Topical steroids (part 1 of 2)

In this 2 part series we are investigating topical steroids.

In our previous article, Part 1, we discussed what it is, how it works, in what forms it is available, what it is used for and how to use it. In this article, Part 2, we will discuss the dangers of overuse.

What is it

Corticosteroid hormones are naturally occurring hormones produced by the adrenal glands within the body. Topical corticosteroids are synthetic (man-made), and it is a type of anti-inflammatory drug, that suppresses the immune response and are classified based on their skin vasoconstrictive abilities. Topical steroids are the topical forms of corticosteroids. It is also called glucocorticosteroids, and cortisone.

Corticosteroids were first made available for general use around 1950.

Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. It is used based on the potency, area of the body where it will be applied, and type of skin condition being treated.

This medication is available in creams, ointments, solutions and various other forms.

How does it work?

Topical corticosteroids work through different mechanisms:

  • Steroids (naturally occurring hormones produced by the body) are released whenever the body experiences stress, disease, or trauma. They interact with the DNA in the cell to produce proteins called “lipocortin,” and these proteins, in turn, block the chemical necessary for inflammatory response “arachidonic acid,” leading to less inflammation.
  • Immune cells fight infections with the help of defensive cells (meant to neutralize invading viruses and bacteria). They also release toxins in the body, causing more inflammation. Corticosteroids hinder this action and prevent tissue damage that can be caused by excessive inflammation.
  • Inflammation leads to dilatation of blood vessels around the infected site; topical corticosteroids constrict the capillaries (smallest blood vessels) and reduce swelling and pain.

Forms of the medication:

  • cream,
  • ointment,
  • gel,
  • lotion,
  • solution,
  • foam,
  • spray,
  • shampoo,
  • oil, and
  • pads.

Creams are better for skin that is moist and weepy. Ointments are thicker and greasier, and are better for dry or flaky areas of skin.

The strength of the products range from 0.1% (1mg of hydrocortisone in each gram) to 2.5% (25mg of hydrocortisone in each gram). Pharmacies sell hydrocortisone skin cream up to a maximum 1% strength.

There is a stronger hydrocortisone cream called hydrocortisone butyrate. However, this is only available with a prescription.

Sometimes hydrocortisone is mixed with antimicrobials (chemicals that kill germs). This is used to treat skin problems caused by bacterial or fungal infections.

As a general rule, the weakest possible steroid that will do the job, whould be used. Sometimes, It is appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. 

What is it used for

Corticosteroids is used to treat a variety of skin conditions: insect bites, poison oak/ivy, eczema, dermatitis, allergies, rash, itching of the outer female genitals, anal itching.

However, it can make some skin problems worse like impetigo, rosacea and acne. Hydrocortisone skin treatments should only be used on children under 10 years old if a doctor recommends it. Creams you can buy are not supposed to be used on the eyes, around the bottom or genitals, or on broken or infected skin.

  • Weaker topical steroids are utilized for thin-skinned and sensitive areas, especially areas under occlusion, such as the armpit, groin, buttock crease, and breast folds. It can also be used on the face, eyelids, diaper area, perianal skin, and intertrigo of the groin or body folds.
  • Moderate steroids are used for atopic dermatitis, nummular eczema, xerotic eczema, lichen sclerosis et atrophicus of the vulva, scabies (after scabiecide) and severe dermatitis.
  • Strong steroids are used for psoriasis, lichen planus, discoid lupus, chapped feet, lichen simplex chronicus, severe poison ivy exposure, alopecia areata, nummular eczema, and severe atopic dermatitis in adults.

How to use it

Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with the medicine. This will give details of how much to apply and how often.

The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.

Topical steroid is applied once daily (usually at night) to inflamed skin.  Most people only need to use the medicine once or twice a day for 1 to 2 weeks. Occasionally a doctor may suggest using it less frequently over a longer period of time, after that, it is usually stopped, or the strength or frequency of application is reduced.

The medicine should only be applied to affected areas of skin by gently applying a smooth, thin layer onto your skin in the direction the hair grows.

If you’re using both topical corticosteroids and emollients, you should apply the emollient first. Then wait about 30 minutes before applying the topical corticosteroid. Infection may need additional treatment.

Topical steroids should not be used for longer periods than prescribed by your doctor or indicated on the leaflet. Overuse can lead to the development of serious medical conditions.

In our next article, we will discuss the dangers of overuse of topical steroids.


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