Topical steroids remain one of the most prescribed treatments for inflammatory skin conditions across the United Kingdom. Whether you’re dealing with eczema, dermatitis, or psoriasis, understanding how these medications work, their potency classifications, and proper usage is essential for safe and effective treatment.
What Are Topical Steroids?
Topical steroids, medically known as topical corticosteroids, are anti-inflammatory medications applied directly to the skin. These synthetic versions of naturally-occurring hormones help reduce redness, swelling, and irritation by suppressing the immune system’s inflammatory response at the application site.
How Do Topical Steroids Work?
Topical corticosteroids work by penetrating skin cells and binding to specific receptors within the cell nucleus. This action:
- Reduces inflammation by suppressing inflammatory mediators
- Decreases blood vessel dilation (vasoconstriction)
- Inhibits immune cell activity in the affected area
- Reduces cytokine production that triggers inflammatory responses
- Helps restore the skin barrier function
The medication’s effectiveness depends on several factors including potency, formulation (cream, ointment, or lotion), and the area of application.
UK Classification of Topical Steroids: The Potency Chart
The British classification system divides topical steroids into four distinct potency categories. As of June 2025, new MHRA regulations require all topical steroid packaging to clearly display potency strength on the label.
Topical Steroid Potency Chart UK
Mild Steroids (Class IV)
- Hydrocortisone 0.1-2.5%
- Dioderm (Hydrocortisone 0.1%)
- Mildison (Hydrocortisone 1%)
- Hydrocortisone (various brands)
Moderate Steroids (Class III)
- Eumovate (Clobetasone butyrate 0.05%)
- Betnovate-RD (Betamethasone valerate 0.025%)
- Synalar 1 in 4 dilution (Fluocinolone acetonide 0.00625%)
- Haelan (Fludroxycortide 0.0125%)
Potent/Strong Steroids (Class II)
- Betnovate (Betamethasone valerate 0.1%)
- Elocon (Mometasone furoate 0.1%)
- Synalar (Fluocinolone acetonide 0.025%)
- Cutivate (Fluticasone propionate 0.05%)
- Locoid (Hydrocortisone butyrate 0.1%)
- Diprosone (Betamethasone dipropionate 0.05%)
Very Potent/Very Strong Steroids (Class I)
- Dermovate (Clobetasol propionate 0.05%)
- Nerisone Forte (Diflucortolone valerate 0.3%
Which Steroid Cream is Strongest?
Clobetasol propionate 0.05% (commonly branded as Dermovate) represents the strongest topical steroid available in the UK. This very potent corticosteroid is typically reserved for severe skin conditions that haven’t responded to lower-potency treatments.
Very potent steroids should only be used:
- Under close medical supervision
- For short durations (typically 2-4 weeks maximum)
- On thick-skinned areas (avoiding face, genitals, and skin folds)
- When prescribed by a qualified healthcare professional
Steroid Cream Names: Complete List by Potency
Common Eczema Steroid Cream Names
For eczema management, doctors typically prescribe:
First-line treatments:
- Hydrocortisone 1% (mild) for maintenance
- Eumovate (moderate) for flare-ups
- Betnovate (potent) for severe flare-ups
Children and facial use:
- Hydrocortisone 0.5-1% (mild)
- Eumovate (moderate, short-term only)
Body and limb treatment:
- Betnovate or Elocon (potent)
- Dermovate (very potent, severe cases only)
What Topical Steroids Are Available Over the Counter?
In the UK, only mild-potency hydrocortisone preparations can be purchased over the counter without a prescription:
Over-the-counter options:
- Hydrocortisone 0.5% cream
- Hydrocortisone 1% cream (for adults and children over 10)
- HC45 Hydrocortisone Cream
- Lanacort Creme
Conditions requiring prescription: All moderate, potent, and very potent topical steroids require a prescription from a GP, dermatologist, or qualified prescriber. You cannot buy higher-strength steroid creams over the counter in the UK.
