What are Topical corticosteroids?
Your skin has been itchy, red, and inflamed for the longest time. How do you fix it? The most common solution is for a doctor to prescribe topical corticosteroids, better known simply as topical steroid cream. Topical steroid creams are the most commonly used rub-on medicine for conditions such as psoriasis and eczema, skin conditions that cause redness, itchiness, rashes, and dry patches of skin. These creams come in a variety of strengths (hydrocortisone being the lowest, Augmented betamethasone dipropionate being the highest). They work by entering the membrane of cells and binding to a receptor. By doing this, steroids can inhibit the production of inflammatory proteins or increase the production of anti-inflammatory proteins.
Although steroid creams can bring relief, they come with risks and side effects when used recklessly.
The Side Effects
Most times, using steroid creams results in no side effects, but there are still instances of misusing topical steroids. Most misuse occurs with higher potency steroid creams, typically on the face and genitals. Clinicians usually recommend a time limit on most steroid creams; continued use of topical steroids weeks or months beyond the recommended time limit can result in side effects.
Following guidelines given by doctors can decrease the risks of common side effects such as skin thinning, stretch marks (striae), change in skin pigment, easy bruising, and clusters of damaged small blood vessels (telangiectasias or spider veins). Suppression of the adrenal gland can occur in cases where a large amount of steroid cream is absorbed over a large part of the body over a long period. This can lead to rare, but serious side effects like diabetes, osteoporosis, high blood pressure, and fluid retention (parts of the body swell due to trapped fluid). Frequent use of steroid cream around the eyes can cause glaucoma and cataracts.
Imagine a person who’s been using steroid cream for years without stopping. As they begin to experience the side effects of the creams, they decide to go cold turkey. But it isn’t that simple. The sudden disappearance of steroid cream from an everyday routine creates a backlash on the individual; this is called topical steroid withdrawal.
Withdrawal
When one thinks of withdrawal, most think of drug withdrawal. The concept of a cream giving a person withdrawal is strange but unfortunately true. Topical steroid withdrawal (TSW) is a side effect of taking too much or suddenly stopping the use of steroid cream (after prolonged use). The skin symptoms include:
Burning, stinging, or painful skin
Redness
Swelling
Peeling or cracked skin
Pus-filled bumps
Intense itchiness
A few non-skin symptoms include:
Insomnia (may be due to severe itchiness)
Hair loss
Depression
The reasons for TSW are still a mystery. According to Practical Dermatology, one idea
is that withdrawal leads to an increase in levels of nitric oxide, a component of the body that dilates blood vessels, effectively causing symptoms such as redness and itchiness. In the present day, much more research is being conducted on TSW to understand it fully.
Prevention
The message of this article is not to avoid topical corticosteroids. This article hopes to inform and give words of caution. The risks of topical steroid creams are real but also rare and can be avoided if used with care. Steroid creams are an amazing medication to relieve skin inflammation and provide relief for those with eczema, psoriasis, and other conditions.
The next time you have an uncontrollable itch of some kind and are prescribed steroid creams, please remember: to always follow the doctor’s instructions, be wary when placing around soft areas of the body, never use steroid creams for long periods, and watch for side effects.
Sources:
1) Coondoo, Arijit, et al. “Side-Effects of Topical Steroids: A Long Overdue Revisit.” Indian Dermatology Online Journal, U.S. National Library of Medicine, Oct. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC4228634/#:~:text=These%20tend%20to%20occur%20with,skin%20infections%20are%20less%20frequent.
2) Watson, Stephanie Watson. “Steroid Cream Withdrawal.” WebMD, WebMD, www.webmd.com/skin-problems-and-treatments/psoriasis/topical-steroid-cream-withdrawal?scrlybrkr=8b699485. Accessed 28 Oct. 2023.
3) Feldman, Steven R. “How Safe Are Steroid Creams? .” How Safe Are Steroid Creams?, www.arthritis.org/diseases/more-about/how-safe-are-steroid-creams. Accessed 28 Oct. 2023.
4) Assist, TSW. “Topical Steroid Ladder Potency Strength Chart: TSW Assist.” TSW Assist | Topical Steroid Withdrawal Insights, 6 Aug. 2023, tswassist.com/topical-steroid-ladder-potency-strength-chart/.
5) “Steroids (Topical) .” American Osteopathic College of Dermatology - AOCD, www.aocd.org/?page=SteroidsTopical. Accessed 29 Oct. 2023.
6) Ballard, Angela. “TSW: What the Eczema Community Needs to Know.” National Eczema Association, 31 Aug. 2022, nationaleczema.org/blog/tsw-need-to-know/?scrlybrkr=8b699485.
Assessed and Endorsed by the MedReport Medical Review Board
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