Steroid creams, also called topical steroids or corticosteroids, can help treat psoriasis, but long-term use can cause side effects. Here’s what to know about using these creams safely.
Topical steroids are anti-inflammatory drugs you apply directly to your skin. These medications are one common treatment for psoriasis, an autoimmune condition where you develop scaly patches, called plaques, across your skin.
Steroid creams can shrink these patches or even help them go away completely. However, these medications can cause side effects if you use them for an extended period, so it’s important to follow any instructions your primary care doctor or dermatologist provides.
Below, get the details on different types of steroid creams, how they work, and precautions to take while using them.
If you have psoriasis, your immune system gets confused and starts attacking your own skin. Antibodies flood the area to defend against the attack, and the surrounding tissue becomes inflamed. You may notice discolored skin, swelling, pain, and tenderness.
Psoriasis also causes your skin to produce cells faster than the old ones can fall off, which is what creates the plaques of thick and flaking skin.
When you apply a steroid cream, the steroids sink into the layers of your skin and enter various cells.
Topical steroids help treat psoriasis by telling your cells to:
- stop making so many inflammatory chemicals
- make more anti-inflammatory chemicals
- slow down the growth of new skin cells
Because corticosteroids resemble the steroid hormones made by your adrenal glands, the cells accept their instructions as if they came from your own body.
That said, you’ll need to keep applying the cream to replenish the medication in your skin. As the steroids hold off the psoriasis process, the patch should gradually shrink, allowing your skin to heal.
Topical steroids are organized into 7 classes, with class 7 being the mildest and class 1 the strongest. Here are examples of creams you might find in each level:
- Class 7 (mild): Hydrocortisone (Synacort, Mycort-HC, Cortaid)
- Class 6 (mild): Desonide (Desowen)
- Class 5 (medium): Betamethasone valerate (Betaderm)
- Class 4 (medium): Mometasone furoate (Elocon)
- Class 3 (strong): Triamcinolone acetonide (Triderm)
- Class 2 (strong): Fluocinonide (Lidex)
- Class 1 (ultra-strong): Clobetasol propionate (Cormax, Temovate)
The Food and Drug Administration (FDA) has only approved the weakest steroid cream, hydrocortisone, as an over-the-counter (OTC) medication. You’ll need a prescription for all other topical steroids.
If you have plaques on sensitive areas, like your face or groin, you’ll probably want to stick with the mild or medium steroid creams.
Stronger steroid creams are typically prescribed for chronic psoriasis that involves very thick plaques. While high-level creams are more powerful, they also pose a higher risk of side effects. Healthcare professionals tend to reserve them for psoriasis plaques that don’t respond to gentler treatment.
Steroid creams can cause changes to your skin like:
- easier bruising
- color changes (for instance, your skin may appear lighter, darker, reddish, or purplish, depending on your natural skin tone)
- stretch marks
- steroid-induced rosacea
Your risk of side effects goes up if you use steroid cream:
- with a high potency
- over large surface areas
- for longer than 3 weeks
Can topical steroids cause adrenal fatigue?
You may have read that chronic corticosteroid use can suppress the amount of natural steroid hormones your body produces and lead to adrenal fatigue, which can cause:
- low blood pressure
- lack of appetite
However, adrenal fatigue is mostly a concern for other forms of steroid medication, like injections. That’s because injected or oral steroids have a higher rate of systemic absorption, which means they affect your body overall.
Even high potency steroid creams only rarely affect your adrenal glands. Topical steroids — those absorbed through your skin — only have a minimal effect on your body overall.
Each medication works a little differently, so it’s important to follow the label instructions for your specific cream. If you have a prescription medication, make sure to use the cream exactly as the prescribing clinician directed — and check with them if you have any questions.
That said, here are a few things to keep in mind when using steroid cream:
- Apply regularly: Depending on the cream, you may need to apply it one to four times a day. Try to put it on at roughly the same time each day.
- Start small: You only need enough cream to make a thin layer over the psoriasis plaque. Rub it in gently.
- Only cover the plaques: Your regular skin doesn’t need thinning as a thick plaque does, so avoid rubbing the cream into your healthy skin.
- Only wrap if your doctor tells you: Covering your psoriasis plaques with a bandage or cloth can help the cream soak in better. But they might also spread the cream to healthy skin, so you’ll want to check with your doctor before wrapping your skin.
- Check with your doctor if you don’t notice an improvement: With most prescription steroid creams, you should notice some improvement in about a week — but if your symptoms don’t improve within about
2 weeks, you may want to check in with your doctor. If you’re using an OTC cream, it may take a little longer to notice the results.
If you’ve used a steroid cream for a long time and want to stop, your doctor may taper you off the medication. This means they’ll lower your dose gradually to prevent your psoriasis from flaring up in response to the sudden absence of medication.
Since steroid creams affect your immune system, they may not be the best option if you’re currently recovering from an infection or living with an immunodeficiency disorder.
Your primary care doctor or other healthcare professional may also recommend nonsteroid psoriasis treatments if you live with certain endocrine disorders, like Cushing syndrome.
Other treatments for psoriasis include:
- Vitamin D analogues: topical oils and ointments made of synthetic vitamin D
- Tar soap: soap made from pine tree resins or coal byproducts
- Salicylic acid: a chemical exfoliant found in OTC face washes and creams that can slough off dead skin cells
- Methotrexate: a tablet or injection that suppresses your immune response
- Cyclosporine: another immune suppressant you can take orally or via injection
- Retinoids: oral or topical medications made from vitamin A compounds
- Biologics: medications made from living organisms that can block proteins that cause inflammation
- Phototherapy: a skin treatment that uses controlled exposure to UV light
- Laser therapy: lasers that target small areas of skin to destroy unhealthy cells
Your doctor may recommend combining steroid creams with other approaches to develop a treatment program that’s right for your specific psoriasis symptoms.
Steroid creams are one of the most common topical treatments for psoriasis.
While they can have powerful anti-inflammatory effects, they may also cause acne and skin discoloration or thinning if you use them for a long time.
Following your doctor’s directions when using steroid creams to treat psoriasis can minimize your risk of side effects.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.