Topical Steroids for Eczema & their Side Effects

Topical steroids are creams, ointments and lotions which contain steroid medicines. Topical steroids work by reducing inflammation in the skin. They are used for various skin conditions including eczema. (Steroid medicines that reduce inflammation are sometimes called cortico-steroids. They are very different to the anabolic steroids which are used by some bodybuilders and athletes.
 

What types of topical steroids are there?

There are many types and brands of topical steroid. However, they are generally grouped into four categories depending on their strength - mild, moderately potent, potent and very potent. There are various brands and types in each category. For example, Hydrocortisone cream 1% is a commonly used steroid cream and is classed as a mild topical steroid. The greater the strength (potency), the more effect it has on reducing inflammation but the greater the risk of side-effects with continued use.
Creams are usually best to treat moist or weeping areas of skin. Ointments are usually best to treat areas of skin which are dry or thickened. Lotions may be useful to treat hairy areas such as the scalp.
 

Are there any side-effects from topical steroids?

Short courses of topical steroids (fewer than four weeks) are usually safe and usually cause no problems. Problems may develop if topical steroids are used for long periods, or if short courses of stronger steroids are repeated often. The main concern is if strong steroids are used on a long-term basis. Side-effects from mild topical steroids are uncommon.
Side-effects from topical steroids can either be local or systemic. Local means just affecting that bit of skin and systemic means affecting the whole person.
 

Why and What kind of Side Effects?

 

Local effects

These include:

  • A stinging or burning feeling when you first apply the treatment. This is quite common but improves as your skin gets used to the treatment.

  • Thinning of the skin has always been considered a common problem. However, recent research suggests that this mainly occurs when high-strength steroids are used under airtight dressings. In normal regular use skin thinning is unlikely and, if it does occur, it often reverses when the topical steroid is stopped.

  • With long-term use of topical steroid the skin may develop permanent stretch marks (striae), bruising, discolouration, or thin spidery blood vessels (telangiectasias).

  • Topical steroids may trigger or worsen other skin disorders such as acne, rosacea and perioral dermatitis.

  • Skin colour may change. This is more noticeable if you have dark skin.

  • Hair may grow more on the area of skin being treated.

  • Some people may develop an allergy to the contents of the treatment, such as any preservative used. This may irritate the skin being treated and make the inflammation worse


Systemic effects

These include:

  • Some topical steroid gets through the skin and into the bloodstream. The amount is usually small and usually causes no problems unless strong topical steroids are used regularly on large areas of the skin. The main concern is with children who need frequent courses of strong topical steroids. The steroid can have an effect on growth. Therefore, children who need repeated courses of strong topical steroids should have their growth monitored.

  • Fluid collection in the legs.

  • High blood pressure.

  • Bone damage (thinning).

  • Cushing's syndrome - this is a rare problem caused by high levels of a hormone (chemical messenger) in your blood. Symptoms include fast weight gain, skin thinning and changes to your mood.

Usually a leaflet comes with each topical steroid and gives a full list of possible side-effects. That can give a guidance on how to use these medicines.

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