Topical Steroids: Uses & Side Effects

Topical steroids are aerosols, creams,
gels, lotions, solutions, and tapes that contain corticosteroids (often
abbreviated to steroids) and are designed to be applied externally to the scalp
or the skin, depending on the condition being treated.

Corticosteroids control inflammation by
mimicking naturally occurring corticosteroid hormones produced by our adrenal
glands, which are two small glands that sit on top of our kidneys. In addition
to reducing inflammation (redness and swelling) in the area that they are
applied, topical corticosteroids also suppress the immune response, reduce cell
turnover, and constrict (narrow) blood vessels.

What
are topical steroids used for?

Topical steroids of low to medium potency
may be used for the treatment of various skin disorders that respond to
corticosteroids such as:

  • atopic dermatitis (mild-to-moderate)
  • contact dermatitis
  • discoid lupus erythematosus of the face and skin folds
    (intertriginous areas)
  • dry skin
  • insect bites
  • intertrigo
  • itching confined to small areas of skin
  • itching of the anogenital regions
  • lichen planus of the face and intertriginous areas
  • nummular dermatitis
  • polymorphous light eruption
  • psoriasis of the face and intertriginous areas
  • seborrheic dermatitis of the face and intertriginous areas.

More potent topical corticosteroids may be
used for the treatment of:

  • Alopecia areata
  • Atopic dermatitis (resistant)
  • Discoid lupus erythematosus
  • Lichen planus
  • Granuloma annulare
  • Psoriatic plaques and psoriasis that affects the palms, soles,
    elbows, or knees
  • Severe hand eczema
  • Severe poison ivy.

Generally, the weakest effective steroid
should be used; however, some doctors may choose to use a more potent topical
steroid initially for the first few days.

Are
there any differences between topical steroids?

Topical steroids come in various potencies
(strengths), ranging from very high potency (Class 1) to low potency (Class 7).

In some instances, absorption of different
formulations containing the same active ingredient can vary (for example,
betamethasone ointment is absorbed better than betamethasone cream) which can
also affect potency.

Skin thickness can also affect absorption.

  • The skin of the eyelids, genitals, and skin creases is thin and
    potent topical steroids should be avoided.
  • The skin of the palms and soles is thick and mild topical steroids
    are usually ineffective.

Absorption (and potency) is greatly
enhanced by occlusion (covering the area with impermeable or semi-impermeable
dressings).

Topical steroids are sometimes combined
with other ingredients, such as antifungal or antibacterial agents. Combination
antibacterial/corticosteroid preparations should only be used short-term (for
less than one week) to reduce the risk of antimicrobial resistance developing.

Very
high potency (Class 1)

These topical corticosteroids are up to 600 times more potent than topical hydrocortisone.

Potent
(Class 2)

These topical corticosteroids are 100-150
times more potent than topical hydrocortisone.

Upper
medium potency (Class 3)

These topical corticosteroids are up to 25
times more potent than topical hydrocortisone.

Medium
potency (Class 4 and 5)

These topical corticosteroids are between 2 and 25 times more potent than topical hydrocortisone.

Mild
(Class 6)

These topical corticosteroids are slightly
more potent than topical hydrocortisone.

Least
potent (Class 7)

Hydrocortisone is the least potent topical
corticosteroid.

Are
topical steroids safe?

Serious side effects are uncommon or rare
when topical corticosteroids are used exactly as directed and for the time
intended, but may include:

  • Cushing syndrome: Rare, but the risk is higher if large quantities
    of a topical corticosteroid (>50g/week of clobetasone propionate or
    >500g/week of hydrocortisone) are used long-term
  • Glaucoma or cataracts caused by excessive use of topical steroids
    near the eye.

Topical steroids should not be confused
with anabolic steroids often abused by body-builders to increase muscle mass.

Side
Effects

Common side effects reported with topical
steroids include:

  • Easy bruising and tearing of the skin
  • Enlarged blood vessels (telangiectasia)
  • Folliculitis (inflammation of the hair follicles) and miliaria
    (sweat rash): ointments
  • Increased hair thickness and length in the area of application
    (hypertrichosis)
  • Skin thinning
  • Stinging or inflamed skin: creams
  • Stretch marks (striae) especially in the armpits or groin.

Side effects associated with more potent
topical steroid use include:

  • Perioral dermatitis (also called “Muzzle rash”). Consists of small,
    red, pus-filled bumps and mild peeling around the mouth
  • Steroid rosacea: A rosacea-like condition near the middle of the
    face. Can worsen when the topical steroid is discontinued
  • Pustular psoriasis: Clearly defined raised bumps filled with pus
  • Topical corticosteroid withdrawal: Symptoms include red burning
    skin, swelling, or pimples after discontinuation of the topical corticosteroid.

Topical corticosteroids can also mask the
symptoms of infections caused by bacteria, fungi, or viruses.

Always consult your healthcare provider to
ensure the information displayed on this page applies to your personal
circumstances.

Keyword: topical steroids; corticosteroids.

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