Recommended Topical Steroid for Facial Dermatoses
For facial eczema, psoriasis, or dermatitis, use hydrocortisone 1-2.5% cream or alclometasone dipropionate 0.05% cream applied once or twice daily. 1, 2
Why Low-Potency Steroids for the Face
The face requires low-potency topical corticosteroids due to thinner skin in this anatomical location, which results in increased percutaneous absorption and substantially higher risk of adverse effects including atrophy, telangiectasias, and other complications compared to other body sites. 1, 2 Ultrahigh-potency and high-potency steroids should be avoided on the face due to unacceptable risk of atrophy. 3
Specific Agent Selection
Hydrocortisone 2.5% cream is the most commonly recommended low-potency option for facial application, with established effectiveness and safety profile. 2
Alclometasone dipropionate 0.05% is particularly suitable for sensitive areas including the face and represents an appropriate alternative to hydrocortisone. 2
Desonide 0.05% is another low-potency option safe for facial use. 2
Application Guidelines
Apply the selected low-potency steroid cream once or twice daily to affected facial areas. 1, 2 Use cream or ointment formulations rather than alcohol-containing preparations to avoid excessive drying. 2 Unlike high-potency steroids used on the trunk and extremities, there is no specified time limit for mild potency topical corticosteroids when used appropriately on the face. 2
When Low-Potency Agents Are Insufficient
If facial dermatitis does not respond adequately to low-potency steroids after appropriate trial, consider:
Topical calcineurin inhibitors (tacrolimus 0.03% or pimecrolimus 1%) as steroid-sparing alternatives, which are particularly valuable for facial application where long-term steroid use poses greater risks. 1
Medium-potency steroids (such as triamcinolone acetonide 0.1%) may be cautiously used for short courses on the face if low-potency agents fail, though this carries increased risk and requires close monitoring. 4
Critical Safety Considerations
Topical corticosteroids are the mainstay of treatment for atopic eczema and can be used safely if certain precautions are taken, with the basic principle being to use the least potent preparation required to keep the condition under control. 1 Local cutaneous side effects occur more frequently at steroid-sensitive sites, including the face and intertriginous areas. 1