Topical corticosteroids are a popular prescription drug typically used in dermatology. They are known for rapidly alleviating symptoms of inflammatory skin issues. However, it’s important that they are properly prescribed and that patients are given adequate instructions on how and when to use them. When topical corticosteroid abuse occurs, this can lead to adverse effects. Glucocorticoid (GC)-induced osteoporosis (GCOP) is an example of a condition that can result from misuse of topical corticosteroids. This is whyit’s critical to understand the uses, formulations, strengths, and side effects of this essential tool. Continue reading to learn more about this type of topical steroid.
This is a synthetic (man-made) corticosteroid medication that is used to address skin conditions like eczema. This has powerful anti-inflammatory actions that are used according to their potency, the area of the body where they’ll be used, and the dermatological conditions being addressed. In the United States, topical corticosteroids are categorized as very high, high, medium, and low potency. Additionally, these are available in several formulations, including creams, gels, ointments, foams, lotions, oils, shampoos, pads, solutions, and sprays.
Not all topical corticosteroids can be bought over the counter. You can purchase mild corticosteroids, such as clobetasone, over the counter from pharmacies. However, stronger kinds, such as beclomet, are only available on prescription.
In general, corticosteroid cream should only be used once or twice a day for 3 to 7 days. Sometimes, doctors suggest using it less frequently over a longer period. Still, the timeframes for using topical steroids can vary, and age, the severity of the condition, and the part of the body that’s afflicted are factors that determine a timeframe for use.It's generally safe if used as instructed.
Topical corticosteroids support a wide array of mechanisms of action and provide anti-inflammatory, anti-mitotic, and immunosuppressive effects. According to information in StatPearls, its anti-inflammatory effect occurs, in part, because it decreases the number of inflammatory mediators that are delivered to the area of the skin to which it’s applied, increases the expression of anti-inflammatory genes, and indirectly inhibits inflammatory transcription factors. Also, the anti-mitotic effect helps to inhibit cell proliferation, and the immunosuppressive effect inhibits humoral factors involved in the inflammatory response and suppresses the maturation, differentiation, and proliferation of all immune cells.
According to BMJ Open, a topical corticosteroid is usually the first-line therapy for managing inflammatory eczema flares. Eczema is a term for a group of conditions that result in the skin becoming inflamed and irritated. It’s sometimes called atopic dermatitis or atopic eczema. An itchy, red rash on any part of the skin (face, behind the knees, wrists, hands, feet, etc.) is the main symptom of eczema. The affected area can also become dry, scaly, or thickened. If you have fair skin, the affected area typically begins as red but subsequently turns brown. Also, in individuals that have darker skin, the affected area will start either lighter or darker in comparison to the rest of your skin.
Furthermore, in infants, an eczema rash may become crusty and oozy and is usually on the baby’s scalp or face, although patches can appear on any area of the body.
Eczema can have several triggers.
Eczema can stem frompoor gut health, leaky gut, poor immunity, or food sensitivities. Eczema symptoms can occur due to the actions of your immune system. In response to a perceived threat on the skin, the immune system creates inflammation, which in turn causes the itchy rash to develop.
Some experts believe that dysbiosis in the gut and on the skin may be the culprit at work. Dysbiosis is a condition that happens when significant changes occur to your gut or skin microbiome that results in an imbalance. Imagine the immune system detecting harmful levels of “bad” microbes on your skin. Once it detects this “harm”, it reacts in defense.
The combination of dysbiosis and eczema could potentially create a vicious cycle of inflammation. The result is symptoms that persist.A 2021 review published in Microorganisms suggests that atopic dermatitis is associated with lower bacterial diversity, lower levels of beneficial species, and higher levels of harmful bacteria species. As such, when the microbiome experiences changes, it couldalter the body’s immune response and cause it to dysregulate.
Some foods can be a potential trigger for eczema flare-ups if you are sensitive to them. Possible triggers include:
Chronic stress can also cause dysregulation in the body's immune system, gut, and the Inflammation circuit of the NeuroEndoMetabolic stress response. This is often caused by Adrenal Fatigue Syndrome (AFS), which is the non-Addison's form of adrenal dysfunction, where your body's stress response is unable to keep up with life's chronic stressors. Due to an unbalanced inflammation circuit, this stress can trigger inflammatory skin conditions like eczema.
