The truth about topical steroids.

How I view Topical Steroids.



Topical steroids are the most common prescription dispensed by doctors and dermatologists for managing the symptoms of chronic inflammatory skin conditions like eczema. For over 50 years, they have been recommended as they act quickly, suppress skin inflammation and appear to be quite effective, especially in the short term. 

They come in various strengths, vehicles (lotions, creams and ointments) and absorb more readily into thin, sensitive areas of skin such as the eyelids, genitals and skin folds.

Having used them for the first 15 years of my life I can see the allure of them. They are quick to dispense, inexpensive, there are a variety of strengths, you are in and out of the door with a prescription and they work quickly. 

However, there are well known adverse effects especially if used on thin areas of the skin like the face, neck and hands for extended periods of time. These adverse effects should be made much more transparent, especially when dealing with someone who has a chronic condition where it is evident that they are using topical steroids for extended periods, over large surface areas of the body and on many sites of thin skin. 

If it is an isolated incidence of contact irritation a topical steroid can be an effective way to manage flare ups and reduce the likelihood of infection that occurs as a result of scratching and damage to the skin.

However, they have no underlying effect on the root cause of the problem so it is only symptom management. When dealing with skin problems the medical profession doesn't have too many other options other than some form of topical or oral immune suppressant. If your symptoms don't improve you may eventually have a skin prick and blood test which is useful information. However, little if any attention is paid to diet, lifestyle, mental health, wellbeing and allergen avoidance. There isn't a system for managing your skin health. 

As a 10 year old, I remember asking my dermatologist Lucinda who was working for one of the top hospitals in Australia if diet was linked with my eczema as I noticed it would usually flare whenever I ate too much fried or processed foods. I still remember being told 'there is no conclusive evidence that diet has a direct effect on the skin'. I also remember her recommend me to use steroids as well as copious amounts of Sorbolene. She taught me to use a huge palm sized dollop and to just keep rubbing until it was absorbed. 

At the hospital I was also shown how to use wet wraps to keep my skin moist. After 30 years I can confidently say that most typical advice for chronic skin problems is superficial, incomplete, short sighted and potentially damaging. It is all symptom management rather than health promotion and immune balancing. 

Since childhood, I had severe eczema and I was using cortisones up until 15. However, they never gave me any long term relief and I kept needing stronger and stronger cortisones. My skin was getting infected far more easily and raw looking. When I went on stronger cortisones it would seem to have a temporary improvement. However, it felt very much like a band aid solution as it would come back even worse if I stopped using it. My skin seemed to take longer and longer to repair, bruised easily and eventually I became irritated by cortisones. Without a doubt, cortisones are not an effective long term solution to chronic skin problems. 

How do Topical Steroids work?
The mechanism of action of topical steroids involves vasoconstriction, anti-inflammation, immune suppression & inhibition of cell proliferation. They work by preventing cells from producing inflammation-causing chemicals that are released in response to a variety of triggers. However, they have no effect on the underlying cause of skin problems and are simply tools for symptom management. 

What are the potential adverse effects of Topical Steroids?
Prolonged, repeated use of high-potency steroids particularly on thin epidermal regions often leads to significant long term adverse effects. Adverse effects include dermal atrophy (skin thinning), erythema (redness), pigment alteration, delayed wound healing and dependency on stronger topical steroids. It also inhibits cell proliferation and collagen synthesis in the dermis which impacts the skin's structure, mechanical strength and appearance. As a result, the skin develops tolerance to the topical corticosteroid which leads to a loss in vasoconstriction (constriction of blood vessels) by the capillaries.