Publications

Adverse effects from inappropriate use of topical corticosteroids

Published: 4 June 2026
Prescriber Update 47(2): 22–24
June 2026

Key messages

From 23 March 2028, all topical corticosteroid products used for inflammatory skin conditions will include potency information on their packaging.
Serious adverse effects from topical corticosteroids are rare when prescribed and used appropriately.
Local and systemic adverse effects are more likely to occur with inappropriate use of topical corticosteroids.
Prescribe the lowest effective potency needed to control the patient’s symptoms.
Clearly explain to patients the potency of the product, when and where to apply it, how often to use it, and how long treatment should continue.
If multiple topical corticosteroid products are prescribed, explain the different potencies, and where and when each product should be used.

Topical corticosteroids are commonly used to manage inflammatory skin conditions, such as eczema. Their benefits are well-established and serious adverse effects are seen rarely when prescribed and used appropriately.^1,2

This article highlights the potential serious adverse effects of inappropriate topical corticosteroid use and outlines ways to minimise these risks.

Inappropriate use of topical corticosteroids includes using an incorrect potency for a body area or using them more frequently or for longer than advised.

Serious adverse effects from inappropriate use of topical corticosteroids

The risk of serious adverse effects is increased with use of higher potency corticosteroids, prolonged or frequent application, application to areas of thin skin, occlusion of the application site and concomitant use of other corticosteroids by other routes (eg, oral and high-dose inhaled corticosteroids).³

Significant local adverse effects

Significant local adverse effects include skin atrophy (thinning), striae (stretch marks), telangiectasia (spider veins), acne and worsening of acne or rosacea. Some effects, such as skin atrophy, may gradually improve after stopping treatment, while striae and telangiectasia are permanent.³

Systemic adverse effects

Adrenal suppression from systemic absorption can occur from long-term and excessive use of potent or very potent topical corticosteroids. Adrenal suppression can lead to reversible hypothalamic-pituitary adrenal (HPA) axis suppression, Cushing’s syndrome and adrenal insufficiency.³

Topical steroid withdrawal syndrome

Topical steroid withdrawal (TSW) syndrome is a rare rebound reaction reported by patients who discontinue topical corticosteroids, particularly after prolonged, inappropriate and frequent use of higher potency topical corticosteroids.^4,5

Features of TSW include an acute skin eruption, burning pain, severe itch and red oozing skin that may extend to untreated areas. TSW can be difficult to distinguish from a flare-up of the patient’s underlying skin condition and other skin conditions that share similar features.^4,5

Minimising adverse effects

Prescribe the lowest effective potency needed to control the patient’s symptoms.² Diluting topical corticosteroids does not result in a less potent medicine.³
Consider seeking specialist advice for patients needing continuous daily treatment with potent or very potent topical corticosteroids for more than 4 weeks. Additional treatments may be needed to manage the skin condition.
Provide clear patient education, explaining when and where to apply the topical corticosteroid, how often to use it, and how long treatment should continue.
The fingertip unit measurement can be helpful to determine the amount to prescribe. This unit can also be used to explain to patients the amount of topical corticosteroid to use, ensuring enough topical corticosteroid is used while avoiding excessive exposure.³
If multiple topical corticosteroid products are prescribed, explain the different potencies, and where and when each product should be used.

Clearer labelling of topical corticosteroids

From 23 March 2028, all topical corticosteroid products used for inflammatory skin conditions will include potency information on their packaging (as shown in Table 1). This change will help patients identify the correct product to use and reduce the risk of accidental use of more potent (stronger) corticosteroids on more delicate areas of the body.

Note that this requirement does not apply to pharmacy dispensing labels. However, we encourage pharmacists to include potency information on the label when appropriate.

Table 1: Potency labelling of topical corticosteroids from 23 March 2028

Potency	Examples	Product labelling
Mild	Hydrocortisone	Mild steroid
Moderate	Clobetasone Hydrocortisone butyrate Triamcinolone acetonide	Moderate steroid
Potent	Betamethasone valerate Betamethasone dipropionate Mometasone furoate Methylprednisolone aceponate	Strong steroid
Very potent	Clobetasol propionate Betamethasone dipropionate (in an optimised vehicle)	Very strong steroid

More information

For consumers

Healthify: Steroid creams, lotions and ointments

For healthcare professionals

bpac^nz: Topical corticosteroids for childhood eczema: clearing up the confusion
Paediatric Society of New Zealand: Topical steroid withdrawal syndrome (PDF, 3 pages, 265 KB)
Refer to local Community HealthPathways for clinical information on topical corticosteroids.

References

Oakley A. 1997. Topical steroid. In: DermNet updated 4 January 2016. URL: https://dermnetnz.org/topics/topical-steroid (accessed 9 April 2026).
bpac^nz. 2021. Topical corticosteroids for childhood eczema: clearing up the confusion. BPJ updated 11 September 2025. URL: https://bpac.org.nz/2021/topical-corticosteroids.aspx (accessed 9 April 2026).
New Zealand Formulary (NZF). 2026. NZF v167:Topical corticosteroids 1 May 2026. URL: https://nzf.org.nz/nzf_6272 (accessed 11 May 2026).
Lee HK and Reiche L. 2023. Topical corticosteroid withdrawal. In: DermNet July 2023. URL: https://dermnetnz.org/topics/topical-corticosteroid-withdrawal (accessed 9 April 2026).
Hajar T, Leshem YA, Hanifin JM, et al. 2015. A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses. Journal of the American Academy of Dermatology 72(3): 541-549.e2. DOI: 10.1016/j.jaad.2014.11.024 (accessed 9 April 2026).