Topical steroids are medical treatments that are applied directly to your skin (as opposed to taking a pill by mouth) to provide relief for a wide variety of dermatological conditions, such as psoriasis, seborrhea, atopic dermatitis, and contact dermatitis. They can be prescribed or purchased over-the-counter, depending on their strength.
Classification by Strength
Topical steroids are divided into seven classes based on how strong they are. The strongest steroids are in Class I and the weakest steroids are in Class VII. The strength of a topical steroid is determined by a standardized test that measures the extent to which it can cause your blood vessels to constrict in the upper dermis (the layer of skin that’s just below the outer epidermis).
Comparatively speaking, a Class I topical steroids are between 600 and 1,000 times stronger than those in Class VII.
The greater the strength, the greater the risk of side-effects with continued use. Which is why many experts advise against the long-term use of topical steroids and many companies are now developing treatments which exclude the use of topical steroids completely.
Common Side Effects from Topical Steroids
Generally, short courses of topical steroids which last under four weeks are considered a safer option. Problems may develop , however, if topical steroids are used for long periods, or if short courses of stronger steroids are repeated too often.
Long-term use topical steroids may cause side effects, the most common of which is skin atrophy. This is worsened by factors such as higher potency steroids, occlusion, thinner skin, and older patient age.
The long-term use of strong steroids is most concerning and side-effects can either be ‘local’ or ‘systemic’. Local means just affecting that bit of skin and systemic means affecting the whole person.
Local effects may include:
- Stinging or burning feeling following the first treatment.
- Skin thinning – this mostly occurs with the use of high-strength steroids, although it can be reversed when treatment is stopped.
- Stretch-marks: long-term use has in some cases led to permanent striae on the skin, bruising, discolouration, or thin spidery blood vessels.
- Topical steroids can also induce rosacea, which may include the eruption of erythema, papules, and pustules.
- Increased hair growth where the skin is being treated.
- Allergy: some people have developed an allergy to the contents of the treatment, which in some instances can make the inflammation worse.
Systemic effects include:
- In some cases, the topical steroid gets through the skin and into the bloodstream, which is primarily a concern in children who are on strong doses as this can affect their growth.
- Fluid build-up in the legs
- Increase in blood pressure
- Bone damage and thinning
- Cushing’s syndrome: although rare, symptoms include rapid weight gain, skin thinning and mood changes.
Should you be prescribed a treatment which includes a topical steroid, it is important to only use it as directed by your doctor and not to continue use as a ‘preventative’ measure.
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