Should I Use Steroids on My Skin?

Topical steroids are creams, ointments and lotions which contain steroid medications and are most commonly used in the treatment of skin conditions such as eczema and psoriasis to reduce skin inflammation.

These steroid treatments are often offered as a first course of action in treating skin conditions. But are they the magic miracle solution they appear to be? 

Steroid creams come in different potencies and the greater the strength, the greater the risk of side-effects with continued use.  Which is why many experts advise against the long-term use of topical steroids. 

HOW DO THEY WORK?

Topical steroids are absorbed into the skin cells. They stop these cells from producing various inflammation-causing chemicals that are normally released when the skin reacts to allergens or irritation.

By preventing inflammatory chemicals from being released, corticosteroids reduce inflammation and relieve its related symptoms such as redness and itching.

LOCALISED EFFECTS

  • Stinging or burning feeling following treatment
  • Skin thinning
  • Stretch-marks - long-term use has in some cases led to permanent skin bruising, discolouration, or spidery blood vessels
  • Topical steroids can also induce rosacea, which may include the eruption of erythema, papules, and pustules
  • Increased hair growth where the skin is being treated.
  • Some people have developed an allergy to the contents of the treatment, which in some instances can make the inflammation worse
  • Because topical steroids change the way the immune system work, they can inhibit the skin’s ability to fight off bacterial and fungal infections

SYSTEMIC EFFECTS

  • In some cases the topical steroid gets through the skin and into the bloodstream, which is primarily a concern in children who are on strong doses as this can affect their growth
  • Fluid build-up in the legs
  • Increase in blood pressure
  • Bone damage and thinning
  • Cushing's syndrome: although rare, symptoms include rapid weight gain, skin thinning and mood changes
  • Glaucoma is a disease in which the pressure inside the eye increases to the point of damaging the optic nerve. There are isolated reports of people developing glaucoma after long-term use of topical steroids around the eyes. How this happens is not completely understood, but it is believed that enough of the steroid can be absorbed in the surrounding tissue to leech into the eye itself.

HOW LONG SHOULD I USE STEROIDS FOR?

It's advised by medical professionals that topical steroids should not be used continuously for more than two to four weeks, then the frequency should be tapered to twice weekly use. Problems can begin to occur when you try and taper off usage. Steroid creams are only ever targeting the symptoms on the surface of the skin - the underlying condition still exists. 

Topical corticosteroids withdrawal (sometimes called “topical steroid addiction” or “Red Skin Syndrome”) is the adverse effect that can occur when topical steroids are inappropriately used or overused, then stopped. It can result from prolonged, frequent, and inappropriate use of moderate to high potency topical corticosteroids, especially on the face and genital area.

TSW might sound like a new phenomenon but topical steroid addiction was actually identified back in the seventies, according to a study called "Steroid addiction" published in the International Journal of Dermatology forty years ago.

HOW TO PREVENT TOPICAL STEROID WITHDRAWAL

1. Don't use steroids in the first place

When you're deliberating whether to begin a course of topical steroid treatment, remember this might not be the magical quick fix you're looking for. Whilst the temptation of temporary remission is there, consider the long-term implications when making this difficult decision. 

2. Don't go cold turkey when coming off topical steroids

This means slowly cutting down on your applications, rather than stopping suddenly. For example, use a lower strength steroid, then only use it every second day for a week, then every third day for two weeks, and so on until you are applying them once a week. After about a 6 weeks of slowly cutting down on topical steroids, stop using them.

3. Feed your skin with nutrients

It's important to give your body what it needs during this time of hormonal imbalance and healing. TSW can take months or even years to recover from, if you do not have extra nutritional support. Nutritional support reduces the risk of loss of hair, eyebrow loss and "elephant skin" and it helps patients with TSW recover faster. Follow the plan and recipes in my book RADIANT - specifically designed to heal skin from within. 

