What Are Topical Steroids?
Topical steroids refer to a range of products including aerosols, creams, gels, lotions, solutions, and tapes that incorporate corticosteroids, often shortened to “steroids.” These preparations are formulated for external application, either on the scalp or the skin, depending on the specific condition being treated.
Corticosteroids function by regulating inflammation through a mechanism that mimics the natural corticosteroid hormones produced by the adrenal glands. These adrenal glands, positioned atop our kidneys, play a crucial role in this process. Beyond mitigating inflammation, characterized by redness and swelling at the application site, topical corticosteroids also exhibit the capacity to suppress the immune response, reduce cellular turnover, and narrow blood vessels.
What Are Topical Steroids Used For?
Topical steroids, ranging from low to medium potency, find application in the treatment of various skin conditions that exhibit a positive response to corticosteroid therapy. These conditions include:
1. Atopic dermatitis (mild to moderate)
2. Contact dermatitis
3. Discoid lupus erythematosus affecting the face and skin folds (intertriginous areas)
4. Dry skin
5. Insect bites
7. Itching localized to small skin areas
8. Itching in the anogenital regions
9. Lichen planus affecting the face and intertriginous areas
10. Nummular dermatitis
11. Polymorphous light eruption
12. Psoriasis affecting the face and intertriginous areas
13. Seborrheic dermatitis affecting the face and intertriginous areas
In cases requiring more potent treatment, high-potency topical corticosteroids may be employed to address conditions such as:
1. Alopecia areata
2. Resistant atopic dermatitis
3. Discoid lupus erythematosus
4. Lichen planus
5. Granuloma annulare
6. Psoriatic plaques and psoriasis affecting the palms, soles, elbows, or knees
7. Severe hand eczema
8. Severe poison ivy.
Popular Steroids, Brands, Common Uses, Benefits & Potential Side Effects
Typically, it is advisable to commence treatment with the mildest effective steroid. However, in some instances, physicians may opt for a stronger topical steroid initially, particularly for the first few days of treatment.
Here’s a table listing popular topical steroids, their brand names, common uses, benefits, and potential side effects:
|Generic Name||Brand Names||Common Uses||Benefits||Potential Side Effects|
|Hydrocortisone||Cortaid, Hydrocort||Mild skin irritations, itching, insect bites||Reduces inflammation and relieves itching||Skin thinning, burning, stinging|
|Triamcinolone||Kenalog, Aristocort||Eczema, psoriasis, dermatitis, skin allergies||Reduces inflammation and itching||Skin thinning, rash, burning, itching|
|Betamethasone||Diprolene, Celestene||Skin conditions, including eczema and psoriasis||Potent anti-inflammatory and anti-itching effects||Skin thinning, stinging, burning|
|Clobetasol||Temovate, Clobex||Severe skin conditions, psoriasis, lichen planus||Highly potent anti-inflammatory properties||Skin thinning, skin discoloration, itching|
|Mometasone||Elocon||Eczema, dermatitis, psoriasis||Effective for reducing skin inflammation||Skin thinning, burning, itching, rash|
|Fluticasone||Cutivate, Flonase||Eczema, psoriasis, allergic reactions||Anti-inflammatory and soothing for skin||Skin thinning, burning, itching, redness|
|Desonide||Desonate, DesOwen||Atopic dermatitis, itching, rashes||Mild potency with anti-inflammatory effects||Burning, itching, dryness, redness|
|Fluocinonide||Lidex, Vanos||Various skin conditions, eczema, psoriasis||Potent anti-inflammatory and anti-itching properties||Skin thinning, rash, burning, itching|
|Halobetasol||Ultravate||Severe inflammatory skin conditions||Very potent and fast-acting||Skin thinning, burning, stinging, rash|
|Flurandrenolide||Cordran||Skin conditions, including dermatitis||Medium potency for inflammation reduction||Burning, itching, dryness, skin peeling|
Please note that side effects can vary in severity and may not affect everyone using these medications. It’s important to use topical steroids as directed by a healthcare professional or a seasoned user and report any adverse reactions or concerns to your healthcare provider.
