Part of our complete guide to eczema and dermatitis in the UK.
Steroid Cream Strengths UK: The Complete Potency Ladder
A complete UK guide to topical corticosteroid potency classes — Class 1 (mild) to Class 4 (very potent), with examples, choosing the right strength by body site, fingertip unit dosing, and side effects.
▶ What are the classes of steroid cream in the UK?
The UK BNF classifies topical steroids into four potency classes: Class 1 (mild) — hydrocortisone; Class 2 (moderate) — Eumovate; Class 3 (potent) — Betnovate (~28× hydrocortisone); Class 4 (very potent) — Dermovate (~600× hydrocortisone). Class determines where it can be used safely and for how long.
One of the most common sources of confusion in eczema management is understanding why you have been prescribed a particular steroid — and whether it is the right one. This guide explains the UK topical steroid potency classification system in full: the four classes, what they contain, when each is appropriate, and how to apply the right amount. It also covers the two prescription steroids most commonly prescribed at Access Doctor — Betnovate and Dermovate — in context.
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View Eczema Treatments →Why Potency Class Matters
Topical corticosteroids are not interchangeable. A steroid that is too weak will not control a flare; one that is too potent for the site or duration will cause side effects. The UK system classifies them into four classes so prescribers can match the treatment to the presentation — by severity, body site, age, and duration of use.
The most common error is using the same steroid for every eczema flare regardless of site or severity. Potent steroids on the face, genitals, or skin folds cause disproportionate side effects because skin in these areas absorbs topical steroids much more readily than on the trunk or limbs.
The UK Topical Steroid Potency Ladder
| Class | Potency | Examples | Relative potency vs hydrocortisone 1% | Typical use |
|---|---|---|---|---|
| Class 1 | Mild | Hydrocortisone 0.5%, 1%, 2.5% | 1× (baseline) | Face, children, mild eczema on any area, genitals |
| Class 2 | Moderate | Clobetasone 0.05% (Eumovate); Betnovate-RD (betamethasone 0.025%) | ~2–25× | Moderate eczema; step-up from mild; step-down after potent |
| Class 3 | Potent | Betamethasone valerate 0.1% (Betnovate); fluticasone propionate (Cutivate); mometasone (Elocon) | ~28× | Moderate-to-severe eczema on body areas; lichenified skin |
| Class 4 | Very potent | Clobetasol propionate 0.05% (Dermovate); halcinonide | ~600× | Severe, resistant, or lichenified eczema; short courses only; prescriber supervision |
Choosing the Right Class by Body Site
| Body site | Maximum recommended class | Reason |
|---|---|---|
| Face, eyelids | Class 1 (mild) | Thin, sensitive skin; high absorption; risk of steroid rosacea and perioral dermatitis |
| Neck | Class 1–2 | Skin folds increase absorption; risk of atrophy |
| Skin folds (armpits, groin, under breasts) | Class 1–2 | Occlusion dramatically increases absorption |
| Genitals | Class 1 (specialist may prescribe Class 2) | Very high absorption; thin skin |
| Scalp | Class 3 (lotion formulation preferred) | Hair provides some protection; lotion distributes easily |
| Hands and feet | Class 3–4 | Thicker skin; often lichenified; lower systemic absorption |
| Trunk and limbs | Class 2–4 depending on severity | Most body areas; standard stepwise approach |
| Children (all areas) | Class 1–2 maximum without specialist guidance | Children absorb more relative to body weight; prolonged use can affect growth |
Class 3 in Focus: Betnovate (Betamethasone Valerate 0.1%)
Betnovate is the most commonly prescribed potent topical corticosteroid in UK primary care. At Class 3 (potent), it is appropriate for moderate-to-severe atopic eczema on body areas that has not responded to mild or moderate steroids. It is available as cream (for moist, inflamed skin), ointment (for dry, lichenified skin), and lotion (for the scalp and hairy skin areas).
For the complete Betnovate guide including mechanism, all indications, safety profile, and when to step up to Dermovate: Betnovate: complete UK guide. For scalp-specific guidance: Betnovate lotion for scalp and hairy skin.
Class 4 in Focus: Dermovate (Clobetasol Propionate 0.05%)
Dermovate is the most potent topical steroid available in the UK at ~600 times the potency of hydrocortisone. It is reserved for severe or resistant eczema that has not responded to Class 3 steroids, and for highly specific indications such as lichenified eczema, plaque psoriasis, lichen planus, and discoid lupus erythematosus. Short courses only — typically 1–2 weeks. The MHRA limit is 50g per week maximum across all applications.
