Zest Health Guide to Topical Steroids

What are Topical Steroids (TCS) and How do They Work?

Topical steroids are anti-inflammatory creams, ointments, lotions, or solutions applied directly to the skin. They work by calming your skin’s immune response — which is what drives the redness, itching, and swelling in conditions like eczema and psoriasis. Topical steroids have safely been used in dermatology for decades when used as directed. Your Zest provider will always choose the right strength for your skin and your situation.

Getting Started: Using a Topical Steroid Safely

Topical steroids come in different strengths, from mild to very strong. Your Zest provider will choose the right topical steroid based on:

• Your specific skin condition
• The location of your rash
• The severity of your symptoms

Topical steroids are effective treatments and like many medicines, they can have side effects if used without guidance. When part of a Zest treatment plan and used as directed by your provider, the risk of side effects is small. Experience of using topical steroids gained over many years shows the benefits of correct use significantly outweigh the risks.

What Is Steroid Potency?

Topical steroids come in four strength levels — mild, moderate, potent, and very potent. Mild steroids are used in sensitive areas and can be used for longer periods. Stronger steroids are used in short bursts for tougher to treat areas. 

Mild – Best for sensitive areas and can be used for longer periods with your provider’s guidance

• Face
• Neck
• Armpits
• Skin folds
• Groin/genitals

Examples:

• Hydrocortisone 
• Desonide

Moderate – Best for thicker skin

• Arms
• Legs
• Hands
• Feet
• Body (trunk)

Examples:

• Triamcinolone acetonide 
• Mometasone furoate 

Potent to Very Potent – Best for thick or stubborn areas

• Palms
• Soles
• Elbows
• Knees
• Thick plaques

Examples:

• Clobetasol propionate 
• Halobetasol propionate
• Betamethasone dipropionate 

Applying Topical Steroids 

Your Zest provider will select your topical treatment based on your age, severity of symptoms, body site and monitor for how your body responds. 

Application Tips:

• Wash your hands before and after applying — unless you’re treating your hands.
• Apply a thin layer to affected areas only, typically once or twice daily as directed.
• Gently rub in until absorbed.
• Apply your moisturizer after the steroid to help support your skin barrier.
• For best absorption, apply to slightly damp skin right after bathing.

How Much Should I 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.

Can I Reduce My Dose Over Time?

Yes — and that’s often the goal. Once your symptoms are under control, your Zest provider will work with you to create a long-term plan. 

This may include gradually spacing out applications as your skin improves or using planned treatment breaks when appropriate. Some patients use maintenance therapy, such as applying medication once or twice weekly (“weekend therapy”), to help prevent flares.

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.

Expected Results

• 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.

Is it Safe/Are There Any Side Effects?

Most side effects are mild and are most likely to occur with long-term use of high-potency steroids. They can include, but not limited to:

• Skin thinning (especially with long-term, high-potency steroid use)
• Stretch marks (striae)
• Increased hair growth in treated areas
• Changes in skin color (lightening or darkening)
• Burning or stinging when the medication is first applied

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.

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 chat message from your portal. You’ve got this, and we’ve got you. Together, let’s work toward relief and clear skin!