Topical Corticosteroids for Skin Conditions

What Is the Role of Topical Corticosteroids in Skin Conditions?

Corticosteroids are steroids, which are hormones that are produced in our body's adrenal cortex. Doctors use synthetic corticosteroids to treat various skin conditions. Since the 1950s, they have been the first line of treatment for various skin issues.

If you have issues like itching, redness, cellular overgrowth, skin dryness, or skin exfoliation, you are likely suffering from skin issues. These skin problems can be inflammatory, immune-mediated, or hyperproliferative (excessive cell growth). In such cases, topical corticosteroids are very effective.

The two main properties of topical steroids are anti-inflammatory and immunosuppressive, which are very effective for skin issues. Topical corticosteroids are available in many forms, including ointments, gels, creams, lotions, and solutions.

How Do Topical Corticosteroids Act?

Topical corticosteroids act via various pathways to regulate inflammatory or immune responses.

• Anti-Inflammatory Action:

Topical corticosteroids reduce inflammation by narrowing blood vessels and stopping the release of certain enzymes. They also make a substance called lipocortin, which helps decrease the production of inflammatory chemicals. These medicines can also directly affect DNA (deoxyribonucleic acid) and turn off genes that cause inflammation. Apart from these, they prevent the production of harmful toxins in the body that cause skin damage.

• Antimitotic Action:

Topical corticosteroids help treat psoriasis by preventing the growth of skin cells. The dermis has a way of stopping cells from growing and making collagen. It is called an antimitotic effect.

• Immunosuppressive Action:

Topical corticosteroids weaken your immune system by stopping certain substances that cause inflammation. They also prevent the growth and development of immune cells. Once applied to the skin, they are absorbed into the skin surface, thereby reducing swelling, suppressing immunity, and constricting the skin's blood vessels. Topical corticosteroids are absorbed better in thin epidermal areas than in thick skin areas like the soles.

What Are the Various Types of Topical Corticosteroids Used for Skin Conditions?

The Food and Drug Administration (FDA) has approved a few corticosteroids for skin issues. These are Alclometasone, Desonide, Desoximetasone, Diflorasone, Fluocinolone, Halcinonide, Halobetasol, Hydrocortisone, and Flurandrenolide.

Potency of Corticosteroids:

Depending on the severity of the inflammation, topical steroid creams of varying potencies can be used according to the potency chart.

• Class I or Super Potent Corticosteroids:

Such as Clobetasol Propionate 0.05 percent.

• Class II or High-potency Corticosteroids:

Such as Betamethasone Dipropionate 0.05 percent ointment.

• Medium to High Potency Corticosteroids:

Amcinonide 0.1 percent cream.

• Medium Potency Corticosteroids:

Such as Fluocinolone Acetonide 0.025 percent gel. Medium to high-potency corticosteroids belong to Classes III, IV, and V.

• Class VI and Class VII Low-Potency Corticosteroids:

Such as Hydrocortisone Butyrate 0.1 percent cream.

In addition to the potency of the corticosteroid, the dosage form or formulation of the medication is also important. Different dosages can affect the way the medication is absorbed, its efficacy, and its side effects. Here are some common options for topical corticosteroids:

• Creams:

These are water-based and are easy to apply. Creams are less potent than ointments. They also leave no residue and are better cosmetically.

• Ointment:

Ointments are oil-based and are thicker, greasier than creams. They are more effective and useful at delivering medication to the skin, but can be messy and less convenient to apply. They are often used for dry, scaly, or thickened skin.

• Lotion:

Lotions are lighter and less greasy than creams, and are often preferred for use on hairy areas or large areas of skin.

• Gel:

Gels are clear and non-greasy, and are often preferred for use on areas of the body with hair or on the scalp. They are also useful for treating acne and psoriasis.

• Foam:

Foams are easy to apply and are quickly absorbed into the skin. They are often preferred for large areas of skin and for treating scalp conditions. Foams are costly.

• Solution:

Solutions are liquid-based and are used to treat scalp conditions, such as dandruff and psoriasis. They are also useful for treating skin folds and areas where creams or ointments may be difficult to apply.

What Are the Skin Conditions in Which Topical Corticosteroids Can Be Used?

