Topical steroids are the most prescribed topical medications in the field of dermatology, used to treat a multitude of skin problems such as eczema, allergic and irritant contact dermatitis, psoriasis, and any other condition that causes inflammation, irritation and rashes on the skin. It is an indispensable drug, but it also has a somewhat unfair reputation as a dangerous drug among some patients.
How do steroids help psoriasis and so many other skin problems?
Topical steroids have anti-inflammatory effects. Inflammation is an immune response, so it helps control skin rashes. Note that steroids do not treat eczema or psoriasis but are very effective at controlling inflammation.
What are the advantages of steroids?
Steroids are one of the fastest-acting drugs, reducing itch and decreasing inflammation within a few hours of application. As itch often prompts scratching, this can trigger a cycle called the itch-scratch cycle. Being fast-acting is a significant advantage.
Why do topical steroids have a reputation for being dangerous?
Topical steroids have often been presented as dangerous medications when they are among the most effective and versatile medications used in dermatology. In the past, when the potential side-effects of steroids weren’t well known and were used as a type of panacea, there were cases of unwanted and sometimes severe side-effects. Although much more is known about steroids, and they are now used in a much more controlled manner, unfortunately, this reputation from the past still leads some patients to believe that they should avoid steroids.
Are steroids safe for use now?
Steroids have the potential for numerous side-effects such as triggering diabetes, osteoporosis, skin atrophy, perioral dermatitis, or, more commonly, decreasing effectiveness. The more severe side-effects generally only occur when potent steroids are used for an excessively long time and are rarely seen in topical use. Doctors understand the risks of prolonged steroid use, so they usually prescribe weaker steroids or combine potent steroids with other medication to minimize side effects. Although no medication is entirely risk-free, if you follow a doctor or a pharmacist’s instructions correctly, the chances of unwanted side-effects are minimal.
What is the most common example of incorrect steroid use?
The most common scenario in which steroid is misused is when patients share their steroid medication with another person, usually a family member. As steroids are very effective anti-inflammatory drugs, they work on almost any rash, which can, unfortunately, tempt some people to share use. The other common scenario of misuse occurs when a patient decides to treat a rash on another part of the body for which the steroid was not prescribed, thinking that this is safe. Never share medication and never use a medication other than for specific use as instructed by the doctor. Steroids are prescribed in different strengths depending on the location to be treated. Skin is thicker in certain areas of the body, such as the hands and feet, and these areas do not absorb steroids well, so they are treated with potent steroids. If medication is misapplied to a thin area of the skin such as the face, armpits, or genitals, inappropriately potent steroids are being applied, which can significantly increase the chances of unwanted side-effects.