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Research · Medication

Topical corticosteroids

Trials found stronger topical steroids cleared eczema more often than mild ones, and weekend use cut flares from 58% to 25%. Very potent steroids improved psoriasis more than potent ones. Skin thinning occurred in about 1% of trial participants, mostly on stronger steroids. Adrenal suppression occurred in about 4% of children tested, more in adults covering large areas.

Add to Bio HackChecked 2026-11-14
Status
In the US, hydrocortisone at 1% or less is sold over the counter as an anti-itch cream for minor rashes, eczema, psoriasis, insect bites, poison ivy and anal or genital itching, for adults and children 2 and older. Hydrocortisone 2.5% and the stronger steroids on this page, including triamcinolone, betamethasone, clobetasol, mometasone and fluocinonide, are prescription drugs, FDA-approved for the inflammation and itch of corticosteroid-responsive skin conditions such as eczema and psoriasis.
Also called
steroid cream, cortisone cream, hydrocortisone cream, hydrocortisone 1%, Cortizone-10, Cortaid, hydrocortisone 2.5%, triamcinolone acetonide, Kenalog cream, betamethasone dipropionate, betamethasone valerate, Diprolene, clobetasol propionate, Temovate, Clobex, Impoyz, mometasone furoate, Elocon, fluocinonide, Lidex, desonide, halobetasol, topical steroid
Taken for
eczema, atopic dermatitis, psoriasis, itchy rash, insect bites, poison ivy, contact dermatitis, anal itching, seborrheic dermatitis, preventing eczema flares

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help4

Reported risks7

What people take it for, and what was found

Shown to help4

ModerateVery common

Eczema signs, by steroid strength

Shown to clear or markedly improve eczema more often with moderate or potent steroids than mild ones, 70% against 39% for potent against mild.

Compared with weaker-potency topical steroids [1]; placebo, vehicle and other prescription topical treatments in a network [2]

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Moderate-potency steroids gave more people treatment success than mild ones, 52% against 34% (OR 2.07, 95% CI 1.41 to 3.04, 4 trials, 420 people, moderate certainty). Potent steroids gave 70% against 39% on mild ones (OR 3.71, 95% CI 2.04 to 6.72, 9 trials, 392 people). Potent against moderate showed no clear difference (OR 1.33, 95% CI 0.93 to 1.89), and very potent against potent was uncertain (OR 0.53, 95% CI 0.13 to 2.09). Once-daily potent steroid did no worse than twice-daily (OR 0.97, 95% CI 0.68 to 1.38, 15 trials, 1,821 people) [1]. In a network of prescription topical treatments, group 5 (moderate) steroids improved 6 of 7 eczema outcomes and group 1 (strongest) improved 3, without raising harms [2].
Population
104 trials with 8,443 children and adults with eczema, mostly moderate or severe, lasting 1 to 5 weeks for potency comparisons [1]; 219 trials with 43,123 people with atopic dermatitis [2].
Sources
[1], [2]
Caveats
Only one of the 104 trials was at low risk of bias, and trials were short [1]. The network abstract gives no effect sizes against vehicle [2].
Moderate

Preventing eczema flares with twice-weekly use

Shown to cut eczema flare-ups from 58% to 25% when a steroid was applied twice a week to healed skin, compared with no steroid.

Compared with no topical steroid or use only when flares occur [1]

The numbers and sources
Effect
Weekend (proactive) application lowered the chance of a relapse from 58% to 25% (RR 0.43, 95% CI 0.32 to 0.57, 7 trials, 1,149 people, moderate certainty). No cases of abnormal skin thinning were found in 7 trials that checked for it in 1,050 people [1].
Population
Children and adults with eczema, mostly moderate or severe, in trials lasting 16 to 20 weeks [1].
Sources
[1]
Caveats
One review. The trials lasted under 5 months [1].
ModerateVery common

Plaque psoriasis

Shown to improve plaque psoriasis more than the base cream, most with very potent steroids, and about as much as vitamin D creams with less irritation.

