Topical steroids are creams and ointments that reduce inflammation in the skin. They're very effective for eczema, psoriasis and other inflamed skin conditions, and they're safe when used correctly. Many people use too little because they worry about side effects, which means flares last longer. Others use strong steroids for longer than needed. Getting the amount and the timing right makes all the difference.
The four strengths
| Strength | Example (active ingredient) |
|---|---|
| Mild | Hydrocortisone 0.5% to 2.5% |
| Moderate | Clobetasone butyrate 0.05% |
| Potent | Betamethasone valerate 0.1%, mometasone furoate 0.1% |
| Very potent | Clobetasol propionate 0.05% |
Stronger steroids are used for thicker skin and more severe flares, for short periods. Milder ones are used on thin skin such as the face. The strength is shown on the packaging; check your label or ask a pharmacist.
How much to use: fingertip units
A fingertip unit (FTU) is the amount of cream or ointment squeezed from a standard tube along the tip of an adult's index finger, from the tip to the first crease. One FTU is about 0.5 g and is enough to cover an area the size of two flat adult hands, including the fingers.
| Area | Fingertip units |
|---|---|
| Face and neck | 2.5 |
| One hand (both sides) | 1 |
| One arm (not including the hand) | 3 |
| One foot | 2 |
| One leg (not including the foot) | 6 |
| Front of the chest and tummy | 7 |
| Back and buttocks | 7 |
Children need less. Your prescriber or pharmacist can tell you how much to use for a child.
How to apply it
- Wash and dry your hands.
- Squeeze out the right number of fingertip units.
- Dot it over the affected skin, then smooth it in gently in the direction of hair growth until it disappears. Apply it only to inflamed skin.
- Wash your hands afterwards, unless you're treating your hands.
- Use it as often as directed, usually once or twice a day. Once a day is often enough.
Steroids and emollients
Keep using your emollient even when you're using a steroid. Apply them at different times, waiting around 20 to 30 minutes between the two, so the emollient doesn't dilute or spread the steroid. Ask your prescriber or pharmacist which to apply first.
How long to use it for
Use it until the flare has settled, usually for a few days to two weeks, then stop or step down as advised. Over-the-counter hydrocortisone shouldn't be used for more than seven days without advice, and shouldn't be used on the face, eyes, genitals, broken or infected skin, or in children under 10, unless a doctor has advised it. If you need a steroid regularly, or for longer than your prescriber advised, go back for a review.
Side effects
Used as directed, side effects are uncommon. Using a strong steroid for a long time, especially on thin skin, can cause thinning of the skin, stretch marks, easy bruising, visible blood vessels and changes in skin colour. Short courses used correctly don't usually cause these problems. The MHRA has also described rare topical steroid withdrawal reactions after long-term use; see our guide to topical steroid withdrawal.
Emollients and fire safety
The MHRA warns that emollients, both paraffin-based and paraffin-free, can soak into clothing, bedding and dressings and make them burn more easily. Don't smoke or go near naked flames when using emollients, and wash clothing and bedding often at a high temperature.
Our eczema and psoriasis treatment page explains the steroid and other treatments we offer, including betamethasone cream.
Frequently asked questions
What is a fingertip unit?
The amount of cream squeezed along the tip of an adult index finger, from the tip to the first crease. It's about 0.5 g and covers an area the size of two flat adult hands.
How long can I use a steroid cream for?
Usually until the flare settles, often a few days to two weeks, unless your prescriber advises otherwise. Over-the-counter hydrocortisone shouldn't be used for more than seven days without advice.
Should I apply steroid cream or moisturiser first?
Use them at different times, waiting around 20 to 30 minutes between the two. Ask your prescriber or pharmacist which order suits your treatment.
Can I use steroid cream on my face?
Only a mild steroid, and only if a doctor or prescriber advises it. Stronger steroids can thin the delicate skin on the face and can make conditions such as rosacea worse.
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