Topical steroids are the mainstay for many dermatological treatments for their anti-inflammatory activities. The potency of topical steroids varies greatly from product to product which has been the source of confusion for the public prescribed these medicines.
Below are examples of topical steroids used in the UK with their potency and active ingredient:
The current issues with topical corticosteroid labelling
The variation in strength of steroid allows the right medication to be prescribed depending on the severity of the inflammatory symptoms and where on the body it is to be used. For example, mild preparations are safe to use on the face where skin is thin, but for thickened epidermis such as the foot, very potent preparations are required to have any effect.
However, although prescribers understand various preparations and their strengths, patients often do not and are confused by the array of products [1]. A lay person may make a judgement on the strength of a steroid by looking the percentage but erroneously believe 2.5% hydrocortisone is much stronger than Dermovate (0.05% clobetasol propionate) when in fact the converse is true – with Dermovate being over 50 times stronger. This may lead to inappropriate use of products and a higher rate of steroid related side effects.
In addition, the problem of topical steroid withdrawal syndrome is a risk for many patients (see my previous blog on this topic). After a prolonged use of potent topical steroid, sudden withdrawal can lead to a rebound - a sudden exacerbation of the original symptoms, usually worse than before the topical treatment started.
New Labelling
From June of this year, The Medicines and Healthcare products Regulatory Agency (MHRA) has specified that manufacturers of topical steroids will, from June 2025, state the potency of their product on the tube and packaging as “Mild steroid”, “Moderate steroid”, “Strong steroid” or “Very strong steroid” [2].
Currently until that date, topical steroids have rarely included an indication of their potency that a patient can easily understand, so that usage of topical steroids can be made safer with easier understanding for the patient.
References
1. Moss, C., Z. Haider, and A. Proctor, Do people with eczema and their carers understand topical steroid potency? Results of two surveys. Clinical and Experimental Dermatology, 2024. 49(3): p. 267-270.
2. Medicines and Healthcare products Regulatory Agency, Topical steroids: introduction of new labelling and a reminder of the possibility of severe side effects, including Topical Steroid Withdrawal Reactions. 2024: London.