Compared with placebo emollient base and vitamin D analogue creams [3]; vehicle cream without clobetasol [4]

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
On a 6-point improvement scale, potent steroids improved psoriasis about 1 point more than the emollient base and very potent steroids 1.8 points. Steroids improved psoriasis about as much as vitamin D analogues with less skin irritation, and improved scalp psoriasis more than vitamin D [3]. In two label trials of clobetasol 0.025% cream twice daily for 14 days, 30.2% and 30.1% reached clear or almost clear skin against 9.0% and 9.7% on vehicle [4].
Population
177 trials with 34,808 people with chronic plaque psoriasis, typically 3 to 8 weeks [3]; 532 adults with moderate to severe plaque psoriasis [4].
Sources
[3], [4]
Caveats
The review called its effect sizes indicative because trials were heterogeneous, and safety reporting was often poor [3].
Limited

Anal itch with 1% hydrocortisone

One small trial found 1% hydrocortisone ointment cut anal itch by 68% compared with placebo ointment over 2 weeks.

Compared with a placebo ointment [5]

The numbers and sources
Effect
Itch on a visual analog scale fell 68% more on hydrocortisone than on placebo (P=0.019), and the eczema severity score of the skin fell 81% more (P=0.01). Quality of life scores fell 75% more, which was not statistically significant (P=0.067) [5].
Population
11 adults with primary pruritus ani in a crossover trial, 10 completing [5].
Sources
[5]
Caveats
A pilot trial of 10 people. Anal itching is one of the uses on the over-the-counter label [6].

Mixed results1

Limited

Mosquito bite reactions

One trial found bite swelling shrank on 1% hydrocortisone and on an herbal cream alike, with no untreated group to show how much either added.

Compared with Tinospora rumphii 25% cream, with no placebo group [7]

The numbers and sources
Effect
Lesion size fell from 15 minutes to day 7 in both groups, and the herbal cream was judged comparable to hydrocortisone for lesion size, complete clearing of wheals and itch [7].
Population
58 adults given controlled bites by lab-raised mosquitoes, 29 per group, treated twice daily for 7 days [7].
Sources
[7]
Caveats
Without an untreated or placebo group, the trial cannot separate the cream's effect from bites settling on their own [7].

Doses studied

Topical steroids are grouped by strength into seven US classes. Class I (super high) includes clobetasol propionate 0.05%, augmented betamethasone dipropionate 0.05% ointment, fluocinonide 0.1% cream and halobetasol 0.05%. Class II (high) includes fluocinonide 0.05% and betamethasone dipropionate 0.05% ointment. Classes III to V (medium) include mometasone furoate 0.1%, triamcinolone acetonide 0.1% and 0.5%, and betamethasone valerate 0.1%. Classes VI and VII (low) include hydrocortisone 1% and 2.5%, triamcinolone 0.025% and desonide 0.05%. The review lists a usual maximum of 3 weeks for super-high potency and 12 weeks for high and medium potency [8]. The clobetasol 0.05% label limits treatment to 2 consecutive weeks and 50 g a week [9]. The mometasone label is for once-daily use in people 2 and older [10]. The over-the-counter hydrocortisone 1% label directs use up to 3 to 4 times a day for adults and children 2 and older, stopping and asking a doctor if symptoms last more than 7 days [6]. How much reaches the blood: about 0.4% of applied mometasone cream entered the circulation after 8 hours on normal skin [10]. In adults applying clobetasol 0.025% to about a quarter of their skin, mean plasma clobetasol was 50.7 pg/mL before and 56.3 pg/mL after a dose on day 15 [4]. The labels state absorption rises with inflamed skin, large areas and occlusion [9][10].

Risks

Reported risks6

LimitedVery common

Adrenal suppression in adults

The label reports adrenal suppression in 12.5% of adults after 15 days and 30.8% after 28 days of potent clobetasol cream over large skin areas.

