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 cream, it's important to use them as instructed by your doctor, especially when it comes to using them on your face, a sensitive and unique area of skin.

Type of Topical Steroid Creams Reserved 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 the 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 soles or for more severe skin diseases like psoriasis being treated by a dermatologist.

Common Side Effects of Topical Steroid Creams

Side effects from topical steroid 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 the eyes may result in serious eye problems like glaucoma or cataract formation.

Applying Topical Steroid Cream to Your Face

When applying a steroid cream to your face, it's essential to 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 the face per application.

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

Although if a more chronic application is needed, 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 the Elidel and Protopic, which are topical calcineurin inhibitors (TCIs). These medications are approved by the 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 here 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 are 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. 

Sources:

Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009 Jan 15;79(2):135-40.

Rathi, Sanjay K.D'Souza, Paschal, Rational and ethical use of topical corticosteroids based on safety and efficacy. In: Indian Journal of Dermatology. 2012. 57(4): 251-259J

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