Can I Use Topical Steroid Creams on My Face?

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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 and anti-inflammatory cream, it's important to use only them as instructed by your doctor. This is especially true when it comes to your face, which is a sensitive and unique area of skin.

Potency and Absorption of Topical Steroid Creams

In the United States, topical steroid creams are categorized by their potency, or how strong they are. Group 1 contains the most potent topical steroid creams, referred to as ultra-high potency. Group 7 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 thin, so it absorbs more of the steroid than other areas of your body. Likewise, sticking to a low-potency steroid is also important when applying it to areas of the body with thinner skin like the neck, groin, underneath the breast, or the armpit.

Keep in mind, besides areas of thin skin absorbing more topical steroid, children are more susceptible to increased absorption because of their larger skin surface-to-body-mass ratio.

Examples of low potency topical steroids include hydrocortisone (Cortaid, Cortizone 10), which is in Group 7, and triamcinolone (Kenalog), which is in Group 6. Some lower potency corticosteroids are available over-the-counter, like 1 percent hydrocortisone, whereas others are only available by prescription, like 2 percent hydrocortisone.

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

Your face is more vulnerable to developing side effects from topical steroids due to its higher rate of steroid absorption. With that, 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; although the research on these eye-related side effects is not as clear as it is with oral steroids, like prednisone.

Keep in mind, many of these side effects do resolve after stopping the steroid, but it may take months. This is why the American Academy of Dermatology recommends regular assessment of the areas (such as the face) where the steroid is being applied, as well as avoiding continuous use of topical steroids for long periods of time.

Application of Topical Steroid Creams

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 (for adults 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.

It's also important to note that some experts believe that chronically applying topical steroid cream anywhere on the body, not just the face, may 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 Topical 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 two 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 (but not too small that it's ineffective) and only for the shortest amount of time possible.

Although these creams are widely available and have been around for decades, they're only effective when used to treat specific skin conditions like eczema or psoriasis. 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. 

This all said, be assured that with the proper potency, dose, and duration, along with monitoring by your doctor, topical steroids are quite effective, low-risk medications.

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