Steroid Cream Strengths UK: The Potency Ladder from Mild to Very Potent
The four UK strengths of steroid cream, which products sit where, which strength suits which part of the body, and how much to apply.
Part of our eczema and dermatitis guide.
Get urgent help first. Call 999 or go to A&E if you have swelling of the lips, face or tongue or difficulty breathing. Contact NHS 111 or your GP the same day if eczema suddenly gets much worse with clusters of painful blisters or punched-out sores and a fever (possible eczema herpeticum), or the skin becomes hot, swollen, weeping or crusted and you feel unwell. Online treatment isn’t suitable in these situations.
The short answer: UK steroid creams come in four strengths: mild (hydrocortisone), moderate (Eumovate), potent (Betnovate, Elocon) and very potent (Dermovate). The strength decides where on the body it can be used and for how long. Use the mildest one that controls your eczema, for the shortest time that works.
Adults only online, and not in pregnancy or breastfeeding. Access Doctor’s online eczema service is for adults aged 18 and over, and can’t supply treatment if you’re pregnant or breastfeeding: your GP or midwife can help. Children with eczema should see their GP or a pharmacist.
Why the strength matters
Steroid creams and ointments aren’t interchangeable. One that’s too weak won’t settle a flare, so the eczema drags on. One that’s too strong for the area, or used for too long, raises the risk of side effects such as thinning skin. That’s why the UK groups them into four strengths, so a prescriber can match the medicine to how bad the eczema is, where it is, and how long you’ll need it.
The most common mistake is using the same steroid for every flare, wherever it is. The face, genitals and skin folds absorb steroids far more readily than the arms, legs or body, so a cream that’s fine on your shin can cause problems on your eyelids.
In 2024 the MHRA announced that steroid packs will show their strength, labelled “mild”, “moderate”, “strong” (potent) or “very strong” (very potent), so it’s easier to check what you’re using. Older packs may not show it yet.
The UK steroid strength ladder
The BNF, the reference UK prescribers use, groups topical steroids into four potency levels, based on the steroid itself rather than its percentage strength. You may see these numbered 1 to 4 elsewhere, but UK packs and prescribers use the names.
| Strength | Examples | Typical use |
|---|---|---|
| Mild | Hydrocortisone 0.5%, 1% and 2.5% | Face, skin folds, mild eczema anywhere |
| Moderate | Clobetasone butyrate 0.05% (Eumovate) | Eczema that mild steroids haven’t controlled; stepping down after a potent steroid |
| Potent | Betamethasone valerate 0.1% (Betnovate); mometasone furoate 0.1% (Elocon); fluticasone propionate 0.05% (Cutivate) | Moderate to severe eczema on the body, arms and legs; thickened skin |
| Very potent | Clobetasol propionate 0.05% (Dermovate) | Severe or stubborn eczema on thick skin such as the palms and soles; short courses with prescriber supervision |
You’ll sometimes see claims that one steroid is “600 times stronger” than another. Those multiples come from lab tests and don’t translate neatly to real skin, so UK guidance uses the four names instead. What matters is that each step up is a real increase in strength.
Choosing the right strength for each part of the body
| Body area | Usual maximum strength | Why |
|---|---|---|
| Face and eyelids | Mild (a moderate steroid only for a few days, if a prescriber advises it) | Thin skin that absorbs a lot; risk of thinning, rosacea-like rashes and perioral dermatitis |
| Neck | Mild to moderate | Thinner skin with folds |
| Skin folds (armpits, groin, under the breasts) | Mild to moderate, short courses | Skin rubbing on skin traps the steroid and increases absorption |
| Genitals | Mild, unless a specialist advises otherwise | Very high absorption |
| Scalp | Potent, or very potent for stubborn scalp psoriasis (a scalp application is easier to use) | Thicker skin; hair makes creams hard to spread |
| Hands and feet | Potent, or very potent for the palms and soles | Thick skin, often thickened further by scratching |
| Body, arms and legs | Moderate to potent, depending on severity | The usual step-by-step approach applies |
Our online service follows the same limits. We don’t supply potent or very potent steroids for the face, and very potent steroids are never supplied for the face, genitals or children. Very potent steroids are only supplied to people who’ve been prescribed one before or have a confirmed diagnosis.
Mild and moderate: hydrocortisone and Eumovate
Hydrocortisone is the mildest steroid and the usual first step. Hydrocortisone 1% cream can be bought from a pharmacy without a prescription for adults and children aged 10 and over, but the pharmacy version isn’t for use on the face, eyes, genitals or broken or infected skin, and only for up to 7 days. On prescription, it can be used on the face and for longer, as your prescriber directs. Hydrocortisone is also combined with an antibiotic in Fucidin H, for mildly infected eczema: see our guide to steroid and antibiotic creams.
