Topical Corticosteroids

NHSL Medicines Guidance
NHS Lanarkshire

General Notes

To minimise the potential side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective. Prolonged use of topical corticosteroids (particularly on the face) should be avoided. Please see MHRA Drug Safety Update September 2021 for further information on the risk of topical steroid withdrawal reactions.

Topical corticosteroids are contraindicated in acne; perioral dermatitis; rosacea (in adults); untreated bacterial, fungal or viral skin lesions. Potent corticosteroids are contraindicated in widespread plaque psoriasis. Topical corticosteroids with antimicrobial agent should only be used short-term, where infection of the skin is present.

Topical Corticosteroid: MILD Potency

Preferred list (P)

HYDROCORTISONE 1% cream/ointment

Topical Corticosteroid With Antimicrobial: MILD Potency

Preferred list (P)

HYDROCORTISONE WITH CLOTRIMAZOLE cream

  • Hydrocortisone 1% with clotrimazole 1%.

 

Total list (T)

HYDROCORTISONE WITH MICONAZOLE cream/ointment

  • Both Daktacort 2%/1% cream and Daktacort ointment have been discontinued. 

HYDROCORTISONE WITH BENZALKONIUM CHLORIDE, DIMETICONE AND NYSTATIN cream

  • Hydrocortisone 0.5%, benzalkonium chloride 0.2%, dimeticone 10% and nystatin 3%.
  • Store below 15˚C.

HYDROCORTISONE WITH FUSIDIC ACID cream

  • Hydrocortisone 1% with fusidic acid 2%.
  • There is a high risk of fusidic acid resistance.

Prescribing notes:

  • Short-term use during bacterial skin infection only.

Topical Corticosteroid: MODERATE Potency

Preferred list (P)

BETAMETHASONE valerate 0.025% cream/ointment (Betnovate RD®)

Total list (T)

ALCLOMETASONE 0.05% cream

  • Branded Modrasone® cream has been discontinued. Generic alclometasone 0.05% cream remains available.

CLOBETASONE butyrate 0.05% cream/ointment

FLUOCINOLONE acetonide 0.00625% cream/ointment (Synalar 1 in 4 dilution®)

Topical Corticosteroid With Antimicrobial: MODERATE Potency

Preferred list (P)

CLOBETASONE WITH NYSTATIN AND OXYTETRACYCLINE cream

  • Clobetasone butyrate 0.05%, nystatin 100,000units per gram and oxytetracycline 3%. 

Prescribing Notes:

  • Short-term use during bacterial skin infection only.

Topical Corticosteroid: POTENT Potency

Preferred list (P)

BETAMETHASONE valerate 0.1% cream/ointment

MOMETASONE furoate 0.1% cream

BETAMETHASONE valerate 0.122% scalp application

Total list (T)

FLUTICASONE propionate 0.05% cream/ 0.005% ointment

  • Branded Cutivate® 0.05% cream has been discontinued. Generic fluticasone propionate 0.05% cream remains available.
  • The 15g pack size of Cutivate® 0.005% ointment has been discontinued. The 30g pack size remains available.

FLUOCINOLONE acetonide 0.025% gel (Synalar®)

  • Scalp application.

Topical Corticosteroid With Antimicrobial: POTENT Potency

Preferred list (P)

FLUOCINOLONE WITH CLIOQUINOL cream/ointment (Synalar C®)

  • Fluocinolone 0.025% with clioquinol 3%.

Synalar C® cream and ointment have been discontinued. 

Total list (T)

BETAMETHASONE WITH FUSIDIC ACID cream

  • Betamethasone valerate 0.1% with fusidic acid 2%.
  • There is a high risk of fusidic acid resistance.

BETAMETHASONE WITH CLOTRIMAZOLE cream (Lotriderm®)

  • Betamethasone dipropionate 0.064% with clotrimazole 1%.

BETAMETHASONE WITH CLIOQUINOL cream/ointment

  • Betamethasone valerate 0.1% with clioquinol 3%.

Prescribing Notes:

  • Short-term use during bacterial skin infection only.

Topical Corticosteroid With Salicylic Acid: POTENT Potency

Total list (T)

BETAMETHASONE WITH SALICYLIC ACID ointment/scalp application (Diprosalic®)

  • Betamethasone dipropionate 0.05% with salicylic acid 3%.

Topical Corticosteroid: VERY POTENT Potency

Preferred list (P)

CLOBETASOL propionate 0.05% cream/ointment

  • To be applied thinly for up to 4 weeks - maximum 50g of 0.05% preparation per week.

Total list (T)

DIFLUCORTOLONE valerate 0.3% ointment (Nerisone Forte®)

  • To be applied thinly for up to 2 weeks, reducing strength as condition responds - maximum 60g per week.

Diflucortolone valerate 0.3% ointment (Nerisone Forte®) has been discontinued.

Specialist initiation (S1)

CLOBETASOL propionate 0.05% shampoo (Etrivex®)

  • To be applied thinly once daily for up to 4 weeks – maximum 50g per week.
  • After application, the shampoo should be kept in place without covering for 15 minutes.
  • Frequency of application should be reduced after clinical improvement. If no improvement is seen within four weeks, reassessment of the diagnosis may be necessary.

Topical Corticosteroid With Antimicrobial: VERY POTENT Potency

Specialist initiation (S1)

CLOBETASOL WITH NEOMYCIN AND NYSTATIN cream

  • Clobetasol propionate 0.05%, neomycin sulfate 0.5% and nystatin 100,000units per gram.
  • To be applied sparingly to the affected area once or twice daily until improvement occurs - maximum 50g per week.

Prescribing notes:

  • Short-term use during bacterial skin infection only.
  • Treatment should not be continued for more than 7 days without medical supervision. If a longer course is necessary, it is recommended that treatment should not be continued for more than 4 weeks without the patient's condition being reviewed.
  • Repeat short courses may be used to control exacerbations. If continuous steroid treatment is necessary, a less potent preparation should be used.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.