Topical Corticosteroids for Skin Conditions

Abstract

Topical corticosteroids are the cornerstone therapy for many inflammatory skin conditions. So, the judicious use of topical steroids is necessary. This article discusses the potency, uses, systemic and topical side effects of topical corticosteroids.

What Are Corticosteroids?

Corticosteroids are naturally-occurring or synthetic compounds with cyclopentanoperhydrophenanthrene ring. The major naturally occurring corticosteroid is cortisol, which is synthesized by the adrenal cortex. The synthetic corticosteroids are of different types and are used to treat various problematic skin conditions.

How Do They Act?

Once applied to the skin, they are absorbed into the skin surface and thereby reduce the swelling, suppress immunity, and constrict the blood vessels of the skin.

Potency of Corticosteroids

Depending on the severity of the inflammation, following corticosteroids of different potencies can be used.

Mild: Hydrocortisone 0.1 to 1 %.
Moderate: Fluocinolone acetonide 0.1 %, Betamethasone valerate.
Potent: Betamethasone dipropionate 0.05 %, Beclomethasone 0.025 %, Betamethasone 17 valerate 0.1 %.
Very potent: Beclomethasone dipropionate 0.5 %, Clobetasol 0.5 %.

Uses

Topical corticosteroids are primarily used in the treatment of:

Dermatitis.
Eczema.
Itching.
Rashes.
Psoriasis.
Insect bites.
Lichen Planus.

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.

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 (like if you are using super potent steroid then switch over to mid potent then to low potent).

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 for too long a period.

Observe and report any changes in the skin lesions and any side effects.

Side Effects of Corticosteroids

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

Topical side effects:

Itching, burning or stinging sensation.
Stretch marks (striae).
Thinning of skin (atrophy) and dryness.
Localised increased hair thickness and length (hypertrichosis).

Systemic side effects:

Growth failure in children.
Osteoporosis.
Avascular necrosis.
Atherosclerosis.
Suppression of hypothalamic-pituitary axis.
Cushing's syndrome.
Hypertension.
Hyperglycemia.
Peptic ulceration.
Glaucoma and cataracts.

For more information consult a skin disorders specialist online --> https://www.icliniq.com/ask-a-doctor-online/dermatologist/skin-disorders

Frequently Asked Questions

1. What Is the Best Corticosteroid Cream?

The best corticosteroid creams are,
- Clobetasol propionate 0.05% (Temovate).
- Halobetasol propionate 0.05% (Ultravate cream, ointment, and lotion).
- Diflorasone diacetate 0.05% (Psorcon ointment).
- Betamethasone dipropionate 0.25% (Diprolene ointment and gel).

2. What Are Topical Corticosteroids Used For?

Topical corticosteroids are an anti-inflammatory preparation available as creams, ointments, and solutions used to control,
- Eczema.
- Dermatitis.
- Other skin conditions.

3. Does Topical Corticosteroid Work?

Corticosteroid creams are not a curative option as it does not have any effect on the underlying cause of inflammation. They are helpful to control skin flare-ups and relieve symptoms, and they often work well. In case of no improvement after a week, then a more potent topical steroid is prescribed.

4. Can You Buy Topical Corticosteroids Over-The-Counter?

Hydrocortisone which is a low potency corticosteroid, can be bought over-the-counter and works on the skin by reducing,
- Irritation.
- Itching.
- Inflammation.

5. How Long Can Topical Corticosteroids Be Used?

- The usage of corticosteroids depends on the affected areas of the skin.
- Using ultra-high-potency topical corticosteroids continuously for more than three weeks is not recommended.
- Using low- to high-potency topical corticosteroids continuously for more than three months can lead to side effects.

6. Do Corticosteroids Cause Weight Gain?

Corticosteroids have some side effects, including weight gain. The most common adverse effect of steroid use is weight gain, seen in 70% of patients.

7. What Are the Side Effects of Topical Corticosteroids?

The common side effects of topical corticosteroids are,
- Itching.
- Burning.
- Irritation.
- Redness.
- Dryness.

8. Do Topical Steroids Weaken the Immune System?

Topical steroids work by reducing inflammation and redness, suppressing the body's immune system, and stopping the multiplication of cells in the area where it is applied to.

9. How Do Corticosteroids Treat Vitiligo?

Corticosteroid creams slow the progression of vitiligo with its anti-inflammatory action, and potent formula corticosteroids will help to allow melanocytes to return (vitiligo), and hence dermatologists will closely monitor before prescribing for vitiligo.

10. Do Topical Corticosteroids Help Oral Lichen Planus?

Topical corticosteroids have been found to be effective in the mainstay treatment of oral lichen planus. They help by reducing pain and inflammation.

11. How to Apply Topical Corticosteroids?

Topical corticosteroids should be applied only on affected areas of the skin by gently smoothing a thin layer. In case of having both topical corticosteroids and emollients, the emollient should be applied first, and after 30 minutes, topical corticosteroids should be applied.