Pros and Cons of Using Topical Steroids

If you’ve ever suffered from an itch or rash, you might be familiar with topical steroids, otherwise known as corticosteroids. These oil-based creams, typically available over-the-counter, work by reducing inflammation and the body’s immune response. In the short term, they provide welcome relief for issues such as eczema, psoriasis and dermatitis. However, due to their effects on skin integrity and hormone balance, you should be careful with using corticosteroids for more than a couple of weeks.

L0058221 Jar of 'Domolene' ointment, London, England, 1945-1965
Science Museum, London. Wellcome Images

Corticosteroids are similar in structure and function to the stress hormone cortisol. One function of cortisol is to prevent over-activation of the inflammatory response. This is helpful when your body is fighting off an infection or exposed to a new allergen. Additionally, cortisol is involved in regulating blood glucose; when you’re feeling stressed, cortisol causes glucose to be released into the blood, providing a quick source of energy.

The most common topical steroid is available over-the-counter as hydrocortisone (Cortizone 10). This compound is relatively weak in comparison to prescription steroid creams. For example, Clobetasol propionate and Betamethasone dipropionate are 600 times more potent than hydrocortisone.

 Long term side effects

The prolonged use of corticosteroids can result in several unwanted effects:

Skin atrophy: Steroids suppress cell growth and inhibit collagen production, leading to thinning of the skin.

Telangiectasia (Spider Veins): As the skin becomes thinner, small surface blood vessels become more visible.

Epidermal damage: Steroids can damage the epidermis, decreasing the skin’s ability to act as a barrier. This can increase the likelihood of a bacterial infection penetrating deep into the dermis.

Rosacea: May also occur with long term usage.

Discoloration: Leads to discoloration (hyperpigmentation or hypopigmentation) temporarily. Also, striae (stretch marks) can occur, which are not temporary. Striae appear as a result of skin atrophy, collagen degradation, and epidermal thinning. Collectively, these factors cause the skin to be more susceptible to damage from physical expansion.

Allergies: Sometimes when people develop allergies to hydrocortisone they are usually reacting to the propylene glycol in the base. If you find that you are allergic, look for a PG-free base, like the one found here.

Weight gain: Water weight (fluid retention) from topical steroids is caused by Cushing’s syndrome. Cushing’s can present when you use potent prescription steroids like the ones mentioned earlier, Clobetasol and Betamethasone.

Steroid dependence: Using hydrocortisone long term may result in tachyphylaxis, which means that your skin becomes desensitized to the drug making it less effective. If it is prescribed to you and you use it for a while and realize that it’s stopped working, talk with your doctor about taking a break for a week or two. Your skin receptors can become used to the medicine and may need a break.

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