Dermatology/Topical corticosteroid

Topical corticosteroids

also: TCS · steroid cream · hydrocortisone · Betnovate · Dermovate

Overview

Anti-inflammatory cornerstone of eczema and many dermatoses. Potency is matched to site and severity — the ladder and the fingertip unit are heavily tested.

Mechanism

Bind the cytoplasmic glucocorticoid receptor → induce annexin-1 (lipocortin) → inhibit phospholipase A₂ → ↓prostaglandins/leukotrienes; suppress pro-inflammatory cytokine transcription. Net anti-inflammatory, immunosuppressive, vasoconstrictive and antiproliferative.

Indications

Eczema/dermatitis flares
Psoriasis (with caution)
Lichen planus, discoid lupus, many inflammatory dermatoses

The agents

Hydrocortisone 1%MILD

Face, flexures, children, mild eczema.

Clobetasone butyrate (Eumovate)MODERATE

Moderate eczema; short facial courses.

Betamethasone valerate 0.1% (Betnovate) / MometasonePOTENT

Body/limb eczema, thicker plaques.

Clobetasol propionate (Dermovate)VERY POTENT

Lichenified/palmoplantar; short courses, specialist.

Adverse effects

Skin atrophy, striae, telangiectasiaclassic

Potency- and duration-dependent; worst on face/flexures.

Perioral dermatitis / steroid rosaceacommon

Facial use.

Tinea/“steroid-modified” infection (tinea incognito)common

Masks/worsens untreated fungal or bacterial infection.

Systemic absorption → HPA suppressionserious

Potent steroid, large area, occlusion, infants.

Cautions & contraindications

Untreated bacterial / fungal / viral skin infectionall

Steroid suppresses local immunity → spread.

Potent steroids on the face / flexures / in infantsall

Atrophy + absorption.

Rosacea / perioral dermatitisall

Interactions

Monitoring & kinetics

Skin for atrophy; quantity (fingertip unit ≈ 0.5 g covers two adult palms)

Topical OD–BD; step down potency as it settles. Use a steroid-sparing agent for chronic facial disease.

Source: NICE CKS — Topical corticosteroids · BNF — Topical corticosteroids