Who Can Safely Use Topical Corticosteroids
Topical corticosteroids are generally safe for use by most adults and children; however, there are situations in which their use is not recommended.
They should not be used if:
- You have infected skin unless advised by a doctor.
- You have specific skin conditions, such as rosacea and acne.
In most cases, topical corticosteroids are considered safe for use during pregnancy or while breastfeeding. Your doctor will take into account factors such as the affected skin area, frequency of use, and the condition of your skin. It’s advisable to thoroughly wash off any steroid cream applied to your breasts before breastfeeding your baby.
Very potent topical corticosteroids are typically not prescribed for pregnant or breastfeeding women or very young children. In some instances, a skincare specialist, such as a dermatologist, may prescribe them under close supervision.
How to Apply Topical Corticosteroids
When using topical corticosteroids, it’s important to follow the provided instructions unless directed otherwise by your doctor. Here are some general guidelines:
- Read the Patient Information Leaflet: Refer to the patient information leaflet that accompanies the medication for specific instructions on how much to apply and how often to use it.
- Frequency of Use: In most cases, applying the medicine once or twice a day for a duration of 3 to 7 days is sufficient. However, there may be instances where a doctor recommends less frequent application over a longer period.
- Target Affected Areas: Apply the medication exclusively to the affected areas of your skin. Avoid applying it to unaffected areas.
- Application Technique: Gently spread a thin layer of the medication onto your skin in the direction of hair growth. Be cautious not to use excessive amounts.
- Hand Hygiene: Prior to and after applying the medicine, ensure you wash your hands thoroughly unless you are treating an area on your hands.
- Combining with Emollients: If you are using both topical corticosteroids and emollients (moisturizers), it’s advisable to wait 20 to 30 minutes between applying each product. This allows for the effective absorption of both treatments.
Always adhere to the specific instructions provided with your medication and consult your healthcare provider if you have any questions or concerns about its usage.
Using Fingertip Units (FTUs)
At times, your prescribed medication dosage may be measured in fingertip units (FTUs).
An FTU, equivalent to approximately 500 milligrams, represents the amount required to squeeze a line of medication from the tip of an adult finger to the first crease of that finger. This quantity should be adequate to treat an area of skin double the size of the flat of your hand when your fingers are together.
The recommended dosage varies depending on the area of the body being treated. This variation arises from differences in skin thickness and sensitivity to corticosteroids in different body regions.
For adults, the suggested FTUs for a single application are as follows:
- 0.5 FTU for genital areas
- 1 FTU for hands, elbows, or knees
- 1.5 FTUs for the feet, including the soles
- 2.5 FTUs for the face and neck
- 3 FTUs for the scalp
- 4 FTUs for a hand and arm together or the buttocks
- 8 FTUs for one leg and foot, the chest, or the back
In the case of children, the recommended FTUs will depend on their age, and it is advisable to consult a general practitioner (GP) for guidance in this regard.
Side Effects of Topical Corticosteroids
When used correctly, topical corticosteroids rarely lead to severe side effects. The most common side effect is a temporary burning or stinging sensation upon application, which typically improves as your skin adapts to the treatment.
Less frequent side effects may include:
- Worsening or Spreading of Existing Skin Infections: In some cases, topical corticosteroids can exacerbate or spread an existing skin infection.
- Inflamed Hair Follicles (Folliculitis): This condition may occur as a result of corticosteroid use.
- Skin Thinning: Prolonged use of topical corticosteroids can lead to skin thinning, making the treated area more susceptible to damage or bruising.
- Stretch Marks: Stretch marks may develop, which are generally permanent but tend to become less noticeable over time.
- Contact Dermatitis: Some individuals may experience skin irritation or contact dermatitis, which results from a mild allergic reaction to the components of a particular topical corticosteroid.
- Acne: In some cases, the use of topical corticosteroids can lead to acne or exacerbate existing acne.
- Rosacea: Another potential side effect is the development or worsening of rosacea, a condition characterized by facial redness and flushing.
- Changes in Skin Color: Changes in skin colour may occur, which is more noticeable in individuals with darker skin.
