriasis flarebegin to develop. These will usually be milder (Class VI or VII) drugs that can be applied when needed.
Always check the expiration date and let your healthcare provider know well in advance if you need a refill. Steroid creams and ointment tubes can get messy. It can be helpful to store them in their original box with the prescription label.
How to Safely Use Topical Steroids
Classes of Topical Steroids
Topical steroids come in seven different classes. The mildest topical steroids, categorized as Class VII, include over-the-counter 1%hydrocortisone cream. The strongest topical steroids, known as Class I, include more aggressive preparations like clobetasol.
ClassPotencyIMaximum potencyIIHighly potentIIIPotentIVModerately potentVSomewhat potentVIMildly potentVIILeast potentKeep in mind that the greater the potency of a topical corticosteroid, the greater the risk of side effects. It’s important that your psoriasis be treated based on its severity.Topical Steroid Class IThese topical steroids have the highest potency overall:Diprolene (betamethasone dipropionate 0.05% ointment or gel)Clobex (clobetasol propionate 0.05% lotion, spray, or shampoo)Ultravate (halobetasol propionate 0.05% cream, ointment, or lotion)Vanos (fluocinonide 0.1% cream)Topical Steroid Class IIThese topical steroids are considered highly potent:Cyclocort (amcinonide 0.1% ointment)Halog (halcinonide 0.1% cream, ointment, or solution)Lidex (fluocinonide 0.05% cream, gel, ointment, or solution)Topicort (desoximetasone 0.25% cream or ointment)Topical Steroid Class IIIThese topical steroids are considered potent:Cutivate (fluticasone propionate 0.005% ointment)Elocon (mometasone furoate 0.1% ointment)Florone (diflorasone diacetate 0.05% cream)Topicort LP (desoximetasone 0.05% cream)Topical Steroid Class IVThese topical steroids are considered medium potent:Cordran (flurandrenolide 0.05% cream, ointment, or lotion)Cutivate (fluticasone propionate 0.05% cream)Kenalog (triamcinolone acetonide 0.025% cream or 0.1% lotion)Synalar (fluocinolone acetonide 0.025% cream or ointment)Triderm (triamcinolone acetonide 0.1% cream, ointment, or lotion)Topical Steroid Class VThese topical steroids are considered lower-mid potent:Westcort (hydrocortisone valerate 0.2% cream or ointment)Locoid (hydrocortisone butyrate 0.1% ointment)Dermatop (prednicarbate 0.1% cream or ointment)Pandel (hydrocortisone probutate 0.1% cream)Topical Steroid Class VIThese topical steroids are considered mild:DesOwen (desonide 0.05% lotion, gel, cream, or ointment)Kenalog (triamcinolone acetonide 0.025% cream or lotion)Synalar (fluocinolone acetonide 0.01% cream, solution, or shampoo)Topical Steroid Class VIIThese topical steroids are the least potent overall:Hydrocortisone 1% cream, ointment, or lotionHydrocortisone 2% and 2.5% cream, ointment, or lotionHydrocortisone acetate 2% and 2.5% cream or ointmentSide Effects of Topical SteroidsClass I steroids are not just a little stronger than Class VII; they are between 600 and 1,000 times stronger. These ultra-high-potency preparations have the greatest efficacy overall but also the most side effects. As a result, a Class VII topical steroid may only be prescribed for two to three weeks, while a Class I drug may be used for longer periods.The likelihood of side effects increases with the drug’s strength and the duration of treatment. Use the medication as prescribed and avoid using more than directed.Possible sides effects of topical corticosteroids include:Stinging or burning sensationsSkin redness on light or medium skin tones and discoloration, such as violaceous, grey, brown or black on darker skin tones (erythema)AcneRosaceaSkin thinning (atrophy)Stretch marks (striae) in the armpits or groinEasy bruising and tearing of the skinEnlarged blood vessels (telangiectasia)Increased localized hairiness (hypertrichosis)Hypopigmentation of the treated skinMany of the more severe symptoms can occur after weeks or months of treatment. It is important to stop treatment and call your healthcare provider should any skin abnormality develop. Any damage to the skin may be permanent.Can Steroid Cream Make Psoriasis Worse?On their own, topical corticosteroids should not cause psoriasis symptoms to worsen. However, combinationtreatmentscan. For example, a worsening of psoriasis is a less common side effect of Enstilar, which combines the corticosteroid betamethasone with calcipotriene, a form of vitamin D.A worsening of psoriasis when using topical steroids could also indicate an allergy to an active or inactive ingredient.If you experience a worsening of psoriasis symptoms after applying steroid cream, discontinue use and contact your prescriber.When and How to Taper off SteroidsIf a topical corticosteroid is used for an extended period, you may need to slowly taper off the medication. If stopped abruptly, topical steroids can cause withdrawal.Symptoms of corticosteroid withdrawal include:A severe rebound of psoriasis symptomsExtreme sensitivity to heat or coldResistance to topical medicationsTo prevent steroid withdrawal, your healthcare provider willtaper the dosegradually over weeks or months. If you experience a worsening of symptoms during the tapering phase, call your practitioner.Treating Psoriasis With Topical Retinoids
Keep in mind that the greater the potency of a topical corticosteroid, the greater the risk of side effects. It’s important that your psoriasis be treated based on its severity.
