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.
- 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
- 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)|
|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|