Topical Steroids

A topical steroid is an anti-inflammatory preparation used to control eczema/dermatitis and many other skin conditions

 

What is a topical steroid?

Topical steroids, also called topical corticosteroids, glucocorticosteroids, and cortisone, work to treat all kinds of skin diseases. The most widely given topical medication for the treatment of rash, eczema, and dermatitis is topical steroids. Topical steroids are anti-inflammatory and are categorized according to their ability to constrict blood vessels in the skin.

How does a topical steroid work?

The effects of topical steroids include:

  • Anti-inflammatory
  • Immunosuppressive
  • Anti-proliferative
  • Vasoconstrictive.

The potency of topical steroid

The potency is dependent upon:

  • The specific molecule
  • The amount that reaches the target cell
  • Absorption through the skin (0.25%–3%)
  • Formulation.

Diluting a topical steroid is pointless because its efficacy is unaffected by concentration, thus diluting the substance does not lessen the likelihood of side effects. There is no advantage to administering a topical steroid more than once daily after the first two or three administrations.

Formulations of topical steroid

Topical steroids come in a variety of formulations to suit the type of skin lesion and its location. Creams and lotions are the most common formulas and are used for a variety of purposes.

Ointment

  • The most suitable formulation for dry, non-hairy skin
  • No requirement for preservative, reducing risk of irritancy and contact allergy
  • Occlusive, increasing risk of folliculitis and miliaria

Gel

  • Useful in hair-bearing skin
  • Has an astringent (drying) effect
  • Stings inflamed skin

As a general rule, use the weakest possible steroid that will do the job. It is often appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. 

What are the side effects of topical steroid?

When topical steroids are administered properly under physician supervision, side effects are infrequent to rare. When an underlying disease or another condition is to blame, a topical steroid may be wrongly attributed (for example, postinflammatory hypopigmentation or undertreated atopic eczema).

Cushing syndrome

Internal adverse effects similar to those caused by systemic steroids (Cushing syndrome) are rare with topical steroids, and only after long-term usage of significant amounts of topical steroid (ie, > 50 g of clobetasol propionate or > 500 g of hydrocortisone per week).

The most common cause of Cushing syndrome caused by topical corticosteroids is improper prescribing or over-the-counter sales of corticosteroids in countries where this is legal.

Cutaneous side effects

When a powerful topical steroid is administered daily for lengthy periods of time, local side effects may occur (months). The majority of negative effect reports involve extended usage of an overly strong topical steroid for unsuitable reasons.

  • Skin thinning (atrophy)
  • Stretch marks (striae) in armpits or groin
  • Easy bruising (senile/solar purpura) and tearing of the skin
  • Enlarged blood vessels (telangiectasia)
  • Localised increased hair thickness and length (hypertrichosis)

Impetigo, tinea, herpes simplex, malassezia folliculitis, and molluscum contagiosum are all skin illnesses that can be caused, aggravated, or hidden by topical steroids. The first-line treatment for infected eczema is still a topical steroid.

A potent topical steroid applied for weeks to months or longer can lead to:

  • Periorificial dermatitis (common); this can occur in children
  • Steroid rosacea
  • Symptoms due to topical corticosteroid withdrawal
  • Pustular psoriasis.

Due to underlying inflammation and damaged skin, stinging is common when a topical steroid is first applied. Contact allergy to a steroid molecule, preservative, or vehicle is uncommon, however it might happen after the product’s initial usage or after many years of use.

Ocular side effects

A topical steroid should be used with caution on the skin of the eyelids, as it can cause periocular dermatitis. Excessive use over weeks or months could result in glaucoma or cataracts.

Topical steroid in pregnancy

Topical steroids of mild to moderate potency can be used safely during pregnancy. Potent and ultrapotent topical steroids administered over wide areas or under occlusion, of which a portion will be absorbed systemically, should be used with caution.

Low birth weight newborns reported after being exposed to a high-dose topical steroid are not regarded to be related to the treatment.

How to use a topical steroid

For a period of 5 days to several weeks, a topical steroid is applied to irritated skin once daily (typically at night). It is normally ceased after that, or the strength or frequency of application is lessened.

Emollients can be used to reduce irritation and dryness before or after applying a topical steroid, or as a barrier preparation. Additional therapy may be required if the infection persists.

Fingertip unit

The amount of topical steroid to be given to a body place is guided by the fingertip unit. One unit is the amount of cream squeezed from the tube onto the volar aspect of the index finger’s terminal phalanx.

Illegal topical corticosteroid in cosmetic products

Corticosteroids for topical use are regulated. According to allegations from China and other developing countries, a powerful steroid is unlawfully present in some cosmetic items purchased over the counter or over the Internet. Many cases of steroid-dependent periorificial dermatitis, rosacea, and other side effects have been reported as a result.

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