Everything you should know before using a topical steroid
Steroids are medicines which are prescribed to treat pain and reduce inflammation. They could be natural or synthetic. Natural steroids are produced in your body, e.g., sex hormones, while various synthetic steroids are also available. The body naturally produces steroids in response to stress, e.g., trauma, disease etc...
The steroids applied on the skin to treat skin conditions are called topical corticosteroids or topical corticosteroids. These creams reduce the itching and inflammation and allow the skin to start healing. A large variety of topical corticosteroids with different potency, dosages and concentrations are available in creams (hydrocortisone creams), ointments, gels, creams, lotions, solutions etc... You can see our range of products by visiting our Skin Health page, here.
But how do these topical steroids work? Are these steroids safe for you? What could be the possible side effects? How can creams be used safely?
To answer these questions, you should first know how steroids work.
How do topical steroids work?
A topical corticosteroid is mainly prescribed to suppress the inflammation on the infected skin and reduce the pain and swelling associated with inflammation. They perform their job by;
How do topical steroids help in inflammation?
Applying a steroid cream or ointment to your skin slowly absorbs from your skin to your blood. The steroid molecules travel to your DNA and cause the production of proteins called lipocortins. These lipocortins block arachidonic acid, a necessary mediator of inflammation. In this way, synthetic steroids suppress inflammation.
How do topical corticosteroids reduce pain and swelling?
Have you experienced inflammation? Its two most essential Hallmarks are pain and swelling. This swelling is due to the dilatation of local blood vessels. The steroid molecules act on local blood vessels and constrict them, thus reducing swelling and pain.
Steroids and cell damage
Corticosteroids also suppress the release of bacterial and viral toxins and thus protect the cells from toxin-medicated damage.
What are the side effects of a topical steroid?
The topical corticosteroids are safe to use and seldom cause any side effects, given that you use them correctly. You are more prone to the side effects if you are older, undernourished, or have been using highly potent steroid cream for a long time or on a vast skin area. However, the unsafe user of topical steroid creams can experience two types of side effects;
- Local reactions
- Systemic reactions
- Withdrawal reactions
Local side effects of topical steroids influence the site of application. These can include;
If you are using steroid cream for the first time or are using new steroids, the first side reaction could be a mild to severe skin reaction and itchy skin. You may not have a burning or stinging sensation after application. However, these effects are temporary and will likely disappear as your skin starts to accept this new medicine. Practice extreme care if you have atopic dermatitis.
Hair follicles are present on all of your skin. They have a standard immune mechanism. The steroids suppress your immune system and thus can cause folliculitis, the painful inflammation of hair follicles. As a result, you may note itching and redness around your hair. The most affected area is the face.
When the skin is irritated due to a local substance, including corticosteroids, their application on the skin can cause an allergic reaction if you are allergic to the steroid creams.
Worsening of the already occurring skin conditions
Sometimes, the reaction of corticosteroid creams can exacerbate the situation for which they were being used, e.g., acne and eczema etc...
Stretch marks (Striae)
Some creams can cause permanent marks on the skin. However, these marks will fade over time.
To learn more about stretch marks, see our information page here.
The disturbance of blood supply in the local area can cause the skin to lose strength and become oversensitive and thin. As a result, your skin will become loose and more likely to be damaged and bruised.
Sometimes, hair growth may occur in the area where they are being applied. This condition is called hirsutism and can be a cosmetic blemish for women.
Skin colour changes
This particular occurs in dark-skinned people.
These reactions influence the area away from the site of application. Besides the effects mentioned above, you can experience;
- rosacea, which is the severe facial flushing
- Delayed wound healing
- More chances of fungal infections
- Atrophy, which means a severe decrease in the size of affected areas of skin
These reactions occur when a medicine is used for a long time and suddenly withdrawn. These side effects can include skin redness and colour changes (more pronounced in darker skin people). You can also feel itching, burning, peeling and stinging on the local skin. Don't forget to consult the doctor before stopping topical corticosteroids.
How can a mild topical steroid be used safely?
For the safe use of topical steroids, the following points are worth following;
- To avoid side effects, use steroids only on the advice of a doctor. Never exceed the dosage and duration of use beyond the direction.
- The topical medications are only for skin use. They should not be used on wounds, broken skin, or the eyes. Rinse the area with water in case of accidental application to these areas.
- Thoroughly wash your hands before and after the application of the drug. The cream remaining on your hand can absorb slowly into your bloodstream.
- Don't stuff the skin; apply a thin layer and gently rub it. It will help in easy absorption without causing skin reactions. The fingertip unit (FTU) estimates the required cream for the skin. One FTU is the quantity of cream covering the tip of an adult finger. One FTU is enough for the area of a hand palm and is around 0.5 grams.
- Shake the cream or lotion well before use. The steroid molecules can settle down, particularly in lotions. You might experience severe reactions while using the end part.
- If you are using anabolic steroids (performance enhancers), consult your doctor before using any topical steroids.
- Don't use the bandage or wrap on the affected skin after applying the medicine, unless the doctor advises.
- Use a milder cream if you plan to use it for long periods to treat skin diseases. Never use high and ultra-high potency steroids without consulting the doctor or a dermatologist.
- Follow all instructions of the doctor for use. Don't forget to read the safe use instructions provided by the manufacturer.
Steroids are often used to treat skin inflammation. They are safe and well-tolerated under ordinary conditions. However, unsafe use can lead to adverse reactions. Follow the safe use guidelines to avoid these side effects and report any side effects immediately to your physician.
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