Topical Steroid Potency Chart: How to Choose the Right Strength to Avoid Skin Damage

Using the wrong strength of topical steroid can turn a helpful treatment into a problem. You might think stronger is better - but that’s not true. Too much potency, too long, on the wrong part of your body, and you risk thinning skin, stretch marks, redness, or even permanent damage. The good news? There’s a simple, science-backed way to avoid this: topical steroid potency charts.

What Does Potency Even Mean?

Potency isn’t about how well a steroid works - it’s about how strongly it affects your skin. A superpotent steroid like clobetasol propionate (Temovate) is 100 times stronger than over-the-counter hydrocortisone cream. That doesn’t mean it’s 100 times better. It just means it’s 100 times more likely to cause side effects if misused.

The U.S. FDA uses a seven-class system to rate these strengths:

• Class I (Superpotent): Clobetasol, halobetasol, diflorasone - used for thick, stubborn plaques like severe psoriasis.
• Class II-III (High to Moderate): Betamethasone, mometasone, triamcinolone - common for eczema flares on the body.
• Class IV-V (Moderate to Low): Hydrocortisone butyrate, fluocinolone - used on sensitive areas like the face or groin.
• Class VI-VII (Least Potent): Over-the-counter hydrocortisone 0.5%-2.5% - safe for mild irritation and kids.

These aren’t random labels. They’re based on real lab tests that measure how much a steroid shrinks blood vessels in the skin - the gold standard for judging strength. A Class I steroid causes 90% vasoconstriction. A Class VII? Maybe 10%.

Why Potency Matters More Than You Think

Most people don’t realize that the same steroid can act differently depending on where you put it. Apply a Class IV cream to your face? You’re risking skin thinning. Use it on your elbow? It might be perfect.

The Skin Health Institute of Australia found that potency effectively increases by one class when applied to skin folds - armpits, groin, under breasts. That’s because these areas absorb more. Same cream. Different result.

Even the base matters. Ointments are greasy, but they lock in moisture and let more steroid get through - up to 20% more than creams. So if you’re using a high-potency ointment on your face, you’re asking for trouble. A cream version of the same drug might be safer.

And concentration? Two hydrocortisone creams - one at 1%, one at 2.5% - are in different potency classes. The stronger one is Class VI. The weaker one? Class VII. That’s not a tiny difference. That’s the difference between safe and risky.

Where You Apply It Changes Everything

Your face, eyelids, neck, and genitals have thin skin. They absorb steroids faster. That’s why guidelines are strict:

• Face and eyelids: Only use Class VI or VII (like hydrocortisone 1% or 2.5%). Never Class III or higher.
• Armpits, groin, genitals: Class IV or lower. Even Class V can cause thinning if used daily for more than a week.
• Hands, feet, elbows, knees: These areas have thick skin. You can use Class II or III here - but still limit use to 1-2 weeks.
• Large body areas: Avoid high-potency steroids on more than 10% of your skin. Systemic absorption can mess with your hormones.

A 2020 study showed that 42% of patients used moderate-to-high potency steroids on their faces - often because the label didn’t say “do not use on face.” That’s how side effects start.

How Long Is Too Long?

Duration matters as much as strength. The American Academy of Family Physicians says:

• Class I steroids: Never use longer than 2-3 weeks.
• Class II-III: Don’t go past 3 months.
• Class IV-VII: Can be used longer - but still, take breaks.

Why? Because steroids suppress your skin’s natural repair system. Use them too long, and your skin forgets how to heal itself. That’s when you get:

• Thinning skin (atrophy)
• Visible blood vessels (telangiectasia)
• Stretch marks
• Acne or rosacea flare-ups
• Topical steroid withdrawal (red, burning skin after stopping)

One in five people who use high-potency steroids for more than 3 weeks develop skin atrophy. And it’s not always reversible.

How Much Should You Use?

Most people use way too much. A single fingertip unit (FTU) - the amount of cream or ointment squeezed from a tube from the crease of your index finger to the tip - covers two adult handprints. That’s it.

• One FTU = one adult palm size (front and back)
• Face and neck = 2.5 FTUs
• One arm = 3 FTUs
• One leg = 6 FTUs

Studies show 35% of patients use 2-3 times that amount. That’s not just wasteful - it’s dangerous. More cream doesn’t mean faster healing. It just means more steroid soaking into your skin.

Special Cases: Kids and Chronic Conditions

Children absorb steroids 3-5 times faster than adults. Their skin is thinner, their body weight is lower, and their hormone systems are still developing. That’s why:

• Infants and toddlers: Only use Class VI-VII (hydrocortisone 1% max).
• Children under 12: Limit moderate potency (Class IV-V) to 7-14 days max.
• Never use Class I or II on kids unless under direct dermatologist supervision.

One study found 8.7% of children on high-potency steroids developed HPA axis suppression - meaning their body stopped making its own cortisol. That’s serious.

For chronic eczema, doctors now recommend “proactive therapy”: applying a mild steroid (Class VI) twice a week to areas that flare up, even when they look clear. This cuts flares by 68% over 16 weeks, according to the TRAIN study. It’s like preventive maintenance - not waiting for a flare to get worse.

What About Newer Steroids and Alternatives?

Not all steroids are created equal, even within the same class. For example:

• Elocon (mometasone) is 25% more potent than Diprosone (betamethasone dipropionate), even though both are Class II.
• Advantan (methylprednisolone) is 30% less potent than Elocon.

And then there are new delivery systems. The FDA approved a hydrocortisone valerate foam in 2021 that delivers 35% more steroid than the old cream - even though the concentration is the same. Potency charts haven’t fully caught up.

That’s why more people are turning to non-steroidal options. Crisaborole (Eucrisa) and ruxolitinib (Opzelura) work well for mild-to-moderate eczema and psoriasis. They don’t cause skin thinning. But they’re slower. A Class I steroid clears 85% of psoriasis plaques in 4 weeks. Ruxolitinib? 72%. So sometimes, you need the steroid - just not for long.

How to Use the Chart Right

Here’s your simple checklist:

1. Check the label. Is it Class I-VII? If not, ask your pharmacist.
2. Match strength to location. Face? Use only mild. Body? Maybe moderate.
3. Use the fingertip unit. One FTU per two handprints. No more.
4. Set a timer. If you’re on Class II or higher, set a phone alert for 14 days. Stop unless told otherwise.
5. Watch for warning signs. Thinning skin, redness after stopping, shiny patches? Talk to your doctor.

Most dermatologists and pharmacies now have digital potency charts built into their systems. If yours doesn’t, download the National Psoriasis Foundation’s free chart. It’s updated for 2025 and includes comparisons to non-steroidal options.

What to Do If You’ve Already Damaged Your Skin

If you’ve used a strong steroid too long and now your skin is thin, red, or burning:

• Stop the steroid immediately - but don’t quit cold turkey. Taper slowly under medical supervision.
• Use fragrance-free moisturizers daily. Ceramide creams help rebuild your skin barrier.
• Avoid heat, harsh soaps, and scrubbing.
• See a dermatologist. They can prescribe non-steroidal anti-inflammatories or light therapy to help recovery.

Recovery takes months. But it’s possible. The key? Never go back to the same high-potency steroid without a plan.

Bottom Line

Topical steroids are powerful tools - but they’re not candy. Their strength isn’t a badge of honor. It’s a warning. The right potency, applied correctly, for the right amount of time, can heal your skin. The wrong one? It can break it.

Use the potency chart. Know your class. Respect the limits. Your skin will thank you.