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Understanding Topical Corticosteroids for Skin Conditions

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What are topical corticosteroids used forTopical corticosteroids could well be considered the unsung heroes of dermatology. They can have the ability to work on even the most stubborn skin conditions where other lotions and creams have failed. These creams and ointments come in different strengths, from mild to mighty, and have the power to tackle a wide range of conditions, from eczema to psoriasis. But they need to be used wisely.

Corticosteroids, sometimes simply called steroids, are man-made drug versions of cortisol, a hormone produced by the adrenal glands. They are very effective at reducing inflammation and calming the immune system, which makes them helpful in treating various skin conditions, such as psoriasis and atopic dermatitis. When used on the skin, corticosteroids help slow down the immune response, reduce inflammation, and fast skin cell growth that causes psoriasis symptoms.

What are topical corticosteroids used for?

Topical steroids can treat many skin conditions, including:

  • Psoriasis, an autoimmune disease that leads to thick, scaly patches on the skin.
  • Seborrheic dermatitis, a rash with red, greasy, yellow patches, usually found on the scalp.
  • Contact dermatitis, a red rash triggered by touching something that irritates the skin or causes an allergic reaction.
  • Atopic dermatitis, such as eczema

How do corticosteroids work?

Corticosteroids reduce inflammation by blocking the substances in the body that trigger it. In psoriasis, they lower the activity of T-cells, a type of white blood cell responsible for the autoimmune reaction that leads to quick skin cell growth. By slowing this process, corticosteroids help to reduce redness and swelling, reduce scaling and relieve itching.

Corticosteroids come in different strengths. The strength a patient may need depends on factors such as how severe the condition that needs treatment is, where the affected skin is located, and the person’s age.

Forms of corticosteroids

Forms of corticosteroidsTopical corticosteroids are applied directly to the skin, but their effective use requires a proper diagnosis, the correct form of the drug, and knowing how often to apply it. The form, or “vehicle,” is what carries the medication. Choosing the right vehicle depends on the part of the body being treated and the type of skin issue. The vehicle also helps moisturize the skin and improve absorption.

  • Ointments are used to treat thick, scaly skin conditions because they are highly effective and provide the strongest barrier. However, they may not be recommended for areas with hair, as they can clog hair follicles and cause irritation.
  • Creams are less potent than ointments but are more appealing for everyday use since they don’t leave any residue. Their non-greasy nature makes them ideal for treating moist, inflamed skin or rashes in areas where skin rubs together.
  • Lotions are lightweight, less greasy, and work well on areas with hair.
  • Gels are similar to lotions in being light and non-greasy, but they are especially useful for the scalp since they don’t leave the hair sticky or matted.
  • Foams are great for applying a topical steroid to the scalp, although they can be expensive. 

Topical corticosteroids vary in strength based on how much medication is needed to achieve the desired effect. Their strength, or potency, is usually determined using a vasoconstrictor test, which measures how much the medication narrows blood vessels in the skin. In the United States, these medications are divided into seven categories, with class I being the strongest and class VII being the weakest.

  • Class I: Super-potent corticosteroids include medications like Temovate based on clobetasol.
  • Class II: High potency topical corticosteroids may include several types of medications based on betamethasone, such as Dovobet ointment, Betacorten, and Fucicort creams, or lotions)
  • Class III: Medium- to high-strength corticosteroids include creams like Lidex (amcinonide) and Elocon (mometasone.)
  • Class IV and Class V: Medium-potency topical steroids are available. These include Betacorten in cream, lotion, or foam form and Dermacombin in cream or ointment form.
  • Class VI: Low potency corticosteroids include options like Dermacombin cream.
  • Class VII: Weakest corticosteroids include many over-the-counter hydrocortisone creams, lotions, or ointments in strengths of 1% to 2.5%.

Higher potency corticosteroids are often prescribed for thick-skinned areas like the palms and soles or nonfacial, non-sensitive areas to treat severe conditions like psoriasis or atopic and contact dermatitis. Medium- to high-potency corticosteroids are better suited for thin-skinned areas, like the eyelids, or areas with natural moisture, such as the underarms. Low- to medium-strength corticosteroids are recommended for larger body areas to reduce the risk of too much medication being absorbed into the bloodstream.

The amount of steroid applied needs to be carefully measured for effective treatment and to prevent adverse effects from using too much. The dose is measured in Fingertip units (FTU), where one fingertip unit equals 0.5 grams of medication. The recommended amount depends on the area of the body being treated, and following the doctor’s instructions is essential.

Potential side effects of topical steroid creams and ointments

Corticosteroids work well, but long-term use or use on large parts of the body can cause side effects.

  • Skin thinning: Using corticosteroids for a long time can make the skin thin, weak, and more likely to bruise or tear. This is a common side effect.
  • Stretch marks: Prolonged use, especially on thin-skinned areas like the underarms, groin, or breasts, can cause stretch marks.
  • Visible blood vessels: Small blood vessels may become noticeable on the skin’s surface, a condition called telangiectasia.
  • Dependency: Overusing corticosteroids can make the skin dependent on them, leading to severe flare-ups when the treatment is stopped.
  • Absorption into the body: In rare cases, especially with strong corticosteroids used over large areas or for long periods, the medication can enter the bloodstream and cause side effects like adrenal gland issues.

Topical steroids can be highly effective when used correctly. They soothe, heal, and provide much-needed relief. However, their use requires careful management. Understanding potency levels, appropriate application areas, and potential side effects is essential to maximize their benefits while avoiding complications. It is important to follow a doctor’s instructions, monitor usage, and handle the skin with care.

FAQs

Is it okay to put cortisone cream on an open wound?

Unless instructed by a physician, this medication should not be applied to open wounds, burns, or damaged or inflamed skin. It is intended solely for conditions being treated under medical supervision. Consultation with a doctor is advised before using it for other purposes, particularly if an infection is suspected.

Are corticosteroids addictive?

While these substances are not considered addictive, they impact the brain’s cortisol levels, causing it to produce less cortisol over time. This may result in reliance on corticosteroids, potentially leading to withdrawal symptoms.

Are corticosteroids the same as steroids for muscle growth?

Corticosteroids, such as topical cortisone, are medications commonly prescribed by doctors to reduce inflammation and are not the same as anabolic steroids for muscle growth.

Are topical corticosteroids banned for professional sports?

Substances are added to the banned list for professional athletes if they meet at least two out of three criteria: (1) they can boost athletic performance, (2) they pose a real or possible health risk to athletes, or (3) they go against the values of fair play in sports. As topical corticosteroids are applied to the skin, they do not affect the whole body and are considered acceptable for use in professional sports settings.

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Sarah Ryan

Sarah is a nutritionist focused on integrative health. She embraces an approach to nutrition that combines conventional therapies with proven, safe complementary treatments.
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