Topical corticosteroids are primarily used in the treatment of the following conditions:

• Dermatitis (skin irritation and swelling).
• Eczema or atopic dermatitis (itchy, dry, and inflamed skin).
• Itching.
• Rashes.
• Lichen sclerosis (thin, white skin patches).
• Psoriasis (scaly, itchy, and dry skin patches).
• Insect bites.
• Lichen planus (an inflammatory condition of the mucous membrane and skin).
• Limited areas of vitiligo (skin color loss in blotches).
• Phimosis (inability to retract the foreskin on the penis).
• Acute radiation dermatitis.
• Lichen simplex chronicus (chronic scratching and itching).
• Discoid lupus erythematosus (causes sores on the scalp and face region).

Topical corticosteroids are mainly used in skin conditions that are immunological, inflammatory, and proliferative. Topical corticosteroids are not recommended for use if there is a skin infection, acne, ulcers, or open wounds. Abstain from using potent and very potent topical corticosteroids like Clobetasol, Halobetasol, and Betamethasone in children, on the face and neck, in body folds, for prolonged periods, or over a large area.

Doctors use high-potency corticosteroids to treat conditions such as bullous pemphigoid, lichen planus, melasma, and psoriasis. Conditions like atopic dermatitis, infantile acropustulosis, scabies, and seborrheic dermatitis need mild-potency topical corticosteroids for treatment. Low-potency corticosteroids are effective for conditions such as dermatitis, skin inflammation, and phimosis.

What Are the Contraindications for the Use of Topical Corticosteroids?

The use of topical corticosteroids is contraindicated in the following conditions:

• Bacterial infections.
• Impetigo (skin infection causing red sores).
• Cellulitis or erysipelas (subcutaneous tissue and skin infection).
• Lymphangitis (lymphatic vessel inflammation).
• Furuncles (boils) and carbuncles (clusters of boils or furuncles).
• Erythrasma (bacterial infection).
• Candida infection (fungal infection).
• Dermatophytes (fungi that need keratin for their growth).

What Are the Side Effects of Topical Corticosteroids?

Side effects are more commonly observed at the site of application. They may also be seen systemically (in the body).

Local Side Effects:

• Itching, burning, or stinging sensation.
• Stretch marks (striae).
• Thinning of skin (atrophy) and dryness.
• Localized increased hair thickness and length (hypertrichosis).
• Acne formation.
• Perioral dermatitis (painful red bumps in the area around the mouth).
• Purpura (purple spots due to the leakage of small blood vessels).
• Steroid Rosacea (flushed skin).
• Pigment alteration.
• Delayed wound healing.

Systemic Side Effects:

• Growth failure in children.
• Osteoporosis (brittle and weak bones).
• Avascular necrosis (bone tissue death due to the lack of blood supply).
• Atherosclerosis (fat build-up in and on the blood vessels).
• Suppression of the hypothalamic-pituitary axis.
• Cushing's syndrome (a condition caused by high cortisol levels in the body).
• Hypertension (high blood pressure).
• Hyperglycemia (high blood sugar).
• Peptic ulceration (open ulcers found in the stomach and small intestine).
• Glaucoma (an eye condition causing blindness) and cataracts (clouding of the eye lens).

What Are Some Important Points to Remember When Using Them?

• Avoid application to the unaffected skin.
• Use the weakest corticosteroid possible that will produce the desired effect.
• Lower the strength of the corticosteroid once the skin lesions improve (if a patient is using a superpotent steroid, they should switch to a mild-potent or low-potency corticosteroid).
• Use the corticosteroid for the shortest possible duration.
• Apply the topical immediately after a bath or when the skin is slightly damp to improve the cream's spread, thereby minimizing side effects.
• After application of a steroid, follow up with a moisturizer.
• Use sparingly and as prescribed by the physician.
• Do not use it for too long a period. Topical steroid-damaged skin is a condition associated with topical corticosteroid abuse. Therefore, in any such case, consult the doctor to get treatment for topical-steroid-damaged skin immediately.

Conclusion

Topical corticosteroids are among the first-line treatments for your skin issues. However, not all skin issues need corticosteroids. Doctors prefer these medicines for conditions such as dermatitis, eczema, and lichen planus. These medicines not only control inflammation but also regulate your body's immune response. You should use these medicines after consulting your doctor. For any queries regarding the use of corticosteroids in skin issues, you can talk to a skin care specialist for further evaluation.

Key Takeaways

• Topical or local corticosteroids are the first-line treatment for most skin conditions.
• They not only reduce inflammation but also control immune-related skin changes.
• Doctors recommend different topical steroids of different potencies based on the severity of your skin issues.
• Corticosteroids can also cause mild to moderate side effects. You should only use it after consulting your doctor. Also, any side effects noted must be reported to your doctor.