The truth of topical corticosteroids

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You may have heard that topical corticosteroids are harmful for your skin. This is only true if you use continuously for a long period of time. In some severe cases of certain skin conditions, topical corticosteroids can give relief and help manage the redness and itchiness. Topical corticosteroids have been available since 1950’s and are the most prescribed by dermatologists. This doesn’t mean that they are safe. It just means it depends on the severity of your condition.

Corticosteroids are similar to the cortisol, a hormone naturally produced by our body. It works by suppressing your immune response to a certain allergen or irritant, which leads to inflammation relief. Your dermatologist may recommend the use of topical corticosteroids for the following skin conditions:

  • Eczema;
  • Seborrhoeic dermatitis – a condition that causes flaky skin;
  • Psoriasis;
  • Nappy rash;
  • Lichen planus – a condition that causes an itchy, non-infectious rash;
  • Discoid lupus erythematosus – a type of lupus that usually only affects the skin;
  • Allergic skin reaction caused by insect bites or stings.

Topical corticosteroids are not the only treatment for these conditions. In some cases your doctor may recommend combination therapy with other drugs. Usually topical corticosteroids are only used to give fast relief of symptoms. Before you use a topical corticosteroid, there are some things you should know.

Know the side effects

Topical corticosteroids usually do not have serious side effects if used less frequently. Prolonged use can lead to more serious side effects. Side effects may include:

  • Skin thinning (atrophy);
  • Stretch marks on the armpits or groin area (striae);
  • Easy bruising and tearing of the skin (senile/solar purpura);
  • Enlarged blood vessels (telangiectasia);
  • Localized increased thickness of the hair (hypertrichosis).

Topical corticosteroids should not be used if you are pregnant or breastfeeding. You should also avoid using high potent corticosteroids in children.

Know the potency level

There are many different potency levels of topical corticosteroids. They range from least potent (class 7) to super potent (class 1). High potent corticosteroids are usually reserved for severe cases and should not be used on sensitive areas such as your face. Your doctor will most likely recommend you to start with a low potent corticosteroid and then change to a stronger type if needed. The higher the potency, the more risk for unwanted side-effects. Here is a list of some topical corticosteroids with potency levels.

Superpotent (Class 1)

  • Clobetasol propionate 0.05% lotion, spray, shampoo, solution, cream, ointment
  • Betamethasone dipropionate 0.05% ointment
  • Halobetasol propionate 0.05% ointment, cream
  • Fluocinonide 0.01% cream
  • Diflorasone diacetate 0.05% ointment
  • Desoximetasone 0.25% spray

Potent (Class 2)

  • Betamethasone dipropionate 0.05% cream
  • Mometasone furoate 0.1% ointment
  • Diflorasone diacetate 0.05% ointment
  • Halcinonide 0.1% ointment, cream
  • Fluocinonide 0.05% cream, gel, ointment,
  • Diflorasone diacetate 0.05% cream
  • Desoximetasone 0.025%, cream, ointment
  • Desoximetasone 0.05% gel

Upper Mid-Strength (Class 3)

  • Fluticasone propionate 0.005% ointment
  • Fluocinonide 0.05% cream
  • Betamethasone valerate 0.12% foam

Mid-Strength (Class 4)

  • Hydrocortisone valerate 0.2% ointment
  • Desoximetasone 0.05% ointment, cream
  • Fluocinolone acetonide 0.03% ointment
  • Triamcinolone acetonide 0.1% cream, spray
  • Mometasone furoate 0.1% cream
  • Flurandrenolide 0.05% ointment

Lower mid strength (Class 5)

  • Fluocinolone acetonide 0.01% shampoo
  • Flurandrenolide 0.05% cream, lotion, tape
  • Fluticasone propionate 0.05% cream, lotion
  • Prednicarbate 0.1% cream
  • Desonide 0.05% lotion
  • Hydrocortisone butyrate 0.1% cream, lotion, ointment, solution
  • Fluocinolone acetonide 0.03%, 0.01% cream
  • Hydrocortisone valerate 0.2% cream

Mild (Class 6)

  • Desonide 0.05% foam, gel
  • Fluocinolone acetonide 0.01% cream, solution
  • Aclometasone dipropionate 0.05% cream, ointment

Least potent (Class 7)

  • Hydrocortisone 1%, 2.5% cream, ointment, lotion, spray

Some corticosteroids can found as non-prescription products at your local pharmacy. Higher potent corticosteroids may require a prescription from your doctor.

Dosage form matters

You may think you can use any dosage form and it won’t affect the potency. Think again. The dosage form is important on how the active ingredient in the drug is delivered in your body. Topical corticosteroids are available in the following forms:

  • Ointments – usually oily, greasy and higher potency that makes it ideal for dry and thick affected areas
  • Creams – less oily and easier to apply but may decrease the steroid effectiveness
  • Lotions – both alcohol based and lubricant based are easier to apply for hairy affected areas. The alcohol-based are best for exudative lesions whereas the lubricant-based is best for dry scalp lesions.
  • Gel – have both water and alcohol content. Have a drying effect that makes it good for wet oozing rashes.

Tips on using topical corticosteroids

You should always follow your doctor’s instructions when using a topical corticosteroid. Depending on your doctor’s instructions, most topical corticosteroids are applied once to twice a day for one to two weeks.

You should try to avoid prolonged and continuous use. You should only apply to affected areas only. It is best to squeeze a small amount on your fingertip and gently smooth it into your skin in the direction the hair grows.

If you are using both topical corticosteroids and emollients, it is best to apply the emollient first and wait for 30 minutes before applying the topical corticosteroid.

Hello Health Group does not provide medical advice, diagnosis or treatment.

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