Steroids

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 Overview

Topical corticosteroids are used for the treatment of inflammatory conditions of the skin (other than those arising from an infection).

They are effective in conditions such as eczema and psoriasis. They are of no value in urticaria or pruritus (itch) and will make the symptoms of rosacea and acne worse.

Corticosteroids act by preventing phospholipid release from the cell membrane and thus prevent their conversion via arachidonic acid into prostaglandins and other chemicals which cause inflammation.

Corticosteroids only suppress the inflammatory reaction during use; they will not cure the condition and the skin problem may get worse once the use of topical corticosteroids stops. This is called a rebound effect. They are generally used to relieve symptoms and suppress signs of the disorder when other measures such as emollients are ineffective.

Over the years a number of topical topical corticosteroids have been developed of different strengths. They are now categorised into 4 strength categories; mild, moderate, potent and super potent. Different strengths are used by doctors depending upon the patient and the size and severity of the condition.

The risk of side effects runs parallel with the strength of the steroid, the duration of therapy and, to some extent, how much the skin is exposed to the air. The face, genitals and skin fold areas will absorb more steroids than other areas. If you use a steroid under a bandage it will also have the same effect. Side effects on the skin may be apparent within two weeks use. The potent and very potent steroids should be carefully monitored and limited to a few weeks use, after which a milder steroid should be substituted if possible. Patients should be reviewed every 3 months. Only mildly and moderately potent steroids should be used in children to avoid potential growth retardation and long lasting cosmetic disfiguration.

If allergic contact dermatitis develops patients should be switched to another steroid in the same potency group.

Systemic or potent topical topical corticosteroids should be avoided or given only under specialist supervision in psoriasis because, although they may suppress the psoriasis in the short term, relapse or vigorous rebound occurs on withdrawal (sometimes precipitating severe pustular psoriasis).

In the case of scalp psoriasis it is reasonable to use a more potent corticosteroid.

Antibacterial agents can be combined with steroid preparations with good effect. However, the antibiotic can act as an allergen in some patients. With aminoglycosides there is a risk of ear and kidney damage so they should not be applied to large areas or to the external auditory canal in patients with a perforated ear drum.

Cautions

Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes).

Side effects can include:

  • spread and worsening of untreated infection;
  • thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;
  • irreversible striae atrophicae and telangiectasia (marks on the skin);
  • contact dermatitis;
  • perioral dermatitis around the mouth;
  • acne, or worsening of acne or acne rosacea;
  • mild depigmentation (lightening of the skin) which may be reversible;
  • hypertrichosis (excessive hair growth) has also been reported.

In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only .

Application

Topical corticosteroids preparations should be applied no more frequently than twice daily; once daily is often sufficient.

Topical corticosteroids are spread thinly on the skin; the length of cream or ointment expelled from a tube may be used to specify the quantity to be applied to a given area of skin. This length can be measured in terms of a fingertip unit (the distance from the tip of the adult index finger to the first crease). One fingertip unit (approximately 500 mg) is sufficient to cover an area that is twice that of the flat adult palm.

Topical Steroids have been developed in a range of potencies and formulations to suit most conditions. In general ointments are used for dry skin conditions and creams and lotions for wet, oozing conditions. Special scalp applications have been developed for some products and gel formulations can also be used on hairy skin. Steroids combined with antibacterials, antifungals and other agents are also available in some cases.

For further information on different strengths follow the links below