The numbers and sources
How common
Very common: more than 1 in 10 people.
Effect
Applying clobetasol 0.025% cream twice daily to at least 20% of the body for 15 days, 3 of 24 adults with psoriasis (12.5%) had a stimulated cortisol of 18 mcg/dL or less. Over 28 days on at least 25% of the body, 8 of 26 (30.8%) did. Recovery is generally prompt after stopping [4]. Clobetasol 0.05% cream suppressed the adrenal axis at doses as low as 2 g a day for 1 week in eczema, and the label reports Cushing's syndrome in infants and adults with prolonged use, plus high blood sugar and sugar in the urine [9]. In 6 adults applying 15 g of mometasone twice daily to at least 30% of the body for 7 days, adrenal output fell slightly [10].
Population
24 and 26 adults with moderate to severe plaque psoriasis [4]; people with eczema on clobetasol 0.05% [9]; 6 adults with psoriasis or eczema [10].
Sources
[4], [9], [10]
Caveats
Small label studies chosen to test large-area use of potent steroids, so the rates do not apply to small areas or mild steroids.
ModerateCommon

Skin thinning

Shown to cause abnormal skin thinning in about 1% of trial participants treating eczema flares, mostly with potent or very potent steroids.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Across 22 trials of flare treatment, 26 cases of abnormal skin thinning occurred among 2,266 people (1%). Of these, 16 were on very potent, 6 on potent, 2 on moderate and 2 on mild steroids. No thinning was found in 7 trials of twice-weekly use [1]. In clobetasol 0.025% trials, skin atrophy and telangiectasia occurred in under 1%, and the label states some local reactions may be irreversible [4].
Population
Children and adults with eczema in short trials [1]; 354 adults with psoriasis on clobetasol and 178 on vehicle [4].
Sources
[1], [4]
Caveats
Low-certainty evidence from short trials, so longer use may differ [1].
ModerateStudied in childrenCommon

Adrenal suppression in children

Shown to suppress the adrenal axis in about 3.8% of children on short courses, from 2% on low-potency to 6.6% on high-potency steroids.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
Across pediatric trials testing cortisol before and after treatment, 20 of 522 children had adrenal suppression (3.8%, 95% CI 2.4 to 5.8). Rates were 2% (3 of 148) on low-potency, 3.1% (7 of 223) on medium-potency and 6.6% (10 of 151) on high-potency steroids [11]. With low- to moderate-potency steroids for at least 2 weeks, 2.7% (95% CI 1.47 to 4.89) had biochemical adrenal insufficiency, and none had clinical signs or adrenal crisis [12]. In infants 6 to 23 months treated with mometasone over a mean 41% of the body for about 3 weeks, about 16% developed adrenal suppression [10].
Population
12 trials with 522 children with atopic dermatitis [11]; 9 studies with 371 children [12]; 97 infants aged 6 to 23 months [10].
Sources
[11], [12], [10]
Caveats
The two meta-analyses share authors and overlap in studies [11][12]. The suppression was reversible in the trials [11].
LimitedCommon

Other skin reactions

The label lists stretch marks, visible blood vessels, acne-like bumps, rash around the mouth, lighter skin and infections, more likely with strong steroids, occlusion or long use.

The numbers and sources
How common
Common: between 1 in 100 and 1 in 10 people.
Effect
In clobetasol 0.025% trials, application site discoloration occurred in 2% against 1% on vehicle [4]. In clobetasol 0.05% trials, burning and stinging were the most frequent reactions, in 1% [9]. The labels list atrophy, striae, telangiectasia, burning, itching, irritation, dryness, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, secondary infection and miliaria, more likely with occlusion, prolonged use or higher potency [4].
Population
354 adults on clobetasol 0.025% and 178 on vehicle [4]; clobetasol 0.05% trial participants [9].
Sources
[4], [9]
Caveats
Most reactions on the list come from postmarketing reports with no rate [4].
LimitedStudied in childrenHow often is not known

