Zest Health Guide to Topical Steroids

You applied a cream your provider prescribed and your skin started to calm down. The redness faded. The itch eased up. That is topical steroids at work. They are one of the most prescribed treatments in dermatology, and for good reason. When used the right way, they work.

This guide explains what topical steroids are, how to use them, and what to watch for along the way.

What Are Topical Steroids?

Topical steroids are anti-inflammatory medications you apply directly to your skin. They come as creams, ointments, lotions, and solutions. They work by calming your immune system's response in the skin. That is what reduces the redness, itching, and swelling that come with eczema and psoriasis.

Dermatologists have used topical steroids safely for decades. The key is using the right strength, in the right place, for the right amount of time.

Understanding Steroid Strength

Topical steroids come in four strength levels: mild, moderate, potent, and very potent. Your provider picks the right strength based on where your rash is and how severe it is.

Mild steroids work best for sensitive areas. These include the face, neck, armpits, skin folds, and the groin. They can be used for longer periods with your provider's guidance. Examples include hydrocortisone and desonide.

Moderate steroids work better on thicker skin like the arms, legs, hands, feet, and trunk. Examples include triamcinolone acetonide and mometasone furoate.

Potent and very potent steroids are for tough or thick areas like the palms, soles, elbows, knees, and thick plaques. Examples include clobetasol propionate and halobetasol propionate. These are used in short bursts only.

How to Apply Your Medication

Follow these steps each time you apply:

1. Wash your hands before and after. Skip this step only if you are treating your hands.
2. Apply a thin layer to affected areas only, once or twice daily as directed.
3. Gently rub in until absorbed.
4. Apply your moisturizer after the steroid. This helps support your skin barrier.
5. For best results, apply to slightly damp skin right after bathing.

How Much to Use

Here are simple guidelines to help you use the right amount of topical steroid.

We recommend using the Fingertip Unit (FTU) when you are getting started:

• This is the amount of cream squeezed from the tip of your finger to the first crease.
• 1 FTU covers about the size of the front and back of one adult hand.

Different body parts need different amounts. If you are only treating a small area, you will use less. Your provider can walk you through the right amount for your specific areas.

Reducing Your Dose Over Time

Tapering down is often the goal. Once your symptoms are under control, your Zest provider will work with you to gradually space out applications. This helps your skin stay clear without relying on the medication long term.

Some people use maintenance therapy, applying the medication once or twice a week to help prevent flares from coming back. Your provider will let you know if this approach is right for you.

Getting Started

• Submit baseline photos of your skin condition for a severity assessment.
• No routine blood work is required, but please share all current and past medications with your provider.
• Provide previous treatment records if requested.

What to Expect

• Early improvement: Many people notice a difference as early as 2–4 weeks.
• Significant relief: By the 4-week mark, meaningful relief of symptoms is commonly reported.
• Long-term support: Your Zest provider will check in on your progress and adjust your plan as needed. You won’t be doing this alone.

Safety and Side Effects

Most side effects are mild and are most likely to occur with long-term use of high-potency steroids. They can include:

• Skin thinning, especially with long-term high-potency use.
• Stretch marks.
• Increased hair growth in treated areas.
• Changes in skin color, either lightening or darkening.
• Burning or stinging when you first apply the medication.

Important safety information:

• Don’t stop abruptly if you’ve been using a high-potency steroid for a long time. Your provider may recommend gradually tapering off.
• Avoid the eyes. If you need to treat near your eyes, your provider may recommend a very low-potency option.
• Monitor your skin. Let your provider know if your skin isn’t improving within 2–4 weeks, or if they get worse.
• Don’t share your medication with others.
• Keep moisturizing. Steroids treat inflammation; moisturizers help protect and repair your skin barrier. Both matter.

Tips to Minimize Side Effects

• Use the lowest strength that effectively controls your symptoms. 
• Apply only to affected areas as directed by your provider.
• Avoid medium, high, or very-high-potency steroids on sensitive areas (face, armpits, groin, genitals) unless specifically instructed.
• Follow your provider’s instructions regarding how long to use the medication.
• Do not cover treated areas with tight bandages or occlusive dressings unless your provider tells you to do so.
• Per AAFP guidelines, very potent steroids should not be used for more than 3 weeks continuously, and medium to high potency steroids should not exceed 12 weeks, unless your provider directs otherwise.

Per AAFP guidelines, very potent steroids should not be used for more than 3 weeks in a row. Medium to high potency steroids should not exceed 12 weeks unless your provider directs otherwise.

Storing Your Medication

• Store at room temperature
• Keep tube or bottle tightly closed
• Keep out of reach of children
• Do not ingest medication
• Check expiration date before each use

When to Contact Your Zest Team 

• No improvement after 2-4 weeks of treatment
• Signs of a severe allergic reaction or infection
• Unusual worsening redness, pain, or swelling, or other signs of skin infection (pus, warmth, fever)
• Any vision changes if using medication near your eyes

Have more questions? Contact your Zest care team by texting (865) 426-1746 or sending a message from your portal. You've got this, and we've got you.