If athlete's use steroids, they develop nasty cancers that make them pay in the long run. If you use a topical steroid, the same thing will happen, right? Not at all.
Physicians use topical steroids to treat eczema and psoriasis, but many people use nonprescription steroids for minor skin irritations, bug bites and rashes. We often recommend a 1% hydrocortisone for people that have flare ups due to retinoid use.
True, if you use topical corticosteroids in great doses over a prolonged period, the skin can atrophy and can cause adrenal suppression. If you read the warning labels on most of these preparations, one would think you are flirting with the disaster. Even physicians can add to this phobia by instructing you to apply "thinly and evenly" or "sparingly" over the skin. This implies that you are using a dangerous ointment and to be careful.
The reality is that there is little or no risk from using a topical steroid. Most all preparations have such a low concentration of the active ingredient that patients and physicians need not worry about the short term use of topical steroid.
Since most people are scared to use too much of the cream, they tend to under-treat the underlying problem which causes the patient to use the steroid longer than needed. You should apply a generous amount to the affected area.
Study summaries:
- In a systematic review of treatments for atopic eczema, randomized controlled trials of topical corticosteroids that specifically gathered data on skin thinning and suppression of the pituitary–adrenal axis failed to show evidence of harm – although the studies were short term Study Reference
- Two longer-term studies on intermittent use of the potent topical steroid, fluticasone (Brand name Cutivate), found no evidence of skin thinning after 4 months Study Reference and Study Reference
- A study of 35 children aged 0.7–18.7 years with a median of 6.9 years of corticosteroid treatment for atopic eczema found biochemical evidence of HPA axis suppression (decreased cortisol response) only in those using potent or very potent topical corticosteroids or those who had received corticosteroids from other routes (inhaled, intranasal or oral). Study reference
- Reassuring evidence about the effects of long-term use of corticosteroids on the HPA axis in patients with psoriasis comes from a study of 46 patients randomized to 0.25% desoximetasone or betamethasone 17- valerate (Brand name Diprosone ). Patients applied their medication to psoriatic lesions on approximately one-third of their body. Plasma cortisol levels were reduced to below normal levels in nine patients using desoximetasone during the study, but in none of the betamethasone group. Levels returned to normal spontaneously in four of the desoximetasone group. In four other patients, plasma cortisol remained suppressed at the end of 5 months of continuous therapy, but returned to normal within 7 days of stopping treatment. Study reference.
- In a 3-week comparative study of 40 patients using 3.5 g of either 0.05% betamethasonedipropionate cream (brand name Diprosone ) or 0.05% clobetasol -17-propionate (Brand name Temovate ) ointment for treatment of moderate to severe psoriasis, temporary reversible suppression of the HPA axis (low morning cortisol) was seen in eight patients – three on betamethasone and five on clobetasol. Study reference.
Some topical corticosteroids (active ingredient) Brand Name
Nonprescription
Prescription Low Strength
Prescription Medium Strength
Prescription High Strength
Prescription Very High Strength
Sources for this posting come from Medline (requires registration)
If athlete's use steroids, they develop nasty cancers that make them pay in the long run. If you use a topical steroid, the same thing will happen, right? Not at all.
Physicians use topical steroids to treat eczema and psoriasis, but many people use nonprescription steroids for minor skin irritations, bug bites and rashes. We often recommend a 1% hydrocortisone for people that have flare ups due to retinoid use.
True, if you use topical corticosteroids in great doses over a prolonged period, the skin can atrophy and can cause adrenal suppression. If you read the warning labels on most of these preparations, one would think you are flirting with the disaster. Even physicians can add to this phobia by instructing you to apply "thinly and evenly" or "sparingly" over the skin. This implies that you are using a dangerous ointment and to be careful.
The reality is that there is little or no risk from using a topical steroid. Most all preparations have such a low concentration of the active ingredient that patients and physicians need not worry about the short term use of topical steroid.
Since most people are scared to use too much of the cream, they tend to under-treat the underlying problem which causes the patient to use the steroid longer than needed. You should apply a generous amount to the affected area.
Study summaries:
Some topical corticosteroids (active ingredient) Brand Name