Topical Corticosteroids for Skin Conditions

Introduction

Corticosteroids, commonly known as steroids, represent a collective of hormones that are synthesized naturally by the adrenal cortex. They are naturally occurring or synthetic compounds with cyclopentanoperhydrophenanthrene rings. Corticosteroids are also made synthetically and are used for various treatment purposes. Synthetic corticosteroids are of different types and are utilized to treat various problematic skin conditions.

What Are Topical Corticosteroids?

Topical corticosteroids refer to the topical formulations of corticosteroids. Topical corticosteroids have a significant therapeutic role in the management of a wide range of dermatological disorders. Topical corticosteroids are available in many different forms like ointments, gels, creams, lotions, and solutions. The two main properties of topical steroids include anti-inflammatory and immunosuppressive properties.

How Do Topical Corticosteroids Act?

• 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.

• Antimitotic Action: Topical corticosteroids help treat psoriasis because they prevent 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 the 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 and thereby reduce swelling, suppress immunity, and constrict the blood vessels of the skin. Topical corticosteroids are absorbed better in thin epidermal areas than in thick skin areas like soles.

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

Potency of Corticosteroids: Depending on the severity of the inflammation, topical steroid creams of different potencies can be used based on the potency chart.

• Super Potent Corticosteroids - Such as Clobetasol Propionate 0.05 percent.

• 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.

• Low-Potency Corticosteroids - Such as Hydrocortisone Butyrate 0.1 percent cream.

• Least-Potent Corticosteroids

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

• Cream: Creams 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 and greasier than creams. They are more effective and potent 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 that have hair or for use 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 use on large areas of skin and are useful 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 (inflammatory condition of 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, and 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.

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 seen in the area 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 leaking 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 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 stomach and small intestinal area).

• 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 on the unaffected skin.

• Use the weakest corticosteroid possible that will produce the desired therapeutic effect.

• Tail down the strength of the corticosteroid once the skin lesions improve (if a patient is using a super potent steroid then they should switch over to mild potent or low potent corticosteroids).

• Use the corticosteroid for as short a duration as possible.

• Apply the topical immediately after a bath or when the skin is slightly damp to allow better spreading of the cream thus 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 for skin conditions should be used as prescribed and the patient should follow the instructions given by their doctor properly. If used within the limitations topical corticosteroids are the best in giving rapid results by relieving symptoms in many skin conditions.