Eumovate (clobetasone butyrate 0.05%) is the main moderate steroid. It’s the step up when hydrocortisone isn’t enough, and the usual step down after a short course of a potent steroid.
Potent: Betnovate and Elocon
Betnovate (betamethasone valerate 0.1%) is one of the most widely prescribed potent steroids in UK primary care. It’s used for moderate to severe eczema on the body, arms and legs that milder steroids haven’t controlled. It comes as a cream (for moist, weepy skin), an ointment (for dry, thickened skin) and a scalp application. Elocon (mometasone furoate 0.1%) is also potent and is applied just once a day.
For more on Betnovate, see Betnovate uses and how to use Betnovate scalp application (scalp lotion). For Elocon, see Elocon and mometasone uses.
Very potent: Dermovate
Dermovate (clobetasol propionate 0.05%) is the strongest topical steroid used in the UK. It’s kept for severe or stubborn eczema that hasn’t responded to a potent steroid, and for some other conditions such as psoriasis (not widespread plaque psoriasis), lichen planus and discoid lupus.
- Short courses: the product information says not to use it for more than 4 weeks without a review.
- No more than 50g a week in total, from all tubes.
- Not for the face, genitals or skin folds unless a specialist advises it.
- Not for children except under specialist advice, and never for babies under 1 year.
Through Access Doctor, Dermovate is supplied as one 30g tube per order, for up to 4 weeks. For more detail, see how Dermovate works, Dermovate cream for eczema and Dermovate ointment.
How much to apply: the fingertip unit
Using the right amount matters as much as the right strength. Too little means the eczema doesn’t settle, so you end up using the steroid for longer.
A fingertip unit (FTU) is a line of cream or ointment squeezed from a standard tube along an adult’s index finger, from the tip to the first crease. It’s about 0.5g and covers an area about the size of two adult hands, palms flat.
| Area (adult) | Fingertip units |
|---|---|
| Face and neck | 2.5 |
| One hand (both sides) | 1 |
| One arm (not including the hand) | 3 |
| One foot (both sides) | 2 |
| One leg (not including the foot) | 6 |
| Front of the body | 7 |
| Back, including the buttocks | 7 |
1
Apply once or twice a day
Follow your prescription. Many steroids work as well once a day as twice, and Elocon is a once-daily steroid.
2
Spread a thin layer on the eczema only
Smooth it gently into the affected skin, not the clear skin around it.
3
Leave a gap after your moisturiser
Keep using your emollient every day. Leave a gap of around 30 minutes between the emollient and the steroid, so one doesn’t dilute or spread the other.
4
Stop or step down once the flare settles
Carry on for the time your prescriber advises, then stop, or step down to a milder steroid. Keep the emollient going.
Side effects and how to keep the risk low
Steroid creams are safe and effective when used as directed. Most side effects come from using too strong a steroid for the area, or using it for too long.
- Thinning skin (atrophy): more likely with potent and very potent steroids, especially on thin skin. It usually improves after stopping.
- Stretch marks: these can be permanent; the risk is highest in skin folds.
- Thread veins, rosacea-like rashes and perioral dermatitis: mainly from strong steroids used on the face.
- Changes in skin colour: lighter patches can appear, which can be more noticeable on darker skin.
- Effects on the body’s own steroid hormones: rare, and only with large amounts of very potent steroids over long periods.
Topical steroid withdrawal. The MHRA warns that, rarely, stopping a moderate or stronger steroid after long-term daily use (usually more than a year in adults) can cause a reaction: burning, spreading redness that looks different from your usual eczema. It’s most often seen on the face and genitals. If your skin gets worse within 2 weeks of stopping, don’t restart the steroid without speaking to a doctor or pharmacist first.
Need a stronger eczema treatment?
If your eczema isn’t settling with pharmacy hydrocortisone and emollients, our GPhC-registered pharmacist independent prescribers can assess you online and, if suitable, prescribe the right strength for the area. Adults 18 and over. Dispensed from our UK pharmacy. Approved before 3pm, Monday to Friday? Dispatched the same day, by Royal Mail Tracked 48, Tracked 24 or Special Delivery guaranteed by 1pm next working day: you choose.
Start Eczema Consultation →UK safety and reporting side effects
Moderate, potent and very potent steroid creams are prescription-only medicines in the UK. Before anything is prescribed, a GPhC-registered pharmacist independent prescriber reviews your consultation, including where the eczema is and what you’ve used before. Always read the patient information leaflet in the pack, and ask before using a steroid on a new part of the body. Never share a prescribed steroid cream.
If you think you’ve had a side effect from a medicine, including a reaction after stopping a steroid, tell your pharmacist or doctor. You can also report it to the MHRA through the Yellow Card scheme, which helps keep medicines safe for everyone.
A pharmacist can advise on mild eczema and sell hydrocortisone 1% cream and emollients without a prescription. Our private online service is for adults aged 18 and over.