Growth slowing and other effects in children

The label warns that slowed growth, delayed weight gain, Cushing's syndrome and raised pressure in the skull have been reported in children using topical steroids.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
The clobetasol and mometasone labels state that HPA axis suppression, Cushing's syndrome, linear growth retardation, delayed weight gain and intracranial hypertension have been reported in children receiving topical corticosteroids, and that children are at greater risk because of a higher ratio of skin surface to body mass. The clobetasol label advises against use under age 12 and the mometasone label under age 2 [9][10].
Population
Labeling statement from reports in children [9][10].
Sources
[9], [10]
Caveats
The labels give no rate.
LimitedHow often is not known

Topical steroid withdrawal (red, burning skin after stopping)

Case reports: reviews describe burning, redness and swelling after stopping long, inappropriate use of potent steroids, almost all on the face or genitals, mostly in women.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Across 34 studies, withdrawal reactions were reported mostly on the face and genital area (99.3%) and in women (81.0%), mainly after long-term inappropriate use of potent steroids. Burning and stinging were the most frequent symptoms (65.5%) and redness the most common sign (92.3%). The review described a pustular type and a red, swollen type [13]. An update covering 2014 to 2020 found it usually followed prolonged use of moderate to high potency steroids, usually on the face, often for cosmetic reasons [14].
Population
34 studies, mostly case reports and series [13]; studies published 2014 to 2020 [14].
Sources
[13], [14]
Caveats
Low-quality evidence with no comparison groups, so no rate is known [13][14].

Mixed results1

ModerateStudied in pregnancyHow often is not known

Use in pregnancy

Mixed results: not linked to birth defects, preterm birth or stillbirth, while large amounts of potent steroids were linked to low birth weight.

The numbers and sources
How common
How often is not known: the sources give no rate.
Effect
Against no exposure, topical steroids were not associated with congenital abnormalities (RR 0.82, 95% CI 0.34 to 1.96), preterm delivery (RR 0.93, 95% CI 0.81 to 1.08) or fetal death (RR 1.02, 95% CI 0.60 to 1.73). Low birth weight was not raised overall (RR 1.08, 95% CI 0.86 to 1.36), but potent to very potent steroids (RR 1.58, 95% CI 0.96 to 2.58) differed from mild to moderate ones (RR 0.90), and three individual studies found more low birth weight with potent steroids. Mild to moderate steroids were linked to fewer fetal deaths (RR 0.70, 95% CI 0.64 to 0.77) [15]. The clobetasol label states that more than 300 g of potent or very potent steroid dispensed during a pregnancy was associated with low birth weight (adjusted RR 7.74, 95% CI 1.49 to 40.11) [4].
Population
14 observational studies with 1,601,515 participants [15].
Sources
[15], [4]
Caveats
All observational, with low or very low quality evidence [15].

Possible, not studied in people1

Untested

Skin cancer with long-term use

Not studied in people. A systematic review found no study of long-term steroid cream use and skin cancer, though local immune suppression could in theory change the risk.

No study in people. This rests on how it acts in the body.

The numbers and sources
Effect
The review authors note topical steroids may have a local immunosuppressive effect that could raise skin cancer risk in theory, or lower it by treating inflammatory skin disease. A search of 1,703 records and drug safety databases found no cohort, cross-sectional or case-control study that met the criteria [16].
Population
No studies were eligible [16].
Sources
[16]
Caveats
The concern rests on how steroids act on the immune system, not on any measured cancer rate [16].

Claims tested and not found

  1. That a potent steroid clears eczema more often than a moderate one. Potent and moderate steroids did not clearly differ in 15 trials (OR 1.33, 95% CI 0.93 to 1.89) [1].
  2. That applying a steroid twice a day clears eczema more often than once. Once-daily potent steroid did no worse than twice-daily in 15 trials (OR 0.97, 95% CI 0.68 to 1.38) [1].
  3. That twice-weekly preventive use thins the skin. No abnormal skin thinning was found in 7 trials that checked 1,050 people [1].

