Topical Steroids 101

By Rachel Oberlin
Rachel Oberlin is a Registered Nurse and mom of two children who were healed from significant eczema through an integrative approach. Rachel is the author at EczemaMom.com, where she shares her family’s story, research-based articles, and helpful products.”

Topical Steroids & Eczema: Helpful or Harmful?

Topical steroids (corticosteroids) are the most commonly prescribed treatment for eczema, having been around for over 60 years. But what was once hailed as almost a miracle treatment for eczema and other skin disorders is now increasingly scrutinized and questioned by eczema patients. This hesitancy often comes from fear of the possible side effects and addiction. Is this attitude a little overly cautious or founded on good reason? Let’s take a look at what steroids do, when they should be used, side effects, and possible alternatives- and a little about my personal experience with steroids too.

What are Topical Steroids?

Steroids are actually naturally occurring hormones in our bodies that control inflammation, growth and other functions. Some familiar steroids produced in our bodies are cortisol, aldosterone, estrogen and testosterone.
Topical steroid medications are synthetic substances that closely resemble the body’s natural steroids. They are effective for skin conditions specifically by their ability to modulate inflammation and the immune system:

• When steroids enter the cell, theyprevent or reduce the production of inflammatory substances that would usually be released in response to various triggers.
• One of the ways in which the immune system fights invading bacteria or viruses is by the release of inflammatory substances to kill the invaders. Steroids reduce this inflammatory release, therefore, they alter the immune system.
• Steroids also work to combat inflammation by constricting blood vessels. The redness, warmth and swelling that is present at the site of an injury to the skin is due to the extra blood flow to the injury. This is a form of inflammation. Steroids work against this by reducing blood flow to the blood capillaries in the area of application.

Topical steroids come in many forms including creams, ointments, lotions, powders, and sprays. They are organized from Class I to Class VII with Class I being the strongest and Class VII the weakest. The percentage that is present with the steroid name is significant, but by itself does not indicate the strength of the steroid. It is important to refer to the classes to understand the strength.

How Can Topical Steroids help Eczema?

Because of their powerful anti-inflammatory effects, topical steroids can certainly alleviate the symptoms of eczema (redness, itching, swelling). A course of topical steroids will prove to be the most effective when the exact orders for the medication are followed. For example, use the correct number of applications for as many days as directed. If you miss an application, don’t “catch up” by adding an extra the next day.

When should Topical Steroids be Used?

According to the National Eczema Association,
“Topical corticosteroids are recommended when patients have failed to respond to a consistent eczema skin care regimen, including the regular use of moisturizers (emollients), appropriate anti-bacterial measures, and trying to eliminate any possible allergens that may be contributing to the underlying problem.”
So, topical steroids, although offering fast relief, are not to be the first response to eczema. Non-medicated treatments like moisturizers and trigger identification do not carry the possible side-effects of topical steroids, and should be attempted first.
It’s important to find a healthcare provider who will work with you on non-medication options as a first line treatment and then prescribe topical steroids judiciously and according to proper research-based guidelines.

What are the Side Effects and Risks?

Unfortunately, topical steroids are not without possible side effects. Among the most common side effects are:

• Thinning of the skin (atrophy)
• Thickening of the skin (lichenification)
• Skin darkening
• Stretch marks
• Visible broken blood capillaries (telangiectasias)

More serious and less common side effects include:

• Suppression of the hypothalamic-pituitary-adrenal axis
• Cushing’s syndrome
• Glaucoma or cataracts
• Growth retardation in infants and children
• Development of allergies to the steroid or additives in the medication (e.g. propylene glycol)
• Topical Steroid Withdrawal (steroid addiction)
• Osteoporosis
• Diabetes

Keep in mind that the risk for these side effects, especially the more serious systemic ones increase based on several factors:

• The strength of the steroid used, the amount used,frequency of application and the body surface area it is used on
• Long-term usage of topical steroids, especially high strength formulas
• Application to areas which more readily absorb the steroid: face, genitals, thin skin, areas that rub together/folds
• The elderly are more at risk due to thin skin
• Risk is also higher for infants due to body surface to volume ratio

Advantages and Disadvantages to Topical Steroids

The advantage of topical steroids is that for most people suffering from eczema, upon first using topical steroids, they are fast-acting to relieve symptoms. This can seem like a miracle for someone who has been struggling in discomfort and pain for many weeks or months or even years.
However, notice that topical steroids bring relief of symptoms. They are not a cure for eczema. They are used to control eczema, to manage it. They quell inflammation at the skin level but do nothing to address the actual reason for the inflammation.
Among the disadvantages of topical steroids are the side effects and risks as discussed above. Although each course of topical steroids has a limited time of use, it is quite usual to return to another course for the next flare-up and so on and so on because the root cause is not being addressed. Often when a weaker strength steroid becomes ineffective, a stronger one is prescribed. Misuse or overuse of steroids can lead to the terrible condition known as Topical Steroid Withdrawal (also known as “Topical Steroid Addiction” or “Red Skin Syndrome”).
If the root cause of eczema is not discovered and addressed, steroids can be used for flares year after year, with the discomfort and pain of eczema continuing on.

What are the Alternatives?

For my own two children who struggled with eczema, conventional use of topical steroids were not a solution. We did use them for a short time as directed by our physicians, but each time we stopped as directed, the eczema only came back worse than before, leading to a stronger prescription. It was plain to me that steroids were only suppressing the inflammation when we truly needed to find and fix the reason for the true reason for the inflammation.
The ultimate answer for us was healing the gut through cutting allergens and eating a healing diet. It was a process of time, but with healing from the inside out truly worked to get to the root of the inflammation and now my kids are eczema-free. While we worked on healing from the inside out, we used natural skincare options.
Did you know that natural oils like emu oil, olive oil, and shea butter are highly anti-inflammatory? They are also full of naturally occurring vitamins that nourish and repair the skin. Other natural methods that can provide a lot of relief are therapeutic baths with bath salts or apple cider vinegar. Wet wraps are wonderful as well for especially hydrating the skin and reducing itch.

The Bottom Line

While a course of topical steroids can offer fast symptom relief, it is not without side effects, or the possibility of continuing down the path of using more and stronger steroids. True healing can be found when the source of the inflammation is addressed and there are many safe and natural skincare options to relieve and sooth eczema while on the healing journey.

Do you have more questions about topical steroids? Comment below and let me know! (insert whatever you wish for your readers to comment)

Author’s note:
While I am a licensed Registered Nurse in the US, I cannot diagnose or prescribe, and I am not your medical professional. The information presented in this article is based on both credible research sources and my family’s own experience with eczema. This article is for informational purposes and not intended as medical advice. Please work with your qualified medical professional to make decisions for your treatment.