Can I Use Topical Steroid Creams on My Face?

The side effects may surprise you

African American woman applying makeup
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A walk down the aisles of your local pharmacy will reveal a wide variety of over-the-counter topical corticosteroid brands and preparations, also known as cortisone or steroid creams.

While topical steroids are the most common and effective type of anti-itch cream, it's important to use them as instructed by your doctor, especially when it comes to your face, a sensitive and unique area of skin.

Topical Steroid Creams Especially for Your Face

Topical steroid creams are categorized by their potency, or how strong they are. Group I contains the most potent topical steroid creams, referred to as ultra-high potency. Group VII contains the least potent topical steroid creams, referred to as low potency.

Only the lowest potency topical steroids should be used on your face. This is because the skin on your face is particularly susceptible to the side effects of topical steroids. Likewise, sticking to a low-potency steroid is also important when applying it to areas of the body with thinner skin like the groin, underneath the breast, or the armpit.

In general, high and ultra-high potency steroids are reserved for areas of the body where the skin is thick, like your palms or the soles of your feet, or for more severe skin diseases like psoriasis that's being treated by a dermatologist.

Common Side Effects of Topical Steroid Creams

Side effects from topical steroids are most often seen on the area of skin where the medication is applied. These local skin side effects may include:

  • Thinning of the skin
  • Pigment changes (lighter or darker skin)
  • Telangiectasia (blood vessel) formation
  • Striae (stretch marks)
  • Rosacea, perioral dermatitis, and acne
  • Increased risk of developing skin infections (for example, fungal or bacterial)
  • Delayed wound healing ability
  • Irritation, redness, burning, stinging, and peeling of the skin
  • Contact dermatitis from the topical steroid itself

In addition, getting topical steroid preparations in your eyes may result in serious eye problems like glaucoma or cataracts.

Applying Topical Steroid Cream to Your Face

When applying a steroid cream to your face, it's essential to be under the care of and follow the advice of your doctor. Too little cream may not work and too much increases your risk of side effects.

A good rule of thumb when deciding how much steroid cream to apply is to use the fingertip unit method. A fingertip unit is defined as the amount of steroid cream that can be squeezed from your fingertip to the first crease of your finger. Generally speaking (although confirm with your doctor), 2.5 fingertips units may be used on your face per application.

Lastly, it's important to note that chronically applying topical steroid cream anywhere on the body, not just the face, can make it less effective—a phenomenon called tachyphylaxis. This is why using the shortest duration of steroid cream is recommended. 

However, if a longer-term application is needed for a chronic condition, your doctor will likely recommend following a specific schedule where the steroid amount is reduced, stopped, and then restarted after a steroid-free period.

Alternatives to Steroid Creams

Alternative creams that can be used on the face include Elidel and Protopic, which are topical calcineurin inhibitors (TCIs). These medications are approved by the Food and Drug Administration (FDA) for the treatment of atopic dermatitis in people 2 years of age and older.​

Unlike topical steroids, TCIs do not cause skin thinning, pigment changes, blood vessel formation, or striae formation, nor do they lose effectiveness with prolonged use.

In addition, TCIs can be used on any skin, including the face and eyelids. Just like any medication, however, even TCIs have possible side effects, and there are FDA warnings associated with Elidel and Protopic.

A Word From Verywell

The bottom line is that when it comes to applying steroid creams to your face, only the smallest amount of medication should be used, and only for the shortest amount of time possible.

Remember, although these creams are widely available and have been around for decades, they're only effective when used to treat specific skin conditions. In other words, slathering on a steroid cream for any rash is not the way to go. Instead, use it only under the guidance of a healthcare provider. 

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