Sources

  1. Lax SJ, Harvey J, Axon E, et al. Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systematic Reviews. 2022. https://doi.org/10.1002/14651858.cd013356.pub2
  2. Chu DK, Chu AWL, Rayner DG, et al. Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials. Journal of Allergy and Clinical Immunology. 2023. https://doi.org/10.1016/j.jaci.2023.08.030
  3. Mason A, Mason J, Cork M, Hancock H, Dooley G. Topical treatments for chronic plaque psoriasis: an abridged Cochrane systematic review. Journal of the American Academy of Dermatology. 2013. https://doi.org/10.1016/j.jaad.2013.06.027
  4. FDA label (DailyMed). Impoyz (clobetasol propionate) cream 0.025%. Primus Pharmaceuticals. 2024. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=40173654-334e-4618-847b-6a1e030cd2fd
  5. Al-Ghnaniem R, Short K, Pullen A, et al. 1% hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial. International Journal of Colorectal Disease. 2007. https://doi.org/10.1007/s00384-007-0325-8
  6. FDA label (DailyMed). Cortizone-10 Soothing Aloe Creme (hydrocortisone 1%), Drug Facts. Chattem, Inc. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1a841bf0-9d7b-4566-b442-aa9bcc827846
  7. Gatmaitan JG, Gatmaitan-Dumlao JKG, Dayrit J, Gabriel MT. Efficacy and Safety of Makabuhay (Tinospora rumphii) 25% Cream Versus Hydrocortisone 1% Cream in the Management of Mosquito Bite Reactions: Randomized Double-Blind Controlled Trial. JMIR Dermatology. 2023. https://doi.org/10.2196/50380
  8. Stacey SK, McEleney M. Topical Corticosteroids: Choice and Application. American Family Physician. 2021. https://pubmed.ncbi.nlm.nih.gov/33719380/
  9. FDA label (DailyMed). Clobetasol propionate cream USP 0.05%. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=98b23b99-fab4-49fb-b070-758fb030e9bb
  10. FDA label (DailyMed). Mometasone furoate cream USP 0.1%. Preferred Pharmaceuticals Inc. 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=831f7694-8153-4a79-a453-48020b26f035
  11. Wood Heickman LK, Davallow Ghajar L, Conaway M, Rogol AD. Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis. Hormone Research in Paediatrics. 2018. https://doi.org/10.1159/000489125
  12. Davallow Ghajar L, Wood Heickman LK, Conaway M, Rogol AD. Low Risk of Adrenal Insufficiency After Use of Low- to Moderate-Potency Topical Corticosteroids for Children With Atopic Dermatitis. Clinical Pediatrics. 2019. https://doi.org/10.1177/0009922818825154
  13. Hajar T, Leshem YA, Hanifin JM, et al. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. Journal of the American Academy of Dermatology. 2015. https://doi.org/10.1016/j.jaad.2014.11.024
  14. Hwang J, Lio PA. Topical corticosteroid withdrawal ('steroid addiction'): an update of a systematic review. Journal of Dermatological Treatment. 2022. https://doi.org/10.1080/09546634.2021.1882659
  15. Chi CC, Wang SH, Wojnarowska F, et al. Safety of topical corticosteroids in pregnancy. Cochrane Database of Systematic Reviews. 2015. https://doi.org/10.1002/14651858.cd007346.pub3
  16. Ratib S, Burden-Teh E, Leonardi-Bee J, Harwood C, Bath-Hextall F. Long-term topical corticosteroid use and risk of skin cancer: a systematic review. JBI Database of Systematic Reviews and Implementation Reports. 2018. https://doi.org/10.11124/jbisrir-2017-003393

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