Steroids are hormonal substances that are produced naturally in the body by the adrenal glands (which are just above each kidney) and by the reproductive organs.
Steroid medicines are man-made versions and can be given in many ways, including intravenously (into a vein) and orally (by mouth) in the form of tablets or a liquid.
What are topical steroids?
Topical steroids are medicines in the form of a cream, ointment or lotion that are used to treat certain skin problems, such as eczema, psoriasis and other conditions where the skin is sore and inflamed.
Topical steroids are usually described as mild, moderate, potent or very potent. In most cases, they are available in different forms, such as creams, ointments and lotions. Which format your child is prescribed depends on his or her skin problem. The most common forms of topical steroids used at Great Ormond Street Hospital (GOSH) are as follows. The usual brand name used is given in brackets after the generic name.
Mild
- hydrocortisone 0.5%
- hydrocortisone 1%
- fluocinolone 0.0025% (Synalar 1 in 10 dilution®)
Moderate
- betamethosone valerate 0.025% (Betnovate-RD®)
- clobetasone butyrate 0.05% (Eumovate®)
- fludroxycortide 0.0125% (Haelan®)
- hydrocortisone 2.5%
- fluocinolone acetonide 0.00625% (Synalar 1 in 4 dilution®)
Potent
- betamethasone valerate 0.1% (Betnovate®)
- fluticasone propionate 0.05% (Cutivate®)
- mometasone furoate 0.1% (Elocon®)
- hydrocortisone butyrate 0.1% (Locoid Crelo®)
- beclometasone dipropionate 0.025% (Propaderm®)
- fluocinolone acetonide 0.025% (Synalar®)
Very potent
- Clobetasol propionate 0.05% (Dermovate®)
The strength of topical steroids is usually described as a percentage, showing the proportion of active ingredient in the base cream. For instance, hydrocortisone 1% contains one per cent of the active ingredient and the rest of the medicine is the cream in which the active ingredient is dissolved.
How are topical steroids given?
Topical steroids should be spread thinly on the affected area of skin. One way of measuring amounts of topical steroids is in ‘fingertip units’, which is the distance from the tip of the index finger to the first crease. The label on the medicine will tell you how often to apply treatment to the affected areas. After you have applied the topical steroid to your child’s skin, wash your hands thoroughly. With some of the more potent topical steroids, you may be advised to apply the medicine using a cotton bud rather than your fingers.
If you are using other ointments or creams on your child’s skin, you should wait at least half an hour before applying another ointment or cream on top of the topical steroid. This will give enough time for the active ingredients in the topical steroid to sink in and will stop the two medicines reacting together.
In most cases, applying the topical steroid once or twice a day is enough to control the symptoms of the skin problem. Your doctor, nurse or pharmacist will give you precise instructions for how much topical steroid to use, how often and to which areas of skin.
Some parents worry about using topical steroids so they tend not to use enough. Using too little will mean that a child’s skin condition may need treatment for much longer than originally needed or with more potent steroids.
What are the side effects of topical steroids?
Topical steroids are safe when they are used correctly. They can have side effects, but these depend on the potency of the topical steroid, how much is used and for how long. Side effects are very rare with short courses of mild and moderate topical steroids, but may occur with potent or very potent types, especially if used for a long time.
Some of the reported side effects of topical steroids are as follows.
Spread or worsening of any untreated skin infection in the area
Sometimes using a topical steroid can ‘hide’ an underlying skin infection, making it worse or allowing it to spread to other areas.
Thinning of the skin, development of marks or broken veins or white patches
This tends to only happen if potent or very potent topical steroids are used for a long time. In most cases, the skin thinning will improve once the topical steroids are stopped. Marks like stretch marks, broken veins or white patches can be permanent but can often be disguised with make up or cosmetic camouflage.
Skin irritation
Some people become sensitised to an ingredient such as a preservative added to stop the cream or ointment going off. This can make the skin inflammation worse but is often improved by switching to another type of topical steroid.
Acne
Topical steroids can make acne worse if applied to the area affected by acne.
Effects on growth
This is extremely rare and tends only to affect young children who are using certain types of potent topical steroids on a very long-term basis on large areas of skin.
Important information about topical steroids
- Some topical steroids, particularly those containing white soft paraffin or petroleum jelly can catch fire if used near a naked flame. Never apply topical steroids to your child by candlelight, near an open fire or while smoking a cigarette. Once the topical steroids have been applied to your child’s skin, he or she should also avoid naked flames, such as candles or open fires. Store the topical steroids in a cool, dry place, away from any naked flames or heat sources such as radiators.
- Use the medicine only as you have been instructed.
- When your child stops treatment, please return the medicine to your pharmacist for disposal. Do not throw it away.
- Keep all medicines out the reach of children.
Last reviewed by Great Ormond Street Hospital: May 2007
Ref: F070259 © GOSH Trust May 2007
Compiled by the Pharmacy Department in collaboration with the Child and Family Information Group
Please read this information in conjunction with any patient information leaflet provided by the manufacturer. However, please note that this information explains about the use of medicines in children and young people so may differ from the manufacturer’s information.
Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. This information does not constitute health or medical advice and will not necessarily reflect treatment at other hospitals. If you have any questions, please ask your doctor. No liability can be taken as a result of using this information.
