Topical Corticosteroids: Potency, Vehicles, and Best Practices

During his presentation at the 2025 South Beach Symposium in Miami, Florida, Christopher Bunick, MD, PhD, associate professor of dermatology and translational biomedicine at Yale School of Medicine, shared insights regarding the selection and application of corticosteroids for inflammatory dermatoses. As the medical chair of the curriculum, he highlighted key considerations in choosing the appropriate corticosteroid potency and vehicle for effective treatment.

"The first and most common is using the body site," Bunick explained. "If you have a rash on the face or in a thin-skinned area, like the armpits, the genital area, then you're generally going to pick a corticosteroid that's of a lower to medium potency, whereas if you have a rash that's on the trunk or the extremities, you're more likely to use a higher potency or super potent topical corticosteroid." Selecting the right vehicle—such as ointments, creams, lotions, or foams—is equally crucial. He noted that ointments are often unsuitable for hair-bearing areas like the scalp, where foam formulations have become a preferred option for conditions such as seborrheic dermatitis.

Bunick emphasized the growing role of non-steroidal topicals, which have emerged as alternatives for treating psoriasis, atopic dermatitis, and seborrheic dermatitis. "What we've seen in dermatology over the last year or 2is significant innovations in being able to develop foam formulations that work really well in treating seborrheic dermatitis of the scalp, such as the roflumilast foam," he said. These innovations ensure better patient compliance and effectiveness by enhancing drug penetration through the skin.

A critical aspect of dermatologic care is recognizing corticosteroid misuse or overuse. "One of the first things is talking to the patient and simply asking them in a really good history-taking session, how are you using your steroid?" Bunick advised. Signs of overuse include skin atrophy, hypopigmentation, redness, and increased blood vessels, particularly in thin-skinned areas. Misuse may also lead to recurrent infections and striae, making clinical assessment essential.

Steroid phobia remains a significant barrier to treatment adherence. Bunick acknowledged that many patients, particularly parents of pediatric patients, hesitate to use corticosteroids due to fear of adverse effects. "It is absolutely true that steroid phobia is real," he stated. Educating patients on proper steroid use—applying them twice daily for a couple of weeks—is vital to achieving long-term resolution of inflammation without unwanted side effects. For patients opposed to corticosteroids, emerging non-steroidal alternatives, such as topical JAK inhibitors and phosphodiesterase-4 inhibitors, provide effective and safer options.

The dermatology field continues to evolve with innovative treatments, offering both corticosteroidal and non-steroidal options tailored to individual patient needs. Clinicians must balance efficacy, safety, and patient preferences to optimize dermatologic care.