How to Prescribe Topical Steroids: Best Practice Guidelines
Healthcare professionals in the UK follow specific prescribing protocols:
The Steroid Ladder Approach
- Start low: Begin with the lowest effective potency
- Step up: Increase potency if inadequate response
- Step down: Reduce potency once condition improves
- Maintenance: Use minimal effective strength
Prescribing Recommendations
- Face and genitals: Use only mild or moderate steroids
- Body and limbs: Can use potent steroids as appropriate
- Children: Prefer mild steroids; use potent only short-term
- Elderly: Lower potency due to skin thinning
- Pregnancy: Generally safe but discuss with healthcare provider
Topical Steroids for Phimosis UK
For phimosis (tight foreskin) in children and adults, UK doctors typically prescribe:
- Betamethasone 0.05% cream (moderate-potent)
- Applied twice daily for 4-8 weeks
- Combined with gentle stretching exercises
- Success rate of 60-90% when used correctly
Best Steroid Cream for Face
Facial skin is particularly thin and sensitive, requiring special consideration:
Recommended for facial use:
- Hydrocortisone 1%: First choice for mild facial inflammation
- Eumovate (Clobetasone butyrate 0.05%): For short-term use (5-7 days)
- Betnovate-RD: Reduced-strength option for facial eczema
Avoid on face:
- Very potent steroids (Dermovate)
- Prolonged use of any steroid
- Application around eyes without specialist advice
Important: Facial use should be limited to 5-7 days maximum to prevent skin thinning, telangiectasia (visible blood vessels), and perioral dermatitis.
Steroid Cream Side Effects: What You Need to Know
While topical steroids are generally safe when used correctly, potential side effects include:
Common side effects:
- Skin thinning (atrophy)
- Stretch marks (striae)
- Easy bruising
- Visible blood vessels (telangiectasia)
- Acne or rosacea-like symptoms
- Increased hair growth at application site
- Skin colour changes (hypopigmentation)
Serious side effects (rare):
- Systemic absorption with very potent steroids
- Adrenal suppression (long-term, high-potency use)
- Glaucoma or cataracts (near eyes)
- Growth suppression in children
Risk factors for side effects:
- Using very potent steroids
- Applying to face, genitals, or skin folds
- Long-term continuous use
- Using under occlusive dressings
- Applying to broken skin
Topical Steroid Withdrawal (TSW): Recognition and Management
Topical Steroid Withdrawal, also known as Red Skin Syndrome, has gained increased recognition in the UK medical community. Following MHRA guidance issued in May 2024, healthcare providers must inform patients about TSW risks.
What is Topical Steroid Withdrawal?
TSW occurs when someone stops using moderate-to-potent topical steroids after prolonged use. The condition is characterized by rebound inflammation that can be more severe than the original skin condition.
TSW Symptoms:
Skin changes:
- Intense redness or darkening of skin
- Burning or stinging sensations
- Severe itching beyond original areas
- Skin flaking or peeling
- Oozing or weeping skin
- Skin that feels tight or raw
Systemic symptoms:
- Sleep disturbance
- Temperature regulation problems
- Anxiety or depression
- Fatigue
- Social isolation due to appearance
Who’s at Risk for TSW?
Risk factors include:
- Daily use of moderate-to-potent steroids for months or years
- Facial or genital application
- Using steroids as a moisturizer rather than treatment
- Frequent potent steroid use without breaks
- Application to large body surface areas
Managing TSW
If you suspect TSW:
- Consult your GP or dermatologist – Do not self-diagnose
- Gradual tapering – Your doctor may recommend slowly reducing use
- Supportive care – Emollients, cool compresses, antihistamines
- Patience – Recovery can take months to years
- Mental health support – TSW can significantly impact quality of life
Can Skin Recover from Steroid Cream?
Yes, skin can recover from steroid cream side effects, though the timeline varies:
Recovery timelines:
Mild side effects (slight thinning, redness):
- 3-6 months after discontinuation
- Full recovery in most cases
Moderate side effects (visible blood vessels, stretch marks):
- 6-12 months for improvement
- Some changes may be permanent (stretch marks)
Topical Steroid Withdrawal:
- Initial worsening for 2-4 weeks
- Gradual improvement over 6-24 months
- Complete recovery possible but not guaranteed
Promoting skin recovery:
- Use gentle, fragrance-free emollients daily
- Protect from sun exposure
- Maintain good hydration
- Avoid harsh soaps and irritants
- Consider vitamin C serums (for collagen support)
- Be patient – skin regeneration takes time
Safe Usage Guidelines: How to Use Topical Steroids Correctly
The Fingertip Unit (FTU) Method
One FTU = amount of cream squeezed from fingertip to first finger crease
- Covers area equal to two adult palms
Recommended FTU by body area (adults):
- Face and neck: 2.5 FTU
- One hand: 1 FTU
- One arm: 3 FTU
- One leg: 6 FTU
- Front of trunk: 7 FTU
- Back of trunk: 7 FTU
Application tips:
- Moisturize first: Apply emollient 30 minutes before steroid
- Thin layer: Less is more – don’t over-apply
- Affected areas only: Don’t apply to healthy skin
- Proper timing: Usually once or twice daily as prescribed
- Treatment duration: Follow prescribed course, typically 1-2 weeks
- Weekend breaks: Some doctors recommend 2 days off weekly
Storage and handling:
- Keep at room temperature
- Check expiration dates
- Don’t share with others
- Wash hands after application
- Keep away from eyes
Ointments vs Creams vs Lotions: Which Formulation?