Eczema treatments from Access Doctor
Following an online consultation, our prescribers can supply steroid creams and ointments across the strength ladder, matched to the area and severity of your eczema. These include hydrocortisone 1% cream and ointment, Eumovate ointment, Betnovate cream, Elocon cream and Dermovate cream. Potent steroids are supplied as up to 3 × 30g tubes or 1 × 100g per order.
Moderate · Rx
Eumovate Ointment
The step up from hydrocortisone, and the step down after a potent steroid.
View product →Potent · Rx
Betnovate Cream
For moderate to severe eczema on the body, arms and legs. Not for the face.
View product →Potent · Rx
Elocon Cream
A once-daily potent steroid. Not for the face.
View product →Very potent · Rx
Dermovate Cream
For severe or stubborn eczema, if you’ve been prescribed it before. 30g, up to 4 weeks.
View product →Frequently Asked Questions
What are the four strengths of steroid cream in the UK?
UK steroid creams come in four strengths: mild (such as hydrocortisone 0.5% to 2.5%), moderate (such as clobetasone 0.05%, sold as Eumovate), potent (such as betamethasone valerate 0.1%, sold as Betnovate, and mometasone 0.1%, sold as Elocon) and very potent (clobetasol propionate 0.05%, sold as Dermovate). Very potent is the strongest.
How strong is Betnovate compared to hydrocortisone?
Betnovate (betamethasone valerate 0.1%) is a potent steroid, two steps above hydrocortisone, which is mild. That makes it much stronger, which is why it’s used for moderate to severe eczema on the body rather than on the face.
How strong is Dermovate compared to hydrocortisone?
Dermovate (clobetasol propionate 0.05%) is very potent, the strongest of the four UK strengths and three steps above hydrocortisone. It’s used only for short courses of severe or stubborn eczema, usually for no more than 4 weeks, and not on the face.
Which steroid cream should I use for eczema on my face?
Usually a mild steroid such as hydrocortisone. A prescriber may sometimes advise a moderate steroid for a few days for a bad flare. Potent and very potent steroids shouldn’t be used on the face unless a specialist advises it, because facial skin is thin and more prone to side effects such as thinning and rosacea-like rashes.
Can I buy hydrocortisone cream without a prescription?
Yes. Hydrocortisone 1% cream is sold in pharmacies for adults and children aged 10 and over, for up to 7 days. The pharmacy version shouldn’t be used on the face, eyes, genitals or broken or infected skin. Stronger steroids such as Eumovate, Betnovate and Dermovate need a prescription.
What happens if I use a steroid that is too strong?
Using a steroid that’s too strong for the area, or for too long, can cause thinning skin, stretch marks, thread veins, rosacea-like rashes or perioral dermatitis. Rarely, long-term use of large amounts can affect the body’s own steroid hormones. Use the mildest steroid that works, for the shortest time.
Can I use Dermovate on children?
Dermovate shouldn’t be used in children except on a specialist’s advice, and never in babies under 1 year. Children’s skin absorbs steroids more readily, so mild steroids are the usual choice. Access Doctor only treats adults aged 18 and over; children with eczema should see their GP.
What does fingertip unit mean?
A fingertip unit is the amount of cream or ointment squeezed from a standard tube along an adult’s index finger, from the tip to the first crease. It’s about 0.5g and covers an area about the size of two adult hands. It’s a simple way to apply the right amount.
What is topical steroid withdrawal?
It’s a rare reaction that can happen after stopping a moderate or stronger steroid that has been used every day for a long time, usually more than a year in adults. It causes burning and spreading redness that looks different from your usual eczema. If your skin gets worse within 2 weeks of stopping, speak to a doctor or pharmacist before restarting the steroid.
References
- Joint Formulary Committee. British National Formulary: topical corticosteroids. bnf.nice.org.uk
- NICE Clinical Knowledge Summaries. Eczema – atopic. cks.nice.org.uk
- MHRA. Topical corticosteroids: information on the risk of topical steroid withdrawal reactions. Drug Safety Update, September 2021. gov.uk
- Dermovate cream: summary of product characteristics. medicines.org.uk
- Hydrocortisone 1% cream (pharmacy medicine): summary of product characteristics. medicines.org.uk
- Long CC, Finlay AY. The finger-tip unit: a new practical measure. Clin Exp Dermatol. 1991;16(6):444–447.
- MHRA. Drug Safety Update, May 2024 (potency labelling of topical corticosteroids). gov.uk
- National Eczema Society. Topical steroids factsheet. eczema.org.uk
Medical disclaimer: This article is for information only and isn’t medical advice. Moderate, potent and very potent steroids are prescription-only medicines and need a clinical consultation before they can be supplied. Always follow the instructions from your prescriber and the patient information leaflet. In a medical emergency, call 999.