From the Guidelines
Topical steroids should generally be avoided on the face except for short-term use under medical supervision, and if prescribed, use only mild steroids like 1% hydrocortisone cream for no more than 5-7 days. For facial skin conditions, consider non-steroidal alternatives first:
- For eczema: moisturizers, tacrolimus, or pimecrolimus
- For acne: benzoyl peroxide, retinoids, or topical antibiotics
- For rosacea: metronidazole or azelaic acid If a steroid is necessary, apply a thin layer only to affected areas, avoiding the eyes. Never use high-potency steroids on the face. Facial skin is thinner and more sensitive, increasing the risk of side effects from steroids such as skin thinning, telangiectasia, and perioral dermatitis, as noted in a study published in the Journal of the American Academy of Dermatology 1. Long-term use can lead to steroid-induced rosacea or acne. Always follow up with your healthcare provider if symptoms persist or worsen after treatment. According to the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures, lower potency corticosteroids should be used on the face, intertriginous areas, and areas that are susceptible to steroid atrophy 1.
From the FDA Drug Label
INDICATIONS AND USAGE: Topical corticosteroids are indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. INDICATIONS AND USAGE Triamcinolone acetonide cream, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
The indications and usage of topical corticosteroids for facial skin are for the relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses 2 3.
- Key uses include treating skin conditions that respond to corticosteroids, such as:
- Inflammatory skin conditions
- Pruritic (itchy) skin conditions Note that the labels do not explicitly mention facial skin, but dermatoses can occur on the face.
From the Research
Indications for Topical Corticosteroids on Facial Skin
- Topical corticosteroids are used to treat inflammatory skin conditions such as psoriasis and atopic dermatitis 4
- They can be used to treat facial seborrheic dermatitis, a chronic inflammatory skin condition 5
- Topical corticosteroids are classified by strength and the risk of adverse effects, and the risk of adverse effects increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4
Usage of Topical Corticosteroids on Facial Skin
- Patients should be informed that treatment should not exceed prescribed quantities, and continuing treatment should be under careful medical supervision 6
- Topical corticosteroid products should include clear 'fingertip unit' instructions, preferably with images of a 'fingertip unit' and a chart to show the number of units required for specific areas of the body 6
- The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 4
- Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method 4
- Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 4
Precautions and Considerations
- The risk of adverse effects from topical corticosteroids increases with prolonged use, a large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 4
- Lower potencies and shorter durations should be used when prescribing topical corticosteroids for use in children 4
- Topical corticosteroids can work safely and effectively in patients who are pregnant or lactating 4
- Skin thinning was not increased with short-term use of any topical steroid potency, but skin thinning was reported in 0.3% of participants treated with longer-term topical steroids 7