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Topical steroids

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Topical Steroids

What are they used for?

Many skin conditions can be treated with topical steroids which act by reducing inflammation. As topical steroids are applied directly to affected areas of skin, the risk of internal side effects is minimised.

 Topical steroids can be used for skin conditions such as:

 Topical steroids may aggravate some skin conditions such as:

 What precautions should you take with topical steroids?

Please advise your doctor if you are pregnant.

  1. Which topical steroid should I use?

Many different topical steroids are available including betamethasone diproprionate, betamethasone valerate, mometasone furoate, methylprednisolone aceponate, hydrocortisone acetate etc. These have been modelled on the natural hormone cortisol that is produced in our bodies.

Topical steroids are available under a number of trade names and come in a range of strengths and forms including creams, ointments, lotions, gels, sprays and shampoos.. This can be confusing. Your doctor will recommend a topical steroid that is suitable for the severity of your skin problem and the body site being treated.

  1. Which topical steroid is for which area?

In some cases, more than one topical steroid will be prescribed, particularly if more than one body site is being treated. It is important for you to understand where each one should be applied. Weaker steroid strengths are generally used on the face and in delicate areas such as the underarms and groin.

  1. How often should I apply the topical steroid?

Your doctor will advise you how often to apply. In general, topical steroids should be applied once or twice daily. Using them more frequently than your doctor recommends will not improve the results and it may increase the cost of treatment and the risk of side effects. There is a theoretical risk that with frequent application, tolerance to the medication can occur with a loss of effectiveness.

  1. How much should I use?

Topical steroids are efficient at penetrating into the skin. There is often a lot of confusion about how liberally or thinly/sparingly topical corticosteroids should be applied.  Generally dermatologists encourage a liberal application or sometimes an amount based on Finger-Tip-Unit (one index finger tip with a generous amount of topical steroids should cover a surface area the size of 1 to 2 palms). You can help your doctor gauge how much of the treatment you are using by keeping a record of the number of tubes or bottles of medication you finish.

  1. How should i apply the topical steroid?

You can apply the topical steroid with clean hands. If the area of skin being treated is very thick, penetration of the treatment can be improved by covering the topical steroid with a dressing or with plastic film (known as a “wet dressing”). Wet dressing is a technique to help allow the topical steroid to penetrate better and faster into the skin and hence gives faster results. Check with your doctor regarding specific instructions.

  1. How long should i use the treatment?

Topical steroids are generally used until the areas of inflammation being treated have settled.  There are times when this may take longer than others. It also depends on the nature of the condition being treated with chronic relapsing conditions like eczema often requiring long periods of active treatment. Your doctor will tell you how often to apply the treatment, how long you will be on the treatment and when you might need to restart the treatment.

  1. Do i need to use the treatment proactively, or only when my rash is troublesome?

If you have a chronic skin condition, your doctor may recommend maintenance treatment to reduce the chance of flare-ups occurring. Your doctor will advise if this is necessary.

 What monitoring is required?

In general, topical steroids have excellent safety profiles.  Side effects are uncommon and tend to be seen only in cases of prolonged use, often when there is limited direct supervision by a doctor. It is important to remember that the skin disease being treated can sometimes produce changes in the appearance of the skin.

Monitoring for internal side effects is not usually necessary because limited amounts, if any, are absorbed through the skin into the body.

What to expect when using topical steroids and potential side effects

Skin conditions do not often show an immediate improvement after the initial application of topical steroids. It usually takes 48 to 72 hours for a significant change to occur. On the other hand, there are times when the response may be slower due to the disease severity or the nature of the condition being treated. The formulation of the topical steroid being applied may cause temporary symptoms, as creams potentially may briefly cause stinging and ointments in summer may briefly worsen itching. This does not mean that the medication is bad for you. Check with your treating doctor if you have any concerns.

Many people are concerned about using topical corticosteroids because they have read or heard about these treatments from a range of sources including friends, family, the internet, media and even healthcare professionals such as pharmacists and general practitioners. It is important to remember that side effects predominately relate to high doses of systemic or topical steroid treatment in people who are seriously ill. In fact, topical steroids can be used for long periods with complete safety as long as you understand what strength to apply, how often to apply the treatment, how much to apply and how long to continue the treatment. It is a mistake to be too cautious about using topical steroids as sometimes this can mean that your skin condition may be inadequately managed and you then might need a stronger medication such as a

the skin disease being treated can sometimes produce changes in the appearance of the skin.

Monitoring for internal side effects is not usually necessary because limited amounts, if any, are absorbed through the skin into the body.

What to expect when using topical steroids and potential side effects

Skin conditions do not often show an immediate improvement after the initial application of topical steroids. It usually takes 48 to 72 hours for a significant change to occur. On the other hand, there are times when the response may be slower due to the disease severity or the nature of the condition being treated. The formulation of the topical steroid being applied may cause temporary symptoms, as creams potentially may briefly cause stinging and ointments in summer may briefly worsen itching. This does not mean that the medication is bad for you. Check with your treating doctor if you have any concerns.

Many people are concerned about using topical corticosteroids because they have read or heard about these treatments from a range of sources including friends, family, the internet, media and even healthcare professionals such as pharmacists and general practitioners. It is important to remember that side effects predominately relate to high doses of systemic or topical steroid treatment in people who are seriously ill. In fact, topical steroids can be used for long periods with complete safety as long as you understand what strength to apply, how often to apply the treatment, how much to apply and how long to continue the treatment. It is a mistake to be too cautious about using topical steroids as sometimes this can mean that your skin condition may be inadequately managed and you then might need a stronger medication such as a tablet, for a longer time to get the disease under control. In general, topical treatments are considered safer than systemic (oral) treatments.

Short courses of treatment are usually not associated with any significant side effects. Longer courses of treatment with stronger medications, very infrequently, may be associated with:

  • broken capillaries (telangiectasia)
  • bruising
  • acne-like changes
  • colour change of the skin.

It is not clear whether topical steroid use can lead to eye problems such as cataracts and glaucoma. It is sensible to keep the use of topical steroids to a minimum around the eye area.

 For a full list of known side effects, please refer to the product information leaflet provided with the medication.

This information has been written by Dr Jenny Byth

 

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