Topical Corticosteroids for Psoriasis

There Are 7 Classes of Topical Corticosteroids

Applying cream

When you hear a patient talk about topical steroids for psoriasis, she means anti-inflammatory corticosteroids. There are seven different categories of topical corticosteroids based upon strength.

The mildest of these, class 7, includes over-the-counter hydrocortisone 1 percent. The strongest, class 1, consist of the "big gun" steroid creams, such as clobetasol.

What Do Topical Corticosteroids Do for Psoriasis Patients

Topical corticosteroids have a variety of benefits for psoriasis patients.

You can apply these treatments right on your skin, so the medicine goes directly to the affected area. These topical medications help your psoriasis by:

  • helping to reduce inflammation and rate of skin cell renewal
  • suppressing your overactive immune system
  • helping your skin peel and unclogging your pores
  • soothing your skin

Vehicles for Topical Corticosteroids

One of my patients used to always come to the office for refills: "I'm out of grease" he'd say. But topical corticosteroids come in all sorts of vehicles:

  • Ointments are actually petrolatum-based "grease"
  • Creams are lighter and less greasy than ointments and are much nicer to use on your face, groin, or armpits
  • Oils are for whole-body treatment or for an overnight scalp treatment
  • Gels are non-greasy and completely absorb into your skin, which is great for hairy areas
  • Foams are easy to spread and are also good for your scalp and hairy areas
  • Tapes are appropriate for thicker plaques such as the ones frequently seen on the elbows and knees

    In general, for a given active ingredient, ointments will be more potent than creams, but also messier. Foams are very effective in that they tend to penetrate to deeper layers of the skin than other vehicles. Hence, a slightly less potent active ingredient may give more benefit if delivered in a foam.

    Which Topical Corticosteroid Is Right for Me?

    With so many products representing seven classes of corticosteroids I choose the patient's prescription carefully. In an attempt to avoid side effects, I usually try to use the least potent steroid which will actually get the job done. Which one is right for you depends on a number of variables, including:

    • age
    • location of psoriasis on your body
    • the amount of body surface that needs treatment

    Side Effects of Class 1 Corticosteroids

    Class 1 steroids are not just a little stronger than class 7, they are exponentially stronger. These ultra-high-potency preparations have the greatest efficacy and side effects. A typical prescription is only enough for 2 to 3 weeks.

    Side effects of topical corticosteroids include:  

    • Strong steroids can damage your eyes, leading to glaucoma and cataracts. 
    • Using a too-strong steroid on your face can lead to acne, rosacea, and the development of little red blood vessels called telangiectasia.
    • In your groin and armpits, stronger classes of steroid can cause large red stretch marks to develop, which are usually permanent.
    • Continuous use of strong steroids on the same exact areas leads to thinning of the skin, which can also be permanent.
    • Covering large areas of your body with potent steroid creams can lead to systemic absorption and loss of the body's ability to make its own natural cortisol. 


    National Institute of Arthritis and Musculoskeletal and Skin Diseases: What Is Psoriasis? Fast Facts - An Easy-to-Read Series of Publications for the Public (2014)

    World Health Organization: Classification of Topical Corticosteroids

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