LIST OF STEROID TREATMENTS

Brand name Name of corticosteroid Potency Other active ingredients
Alphaderm cream Hydrocortisone 1% Moderate
Aureocort ointment Triamcinolone acetonide 0.1% Potent Urea (humectant moisturiser)
Betacap scalp application Betamethasone valerate 0.1% Potent
Betnovate cream/ointment/lotion Betamethasone valerate 0.1% Potent
Betamethasone and clioquinol cream/ointment Betamethasone valerate 0.1% Potent Clioquinol (antiseptic)
Betamethasone and neomycin cream/ointment Betamethasone valerate 0.1% Potent Neomycin (antibiotic)
Betnovate RD cream/ointment Betamethasone valerate 0.025% Moderate
Bettamousse Betamethasone valerate 0.12% Potent
Calmurid HC cream Hydrocortisone 1% Moderate Urea, lactic acid (humectant moisturisers)
Canesten HC cream Hydrocortisone 1% Mild Clotrimazole (antifungal)
Clarelux foam Clobetasol propionate 0.05% Very potent
Cutivate cream/ointment Fluticasone propionate Potent
Daktacort cream/ointment Hydrocortisone 1% Mild Miconazole (antifungal)
Dermacort cream Hydrocortisone 0.1% Mild
Dermovate cream/ointment Clobetasol propionate 0.05% Very potent
Dermovate scalp application Clobetasol propionate 0.05% Very potent
Clobetasol, neomycin and nystatin cream/ointment Clobetasol propionate 0.05% Very potent Neomycin, nystatin (antibiotic + antifungal)
Dioderm cream Hydrocortisone 0.1% Mild
Diprosalic ointment Betamethasone dipropionate 0.05% Potent Salicylic acid (keratolytic)
Diprosalic scalp application Betamethasone dipropionate 0.05% Potent Salicylic acid (keratolytic)
Diprosone cream/ointment Betamethasone dipropionate 0.05% Potent
Diprosone lotion Mometasone furoate 0.1% Potent
Elocon cream/ointment Mometasone furoate 0.1% Potent
Etrivex shampoo Clobetasol propionate 0.05% Very potent
Eumovate cream/ointment Clobetasone butyrate 0.05% Moderate
Eumovate eczema and dermatitis cream Clobetasone butyrate 0.05% Moderate
Eurax hydrocortisone cream Hydrocortisone 0.25% Mild Crotamiton (anti-itch)
Fucibet cream Betamethasone valerate 0.1% Potent Fusidic acid (antibiotic)
Fucidin H cream/ointment Hydrocortisone acetate 1% Mild Fusidic acid (antibiotic)
Haelan cream/ointment/tape Fludroxycortide Moderate
Locoid cream/ointment/crelo/ lipocream/scalp lotion Hydrocortisone 17-butyrate 0.1% Potent
Lotriderm cream Betamethasone dipropionate 0.064% Potent
Metosyn cream and ointment Fluocinonide 0.05% Potent
Mildison lipocream Hydrocortisone 1% Mild
Modrasone cream/ointment Alclometasone dipropionate 0.05% Mild
Nerisone cream/oily cream/ointment Diflucortolone valerate 0.1% Potent
Nerisone forte oily cream/ointment Diflucortolone valerate 0.3% Very potent
Nystaform HC cream/ointment Hydrocortisone 0.5%, 1% Mild Nystatin, chlorhexidine (antifungal + antiseptic)
Synalar cream/ointment/gel Fluocinolone acetonide 0.025% Potent
Synalar 1 in 4 cream/ointment Fluocinolone acetonide 0.00625% Moderate
Synalar 1 in 10 cream Fluocinolone acetonide 0.0025% Mild
Synalar C cream/ointment Fluocinolone acetonide 0.025% Potent Clioquinol (antimicrobial)
Synalar N cream/ointment Fluocinolone acetonide 0.025% Potent Neomycin (antibiotic)
Timodine cream Hydrocortisone 0.5% Mild Dimeticone, nystatin, benzalkonium chloride (barrier +antifungal +antiseptic)
Trimovate cream Clobetasone butyrate 0.05% Moderate Oxytetracycline, nystatin (antibiotic + antifungal)
Ultralanum plain cream/ointment Fluocortolone Moderate

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