How Long Is It Safe to Use Cortisone on the Face?

Cynthia Bailey, MD|October 22, 2012

ask a dermatologist skin care questionsHello Dr. Bailey, I've been reading your columns about rosacea and have ordered your Replenix CF cream. You mentioned using Locoid Ointment with the Replenix. I would like to know if it's safe to use Locoid Ointment indefinitely. Thanks, Freya W. Hello Freya, No, it's definitely NOT safe to use cortisone on the face indefinitely. Cortisone creams, ointments, gels, foams, and solutions are medicines, and all medicines have side effects. Even over-the-counter cortisone products are medicines with side effects. That said, topical cortisone is also a near-miracle when inflammation is causing havoc on your skin. It is, however, not a long-term fix, because there are cortisone dangers of which you need to be aware. Our goal is always to control rashes using treatments and skin care that don't have side effects. We then use cortisone as an emergency treatment to control inflammation. What are the dangers of applying cortisone indefinitely to your skin? Steroid atrophy. All cortisone topical medicines, even low-potency ones like Locoid, will eventually thin the skin. It's called steroid trophy. It is reversible at first, but eventually the thinning can become permanent. Steroid atrophy of the skin is seen as skin wrinkling, "broken capillaries," and skin weakness. On non-facial areas you can also see striae (stretch marks) as well. Eye damage.  Applying topical cortisone products to the face is not good for your eyes. The product will gravitate to the eye area as it melts and is absorbed into your skin. This can cause the cornea to become dangerously thin. Cortisone can also cause cortisone-specific cataracts (these are different than the more common type of cataracts). Steroid addiction. If the first two reasons are not enough, chronic application of cortisone creams, ointments, foams, gels, and solutions can also cause cortisone "addiction" of the skin, leading to inflammation that gets worse every time you try to stop the cortisone. Perioral dermatitis.  Some cortisone creams, ointments, gels, and solutions can even cause a rosacea-like rash called perioral dermatitis. This rash usually occurs around the nose or mouth, but I've also seen it around the eyes. I've seen it around the mouth and nose on patients who use cortisone asthma inhalers too. The rash causes itchy pimple-like pustules and blisters that are grouped around the involved area. The skin lesions get worse when you try to stop the cortisone. Treatment often requires oral antibiotics, although we don't know why they work. We also don't know the cause of perioral dermatitis beyond its sometime correlation with cortisone usage. To read more about perioral dermatitis click here. So, the answer to your question is a definite NO! Why then do we ever use topical cortisone for skin rashes if the side effects are serious? With chronic and stubborn facial rashes such as rosacea and facial dandruff (seborrheic dermatitis), the use of cortisone creams on facial skin is a last ditch attempt to wrestle control of the inflammation. The cortisone use should be limited in time, however.  Just exactly what that means varies from person to person. I tell my patients that if the rash is not getting better within two weeks, they need to come in and let me rethink treatment. My ultimate treatment goal for chronic inflammatory skin rashes is that my patients only need to use cortisone every now and then for just a day or two. The idea is to stop the beginning signs of inflammation before it builds into a full on rash. In my office, we also don't refill topical cortisone cream, ointment, and solution prescriptions indefinitely. For cortisone refills, I ask my patients to come in and show me their skin from time to time. This is an important part of my supervising their use of topical cortisone treatment because:

  1. I want to be certain that I'm always doing the best job I can with the other skin care treatments available to control their chronic skin problem. This is a key component to minimizing exposure to cortisone so that we prevent side effects! It's why I've made skin care kits like my Redness Relief Kit, which I use to build a basis of good skin care for rosacea and facial dandruff. dermatologist recommended products for rosacea and facial dandruff I add to that the other skin care products and prescriptions that have fewer or no side effects in the hope that these will keep the skin clear, thus negating the need for cortisone topical medicines. See below for links to my dandruff and rosacea skin care recommendations.
  2. It gives me a chance to double check that the cortisone cream is still an appropriate treatment for their skin problem. Remember, the skin has a limited vocabulary. Not every itchy, red, and scaly rash should be treated with cortisone; other skin rashes can develop and look similar, but require different treatments.
  3. It also allows me to supervise the use of the cortisone and examine their skin to be sure there are no signs of early cortisone side effects.