For the complete Dermovate mechanism, safety limits, step-up/step-down guidance, and full side-effect profile: How Dermovate works: clinical guide. For cream formulation guidance: Dermovate cream for eczema. For ointment: Dermovate ointment for dry and lichenified skin.
How Much to Apply: The Fingertip Unit (FTU) Guide
Applying the correct amount of topical steroid is just as important as choosing the right class. Too little produces no benefit; too much increases side effect risk.
A fingertip unit (FTU) is the amount squeezed from a standard tube nozzle along the adult index fingertip to the first crease — approximately 0.5g. This is the standard unit for both creams and ointments.
| Body area | FTUs needed (adult) |
|---|---|
| Face and neck | 2.5 FTUs |
| One hand (both sides) | 1 FTU |
| One foot (both sides) | 2 FTUs |
| One arm | 3 FTUs |
| One leg | 6 FTUs |
| Trunk (front) | 7 FTUs |
| Trunk (back) | 7 FTUs |
Side Effects and How to Minimise Them
Topical steroids are safe when used correctly for appropriate durations. Side effects arise primarily from prolonged use, overuse, or application to the wrong sites:
- Skin thinning (atrophy) — risk increases with prolonged use of Class 3–4 steroids, particularly on thin-skinned areas
- Striae (stretch marks) — irreversible; risk highest in skin folds and flexures
- Telangiectasia — visible thread veins; especially after prolonged facial use
- Steroid-induced rosacea and perioral dermatitis — from Class 3–4 steroids on the face
- HPA axis suppression — rare; risk with large quantities of very potent steroids over extended periods
- Tachyphylaxis — reduced effectiveness with prolonged continuous use; rest periods required
Get Prescription Steroid Cream Online
GPhC-registered pharmacist independent prescribers. Betnovate and Dermovate available following clinical assessment. GPhC pharmacy #9011198.
View Eczema Treatments →Frequently Asked Questions
What are the four classes of topical steroid in the UK?
The UK BNF classifies topical corticosteroids into four classes: Class 1 (mild) — e.g. hydrocortisone 0.5–1%; Class 2 (moderate) — e.g. clobetasone 0.05% (Eumovate); Class 3 (potent) — e.g. betamethasone valerate 0.1% (Betnovate); Class 4 (very potent) — e.g. clobetasol propionate 0.05% (Dermovate). Class 4 is the strongest available.
How strong is Betnovate compared to hydrocortisone?
Betnovate (betamethasone valerate 0.1%) is classified as potent (Class 3) and is approximately 28 times more potent than hydrocortisone 1% on a weight-for-weight basis.
How strong is Dermovate compared to hydrocortisone?
Dermovate (clobetasol propionate 0.05%) is classified as very potent (Class 4) and is approximately 600 times more potent than hydrocortisone 1%.
Which steroid cream should I use for eczema on my face?
Mild potency steroids only (Class 1) — typically hydrocortisone 0.5–1%. Potent steroids (Class 3–4) should not be applied to the face except under specialist direction. Facial skin is thinner, more sensitive, and at higher risk of side effects including skin atrophy and steroid-induced rosacea.
What happens if I use a steroid that is too strong?
Using a steroid that is too potent for the site or duration can cause skin thinning (atrophy), stretch marks (striae), telangiectasia (thread veins), perioral dermatitis, steroid-induced rosacea, and — with very large quantities — systemic absorption affecting the adrenal glands (HPA axis suppression). Always use the lowest effective potency for the shortest effective duration.
Can I use Dermovate on children?
Dermovate (very potent, Class 4) should not be used in children under 12 except under specialist supervision. Children's skin is thinner and absorbs topical steroids more readily. The standard approach for children is mild steroids (hydrocortisone) for most areas, stepping up with prescriber guidance only.
What does 'fingertip unit' mean?
A fingertip unit (FTU) is the amount of cream or ointment squeezed from a standard tube nozzle along the tip of the index finger to the first crease — approximately 0.5g. One FTU covers an area of skin equivalent to both sides of an adult hand. FTUs provide a practical guide to applying the correct amount of topical steroid.
References
- BNF. Topical corticosteroids. NICE/BNF, 2024. bnf.nice.org.uk
- NICE. Eczema — atopic: CKS. 2024. cks.nice.org.uk
- Long CC, Finlay AY. The fingertip unit. Clin Exp Dermatol. 1991;16(6):444–447.
- Hengge UR et al. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54(1):1–15.
Medical disclaimer: This article is for informational purposes only. The treatments discussed are prescription-only medicines — a clinical consultation is required before they can be dispensed. In a medical emergency, call 999.