July 31, 2017

Topical Steroids for Skin Diseases

Many types of skin allergies, including eczema, can be treated with topical steroids. Topical steroids
are anti-inflammatory medications that help to reduce itching, flaking and oozing on the skin. They
have to be applied to skin daily, one or more times a day.

Topical steroids are normally prescribed for patients with eczema that cannot be treated with skin
moisturizers alone.

Types of Topical Steroids

There are many types of topical steroids, as well as packages in which the medications are available.
Some topical steroids can be stronger than others, or come in higher concentrations. They are also
available in different topical formulations like creams, lotions, ointments, etc.

Topical steroids can also be available both by prescription and over the counter. An example of an
over-the- counter topical steroid is hydrocortisone acetate 1% cream.

Lotion, Cream or Ointment?

The potency of topical steroids often depends on how the medication is packaged. The same topical
steroid may have diverse levels of potency, when placed in different formulations. The strongest
type of medications containing topical steroids are ointments, which are followed by creams,
lotions, solutions, gels, and sprays being the lightest option.

Topical Steroids for Children

Only lower potency topical steroids are recommended to be used on children, since their skin is
more sensitive and, therefore, more prone to various adverse reactions caused by the medications.
Nowadays, there are two topical steroids more often recommended for use in children due to the fact
that the less of the medication is absorbed into the body and they can be used only once a day. These
topical steroids are mometasone furoate (marketed as Elocon) and fluticasone propionate (marketed
as Cutivate). The latter is the only topical steroid, approved for the Food and Drug Administration
for infants from 3 months of age.

Topical Steroids for Sensitive Areas of the Skin

Topical steroids may affect the sensitive skin on the face causing some undesirable side effects. Besides,
the medication may lead to glaucoma or cataract formation, if it gets into the eyes. Therefore, if you
decide to treat eczema on the face skin with topical steroids, it is recommended to apply the smallest
amount of the lowest potency topical steroids for the shortest period of time possible.
Other areas of the body that are more prone to the topical steroids’ side effects include the areas with
thinner skin like eyelids, genitals, etc., as well as the areas of skin folds like the armpits, groin, or under
the breasts in women. These areas of the body should be also treated with caution and only with low
potency topical steroids.

Topical Steroids’ Side Effects

Topical steroids usually cause side effects on the areas where the medication is applied.

Side effects from topical steroids are most often seen on the areas of skin where the medication is
applied. Common side effects of topical steroids include irritation, redness, burning, peeling and
thinning of the skin, pigmentation, blood vessel formation, rosacea, perioral dermatitis, acne,
delayed wound healing ability, increased susceptibility to skin infections, as well as contact
dermatitis caused by the substance itself.

When the body absorbs a great amount of topical steroids, the medication may sometimes cause a
systemic effect which includes the symptoms of Cushing’s syndrome. To avoid the risk of
developing this condition, it is recommended not to use the medication over large areas of the skin,
in the areas of sensitive skin, or for extended periods of time.

The probability of the development of the topical steroids’ side effects also depends on the potency
of the corticosteroid, and whether an occlusion dressing is applied over the steroid.

Topical Steroids Classified by Potency

Experts usually separate topical steroids into seven categories based on their level of potency. The
categories, from the strongest to the weakest, are presented below:

Category 1: Temovate (clobetasol) 0.05% cream and ointment, Diprolene (betamethasone) 0.05%
cream and ointment.
Category 2: Lidex (fluocinonide) 0.05% available in any formulation, Topicort (desoximetasone)
0.25% cream, gel, or ointment, and Elocon (mometasone furoate) 0.1% ointment.
Category 3: Topicort (desoximetasone) 0.05% cream, Cutivate (fluticasone proprionate) 0.005%
ointment.
Category 4: Westcort (hydrocortisone valerate) 0.2% ointment, Kenalog (triamcinolone) 0.1%
cream, Elocon (mometasone furoate) 0.1% cream.
Category 5: Cutivate (fluticasone proprionate) 0.05% cream, Westcort (hydrocortisone valerate)
0.2% cream.
Category 6: Desonate (desonide) 0.05% cream.
Category 7: Cortaid (hydrocortisone acetate), available in various forms and concentrations.

OTC Hydrocortisone Cream or Prescription Topical Steroids?

Depending on the severity of the skin disease, you may use over-the- counter hydrocortisone cream
or you may need a prescription medication. Hydrocortisone creams are often effective for mild cases
of condition. However, if the symptoms are severe and long-lasting, you may need a stronger
medication available under prescription.

It is important to remember that prescription topical steroids should only be used by people they are
prescribed for and by anyone else. This is to avoid the risks of undesirable side effects of the
medication.

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