Ointments
Best for:
- Very dry, scaly skin
- Thickened skin (lichenified eczema)
- Maximum penetration needed
Characteristics:
- Oil-based, greasy texture
- Most effective steroid delivery
- Fewer preservatives (less irritation)
- Not ideal for weeping or hairy areas
Creams
Best for:
- Moderate dryness
- Facial application
- Daytime use (less greasy)
- Moist or weeping areas
Characteristics:
- Water and oil emulsion
- Absorbs quickly
- More cosmetically acceptable
- May contain preservatives
Lotions
Best for:
- Scalp application
- Large body areas
- Hairy skin
- Acute weeping dermatitis
Characteristics:
- Liquid formulation
- Easiest to spread
- Dries quickly
- Lower steroid concentration effect
When to See a Doctor
Consult your GP or dermatologist if:
- Your skin condition doesn’t improve after 2 weeks
- Symptoms worsen despite treatment
- You develop signs of skin infection (pus, increased pain, fever)
- You experience significant side effects
- You’ve been using steroids for more than 4 weeks continuously
- You suspect topical steroid withdrawal
- You need treatment for facial or genital areas
- Your condition significantly impacts quality of life
Alternative and Complementary Treatments
While topical steroids remain the gold standard for inflammatory skin conditions, alternatives include:
Non-steroid options:
- Topical calcineurin inhibitors (Protopic, Elidel) – For eczema
- Emollients – Foundation of all eczema treatment
- Topical PDE4 inhibitors (Opzelura) – Newer option
- Antimicrobial treatments – If infection present
- Wet wrapping – For severe eczema
- Phototherapy – UV light treatment
Natural complementary approaches:
- Regular emollient use
- Oatmeal baths
- Avoiding triggers
- Stress management
- Dietary modifications (if food triggers identified)
Important: Always discuss alternatives with your healthcare provider. Don’t stop prescribed steroids without medical advice.
NHS Resources for Topical Steroids UK
For authoritative information on topical steroids:
- NHS website: www.nhs.uk/conditions/topical-steroids
- National Eczema Society: Information on proper steroid use
- MHRA drug safety updates: Latest regulatory guidance
- Your GP practice: Personalized advice and prescriptions
- Dermatology departments: Specialist assessment if needed
Key Takeaways
- Topical steroids are effective and safe when used appropriately under medical guidance
- Four potency levels exist in the UK: mild, moderate, potent, and very potent
- Start with the lowest effective potency and step up only if needed
- Face and sensitive areas require special caution – use mild steroids only
- Short-term use is safer – typically 1-2 weeks for acute flares
- Topical Steroid Withdrawal is real – prolonged use of potent steroids carries risks
- Skin can recover from steroid side effects with time and proper care
- Only hydrocortisone 0.5-1% is available OTC – all other strengths require prescription
- New labeling requirements from June 2025 make potency clearer on packaging
- Emollients are essential – use alongside steroids for best outcomes
Conclusion
Topical steroids represent a cornerstone of inflammatory skin condition management in the UK. Understanding the potency classifications, proper usage techniques, and potential risks empowers patients to use these medications safely and effectively.
The UK’s four-tier classification system – from mild hydrocortisone to very potent clobetasol propionate – ensures treatments can be tailored to individual needs. Recent regulatory changes, including mandatory potency labeling from June 2025, reflect ongoing efforts to improve patient safety and awareness.
While concerns about side effects and topical steroid withdrawal are valid, these risks are minimized through appropriate use: choosing the right potency, limiting treatment duration, and following the steroid ladder approach. When questions arise, NHS resources and healthcare professionals provide accessible guidance.
Remember: topical steroids are powerful tools when used correctly. Work with your healthcare provider to find the right treatment approach for your individual situation, balancing effectiveness with safety for optimal skin health outcomes.
This guide is for informational purposes only and does not replace professional medical advice. Always consult your GP or dermatologist before starting, changing, or stopping topical steroid treatment.