- Excessive Hair Growth: Unwanted hair growth in the treated area is possible.
The likelihood of experiencing side effects is higher if you are using a more potent corticosteroid, using it for an extended period, or applying it over a large skin area. Vulnerable populations, such as the elderly and very young, are also at a higher risk of side effects.
In cases where potent or very potent topical corticosteroids are used extensively over an extended period, there is a risk of the medication being absorbed into the bloodstream, potentially leading to internal side effects. These can include:
- Decreased growth in children
- Cushing’s syndrome
This list does not encompass all possible side effects. For comprehensive information on side effects, refer to the leaflet accompanying the medication.
If you find yourself using potent or very potent topical corticosteroids for several weeks or more, you may receive a steroid treatment card that provides guidance on minimizing the risk of side effects. It is essential to present this card to healthcare professionals when seeking medical or dental treatment to ensure they are aware of your corticosteroid use.
Withdrawal side effects
If you stop using topical corticosteroids after using them continuously for a long time (usually over 12 months in adults), you may have a withdrawal reaction. These can sometimes be severe. Your doctor may advise stopping the treatment gradually to avoid this.
Withdrawal side effects can include:
- redness or changes in skin colour (this may not be as noticeable on brown or black skin)
- burning, stinging, itching or peeling of the skin, or oozing, open sores
- a flare-up of the skin condition you were treating
If you’ve been using topical corticosteroids for a long time, it’s a good idea to ask your doctor to review your treatment.
What is Topical Steroid Withdrawal?
Topical steroid withdrawal (TSW) is a condition that occurs when individuals who have been using topical corticosteroids (commonly known as topical steroids) for an extended period stop using them. TSW is characterized by a range of withdrawal symptoms, which can include redness, burning, itching, dryness, flaking, and increased sensitivity of the skin. These symptoms typically occur in the areas where the topical steroids were previously applied.
TSW is believed to be a result of the body’s adaptation to the presence of steroids on the skin. Prolonged use of topical steroids can lead to a phenomenon where the skin becomes dependent on these medications. When the steroids are discontinued, the skin may react with a rebound effect, leading to withdrawal symptoms.
It’s essential for individuals experiencing TSW to seek guidance from a healthcare professional, typically a dermatologist, for proper diagnosis and management. Treatment may involve discontinuing the use of topical steroids, implementing a skincare regimen, and addressing symptoms as they arise. The duration and severity of TSW can vary widely among individuals.
How long does topical steroid withdrawal last
The duration of topical steroid withdrawal (TSW) can vary significantly from person to person. TSW occurs when an individual who has been using topical steroids for an extended period stops using them. The withdrawal symptoms can include redness, burning, itching, and flaking of the skin.
The duration of TSW can depend on several factors, including:
- The severity of Previous Steroid Use: The more potent the topical steroids used and the longer they were used, the more likely it is that TSW symptoms will be severe and last longer.
- Individual Response: Some individuals may experience shorter TSW periods, while others may endure symptoms for an extended time.
- Skin Sensitivity: Skin sensitivity and resilience can vary from person to person, affecting how the skin reacts during TSW.
- Proper Management: Appropriate management, such as avoiding triggers, moisturizing, and consulting a healthcare professional, can help mitigate the duration and severity of TSW symptoms.
In general, mild TSW symptoms may last a few weeks to a few months, while more severe cases can persist for several months to a year or more. It’s essential to consult a dermatologist or healthcare provider if you suspect TSW or experience prolonged and distressing symptoms, as they can provide guidance and treatment options to manage the condition effectively. Additionally, they can help determine when it is safe to reintroduce topical steroids if necessary.
How to treat topical steroid withdrawal naturally in two sentences
To treat topical steroid withdrawal naturally, focus on gentle skincare practices, including regular moisturization with natural, fragrance-free products and the use of soothing, anti-inflammatory ingredients like aloe vera or chamomile. Stay hydrated, maintain a healthy diet rich in antioxidants, and consult a healthcare professional for guidance on natural remedies that may help alleviate symptoms during the withdrawal process.