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Are topical steroids safe?

August 2, 2019

 

You may have read in the news recently about an infant who developed Cushing’s Syndrome from using a cream containing steroids.

 

So one might ask, “Are topical steroids safe?”

 

 

The answer to that is a little more complicated than a simple Yes or No.

 

 

What are Topical Steroids?

Topical steroids are creams, gels, solutions that contain steroids. They are frequently-prescribed dermatology drugs and have been used to treat inflammatory skin conditions e.g. eczema, contact dermatitis etc for more than 60 years.

 

 

Potential Side Effects of Steroids

They are effective and when used correctly, are very safe.

 

Undeniably, topical steroids have the potential to cause serious side effects such as Cushing’s Syndrome, thin skin, abnormal skin pigmentation etc.

 

However, those side effects are usually the result of long-term use of topical steroids, often for months and with no break.

 

 

How to Use Steroids Safely?

By adhering to the following principles, topical steroids can be used safely and side effects avoided:

 

Adopt a stepped approach to steroid use.

 

Start application of topical steroids when a flare is evident and step-down when the flare subsides – e.g. daily for 7-10 days, reduce to every other day for the next 7-10 days and stop. Such a stepped approach helps to reduce the incidence of steroid rebound, which is a rapid recurrence of a rash after the steroid is stopped and which is often more severe than the original rash.

 

Use the least potent topical steroid

 

Use the least potent topical steroid to control inflammation-match potency of topical steroid to the severity of the disease.

 

Use different potencies for different body areas.

 

Generally, only mild to moderate potency for face and flexural regions. Low to very high potency can be used for all other regions, but it must be matched to the severity of the disease.

 

Use as indicated & Apply thinly

 

Typically once or twice daily. More than 2x application a day has no additional benefits and increases the risk of developing side effects.

 

Use plenty of emollients

 

Use plenty of emollients on a continual basis for conditions such as eczema and chronic dermatitis. That can help prevent flare-ups.

 

 

Do not be afraid of topical steroids

When used correctly, they are the mainstay of treatment of many inflammatory skin conditions. Please clarify with your doctor if you have any doubts regarding the use of topical steroids.

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