Topical Steroid Class I
These topical steroids have the highest potency overall:
Topical Steroid Class II
These topical steroids are considered highly potent:
Topical Steroid Class III
These topical steroids are considered potent:
Topical Steroid Class IV
These topical steroids are considered medium potent:
Topical Steroid Class V
These topical steroids are considered lower-mid potent:
Topical Steroid Class VI
These topical steroids are considered mild:
Topical Steroid Class VII
These topical steroids are the least potent overall:
Side Effects of Topical Steroids
Class I steroids are not just a little stronger than Class VII; they are between 600 and 1,000 times stronger. These ultra-high-potency preparations have the greatest efficacy overall but also the most side effects. As a result, a Class VII topical steroid may only be prescribed for two to three weeks, while a Class I drug may be used for longer periods.
The likelihood of side effects increases with the drug’s strength and the duration of treatment. Use the medication as prescribed and avoid using more than directed.
Possible sides effects of topical corticosteroids include:
Many of the more severe symptoms can occur after weeks or months of treatment. It is important to stop treatment and call your healthcare provider should any skin abnormality develop. Any damage to the skin may be permanent.
Can Steroid Cream Make Psoriasis Worse?
On their own, topical corticosteroids should not cause psoriasis symptoms to worsen. However, combinationtreatmentscan. For example, a worsening of psoriasis is a less common side effect of Enstilar, which combines the corticosteroid betamethasone with calcipotriene, a form of vitamin D.
A worsening of psoriasis when using topical steroids could also indicate an allergy to an active or inactive ingredient.If you experience a worsening of psoriasis symptoms after applying steroid cream, discontinue use and contact your prescriber.
When and How to Taper off Steroids
If a topical corticosteroid is used for an extended period, you may need to slowly taper off the medication. If stopped abruptly, topical steroids can cause withdrawal.
Symptoms of corticosteroid withdrawal include:
To prevent steroid withdrawal, your healthcare provider willtaper the dosegradually over weeks or months. If you experience a worsening of symptoms during the tapering phase, call your practitioner.
Treating Psoriasis With Topical Retinoids
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Castela E, Archier E, Devaux S.Topical corticosteroids in plaque psoriasis: a systematic review of efficacy and treatment modalities.Journal of the European Academy of Dermatology and Venereology. 2012;26:36-46. doi:10.1111/j.1468-3083.2012.04522.x
Gabros S, Zito PM.Topical Corticosteroids. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
Das A, Panda S.Use of topical corticosteroids in dermatology: an evidence-based approach.Indian J Dermatol. 2017;62(3):237–50. doi:10.4103/ijd.IJD_169_17
Jacob SE, Steele T.Corticosteroid classes: A quick reference guide including patch test substances and cross-reactivity.Journal of the American Academy of Dermatology. 2006;54(4):723-727. doi:10.1016/j.jaad.2005.12.028
UpToDate.Topical Corticosteroids: Comparison of representative topical corticosteroid preparations (classified according to the US system).
National Psoriasis Foundation.Topical steroids for psoriasis.
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