This is a really important question, thanks for asking it!  Below, I've added links to posts that outline my skin care recommendations for seborrheic dermatitis (dandruff) and rosacea. These are the two most common facial rashes that I treat -and they are really common, unfortunately. Again, the goal is to try to keep your complexion clear without the use of topical cortisone medicines. Warm Regards, Cynthia Bailey MD, Dermatologist Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

Dr Bailey, I am 53 yrs old and was recently diagnosed with seborrheic dermatitis of my scalp, face and neck….never have had eczema or anything like this…I went to my family dr and am taking over the counter cortisone lotion and a coal shampoo and nixoral shampoo by prescription….my ? Is about the cortisone creme…it was recommended to apply on my face and chest and the redness is almost gone…but I am afraid to use very long…can you please help me???

By Mary Van Brown on 2016 10 22

As mentioned in this post, cortisone will thin skin over time. It can damage eyes too. I always personally monitor the use of cortisone when I recommend it to a patient and I make sure all the other non-cortisone options are in use and that the cause of any diagnosis is being addressed so that we limit the need for cortisone. It is not possible for me to give you assurance about the use of cortisone in your particular case, that is the role of your treating doctor.

By Cynthia Bailey, MD on 2016 10 25

I am using hydrocortisone cream 2% for dermatitis on the face.  Cosmetic products made my face burn and turn bright red.  I normally have an oily skin.  My skin at the moment has dry patches although the redness has minimized.  My question is I need to wear makeup for work.  Can I use a tinted moisturizer over the hydrocortisone cream and if so, do I have to wait before applying.

By Dannie Alter on 2016 10 29

Hello Dannie, I have my patients use sunscreen every day, even if they are applying a cortisone. The sunscreen is tinted. My favorite that is soothing and hypoallergenic is Suntegrity BB Cream. When sunscreen is not needed then mineral powder over a hypoallergenic and non-irritating moisturizer is another option such as the Baked Mineral Powder The trick is avoiding any ingredients that can be irritating to barrier compromised skin. Hydrocortisone 2% is a prescription product and so all care must be guided by the treating physician.

By Cynthia Bailey, MD on 2016 10 30

Please help.
I’ve had a terrible reaction to retin a.
My face has broken out in a severe rash/acne
that is very red and itchy.
Is this permanent?
What can I use to calm it down?

By Laura on 2016 11 09

Hello Laura, I am sorry to hear about your skin problem. I can not addressed any specific reader’s skin problem over the internet. I always recommend a reader seek out a treating dermatologist in their area for help. Warm Regards

By Cynthia Bailey, MD on 2016 11 22

Hello - I’ve had eczema my entire life, but has gotten better with age (33 now). However, my cheeks always seem to be irritated. Because of this, I have been using Aveeno 1% hydrocortisone cream every day for several years (yes, YEARS) on my cheeks. It wasn’t until a few days ago I heard about some of the risks involved with doing this. Reading this article has alerted me to even more risks that I was not aware of.
My question is, how do I know if I have caused permanent damage because of this? What are some things that I should look out for? And, is there any other treatment you can recommend that will help soothe the redness and irritation on my face?
Thank you! In my practice I examine the skin and if we are concerned about occular side effects we enlist the help of an opthalmologist. I treat facial eczema with Tolariane Cleanser and Green Tea Antioxidant Therapy and my Natural Lotion or Day Cream for Dry/Normal Skin and Suntegrity Sunscreen. Hope that helps. CBMD

By Brian on 2016 12 29

Add Your Comment