What are topical corticosteroids?
Corticosteroid drugs are derivatives of natural corticosteroid hormones produced by the adrenal gland. They have many important functions in the body including controlling inflammatory responses. Corticosteroid drugs are mainly used because of their effect in controlling inflammation, and topical corticosteroids are applied to the skin for the local treatment of various inflammatory skin diseases.
Corticosteroids are usually simply called steroids, but it is important to point out that they are very different from other groups of steroids called anabolic steroids, which are notorious for their misuse by some athletes and bodybuilders.
Topical corticosteroids for eczema include hydrocortisone, which is the same as the natural corticosteroid cortisol, and synthetic corticosteroids such as betamethasone, fluticasone, and mometasone. They are applied to the skin in the form of creams, ointments or lotions.
Why are corticosteroids used?
Topical corticosteroids are used to reduce inflammation in the skin that causes changes in the skin called eczema. Since there is no cure for inflammation they do not cure the internal cause of the inflammation but they control it and reduce its symptoms such as itching and redness. Controlling itching reduces the desire for itching and therefore reduces the chance of getting eczema.
In cases where eczema is infected, topical corticosteroids containing an antibiotic or antiseptic may be prescribed.
How do corticosteroids work?
Topical steroids are absorbed within skin cells. They prevent skin cells from producing various chemicals that are normally released when the skin reacts to an allergy or irritation. These inflammatory-causing chemicals include prostaglandins and other inflammatory substances that cause blood vessels to dilate and attract other inflammatory substances, creating redness, inflammation and itching in the affected area of the skin.
What do the possible side effects depend on?
Many people wonder when to use topical steroids for fear of possible side effects. These fears are unfounded if corticosteroids are used correctly because then they rarely cause side effects.
Local side effects affecting the skin are much more likely than side effects from systemic corticosteroids, but are less common if steroids are used correctly. The risk of side effects depends on the strengthof the steroids used, the length of time they are used, the skin area, the size of the skin area and the nature of the skin disease. The chances of unexpected side effects are very rare when a mild or moderate potent steroid is used for a shorter period on a smaller area of skin.
Local side effects:
The most common side effects occur locally in an area of skin that has been treated with a steroid for a long time. Perhaps the most well-known side effect is thinning of the skin (atrophy), which sometimes results in permanent stretching of the skin (stretch marks). Blood vessels may swell and become bulging below the surface of the skin (telangiectasia). Pigment loss in the area of treated skin is more pronounced in dark-colored people. Sometimes the skin can be full of bruisesand susceptible to infections.
Systemic side effects
Systemic side effects occur inside the body. If a large area of skin is taken for an extended period of time potent steroids can be absorbed into the bloodstream and affect other parts of the body. In the most severe cases, which are fortunately very rare, corticosteroids can cause side effects such as reduced growth or decreased secretion of adrenal cortex hormones. The adrenal gland produces natural steroid hormones. If topical steroids are absorbed into the body they can slow down this natural production which can lead to a disease such as Cushing’s syndrome. Children who use potent steroids frequently or for long periods of time are at higher risk of systemic side effects than adults.
To minimize the side effects of steroid use, there are different uses such as:
- Use of weakly potent steroids
- Use steroids strictly only for the affected area of skin
What to do during pregnancy and lactation?
Topical corticosteroids should not be given during pregnancy except in exceptional cases. Animal studies have shown that corticosteroids applied to the skin of pregnant animals can cause abnormalities in fetal development such as cleft palate and decreased fetal growth in utero. Due to the suspicion of similar deformities, patients should not use topical steroids without consulting a doctor. If steroids are used they should not be used on a large area of skin and for long periods of time to minimize absorption and reduce the passage into breast milk. If you need to apply topical steroids to the breastfeeding mother’s breast, the area should be carefully washed with warm water before feeding the baby and corticosteroids should be applied again after feeding the baby.
Are corticosteroids suitable for children?
Children especially babies are much more prone to the side effects of topical steroids but that doesn’t mean they can’t be used without the risk of side effects. The most important thing is to use as weak corticosteroids as possible, as short a period as possible.
Stronger steroids should not be used in children under one year of age and should be avoided or used only for a short period in older children.
Children with chronic eczema should be monitored for growth so that in their case steroid absorption does not interfere with their normal growth.
Occlusions (wrapping the skin in plastic) are not suitable for application to children’s skin that has been smeared with topical steroids because it will increase the absorption of steroids within the body and increase the risk of side effects. Caution should also be exercised when applying steroids in addition to diapers as they act as an occlusive dressing that should not be used if steroids are applied to a child’s diaper region.
What should be avoided if corticosteroids are used?
Only mild steroids can be used on the face and then only as directed by a doctor. Facial skin is thin and absorbs steroids much more easily making it much more susceptible to damage.
What are occlusive dressings?
Occlusive dressingsare airtight dressings that are occasionally applied to increase absorption into the problematic part of the skin. However as they increase steroid absorption they can also increase the chance of side effects. As a rule, they should only be used with mild steroids and should not be used on children’s skin or facial skin.
When to use creams, when corticosteroid lotions, and when ointments?
The form of the steroid formulation depends on the characteristics of the eczema as well as its localization. Lotions and gels are most suitable for hairy skin surfaces. Creamsare better for wet areas while ointmentsare better for dry, scaly parts.
How to use corticosteroids?
The main thing to remember is that steroids are applied sparingly.
How long can corticosteroids be used?
The length of steroid use is individual but as a rule it is true that acutely inflamed eczema can be controlled by steroid administration several times a week. In chronic eczema, the application can be stopped after four to six weeks from the beginning of the treatment and then the application of neutral moisturizing creams can be continued. When steroid treatment is stopped the eczema may return since steroids do not treat the cause of the disease. The application of neutral creams is important to avoid further onset of the disease, keep the skin hydrated and to prevent the chance of further inflammation. As a maintenance therapy, your doctor may suggest using steroids twice a week.
Taken from Helen Marshall, pharmacist
In short: Topical corticosteroids are anti-inflammatory drugs that are applied to diseased skin. The use of topical corticosteroids must be under the strict supervision of a dermatologist as serious side effects can occur. Side effects can be avoided with proper use.
Keywords: Corticosteroids, skin atrophy, stretch marks, Kushing’s syndrome, neutral creams
Did you know: that some cosmetic creams contain corticosteroids even though it doesn’t say so. There are also topical preparations that are sold as a drug that does not contain corticosteroids in its composition even though it does. The drugs are recommended for the treatment of psoriasis and similar diseases and are sold on the market of the former Soviet Union (eg skin lotion – Cap).