Glucocorticoid (GC)-induced osteoporosis (GCOP) is a secondary osteoporosis and is the primary cause of iatrogenic OP and osteoporosis in adults. Individuals with this condition may experience bone loss with or without other symptoms. Also, its severity may depend on the dosage and duration of the topical GC therapy.
It doesn't have to take long for this kind of osteoporosis to develop after you begin taking topical corticosteroids. It’s helpful to measure bone density levels and also monitor them regularly, to begin with. If you do not, you may suffer fractures before you realize what happening.
As helpful as these steroids can be, topical corticosteroids tend to not only reduce your body's ability to absorb calcium but also its ability to increase how quickly bone is broken down. The more of these steroids you take, and the longer you are on them, you heighten your risk of developing osteoporosis.
Once you start taking topical corticosteroids, there is a risk of GCOP. It’s best to use the minimal effective dose. In addition, alternate-day therapy has not been shown to accelerate bone loss in adults and may prevent growth retardation in children, though not bone loss according to research. Still, the outcome may depend on the type of corticosteroid you take.
Calcium is a basic building block of bones and getting the optimal amount is necessary to prevent osteoporosis. Research suggests that a daily dose of 1,500 mg of calcium can effectively prevent negative calcium balance. However, the current Recommended Dietary Allowance (RDA) is 1000 mg of calcium for younger adults and 1200 mg for individuals over the age of 50. Still, these numbers are in line with a diet that is high in fat and protein.
Furthermore, you must have it with boron, strontium, magnesium, and other minerals to help balance calcium absorption into the bones and prevent plaque buildup in arteries. Magnesium, for example, acts as a balancer of calcium in our body, keeping it from being excreted. Also, vitamin D maintains normal blood levels of calcium, while strontium adds strength to the calcium and draws extra calcium into the bones.
These exercises involve your feet and legs supporting your weight, creating force through your skeleton. Weight-bearing aerobic activities, for instance, involve performing aerobic exercise on your feet, with your bones supporting your weight. Research has shown that weight-bearing exercise can aid in slowing down bone loss and build bone as well.
Some examples of these kinds of exercises include:
Weight-bearing exercise, in part, works directly to impact the bones in your legs, hips, and lower spine, helping to slow bone loss. They also improve blood flow and are good for the heart.
It is important that correct patient application is followed when using these steroids. This is not only important from a health and safety perspective, but it’s also critical to successful use.
One method of application that a patient may use is the fingertip unit. According to the American Family Physician, this is “the amount of medication dispensed from a standard 5-mm nozzle over a distance from the tip of the index finger to the crease of the distal interphalangeal joint.”
Topical corticosteroid application is usually once or twice a day for up to three weeks for super-high-potency corticosteroids, or up to 12 weeks for high- or medium-potency corticosteroids. With regards to low-potency topical corticosteroid use, there is no specific time limit. The steroid should be applied in a thin layer with clean hands. Always ask your provider before starting topical corticosteroids. The longer you use topical steroids, the more prone to withdrawal reactions you may be.
With correct usage, topical corticosteroids rarely lead to any serious side effects. The most commonly reported side effect is a burning or stinging sensation with application. Other less common side effects may include:
Prolonged use, especially of high-potency corticosteroids over large areas of skin, can lead to systemic side effects, one of which may include adrenal suppression. When corticosteroids are used, they mimic the effects of cortisol, a hormone naturally produced by the adrenal glands. With prolonged external supply of corticosteroids, the adrenal glands may reduce or halt natural cortisol production because the body perceives that there is already enough cortisol present due to the medication.
This diminished adrenal function can lead to adrenal insufficiency when the external steroid source is reduced or stopped abruptly. Adrenal insufficiency is where no cortisol is produced, while adrenal fatigue is where some cortisol might still be produced, but you still get the symptoms of low cortisol. Symptoms of adrenal fatigue include fatigue, muscle weakness, sleeplessness, weight loss, and an inability to handle stress or recover from illnesses effectively.
Therefore, it's essential for individuals using corticosteroids, especially in high doses or for prolonged periods, to do so under strict medical supervision. Healthcare providers usually manage the risk by tapering the dosage gradually to give the adrenal glands time to resume normal cortisol production. Regular monitoring is also crucial to avoid the complications associated with adrenal insufficiency.
Individuals with adrenal fatigue who are sensitive to oral steroids can sometimes use topical corticosteroids as an alternative to kickstart the adrenal function if they are in the adrenal failure phase. Topical corticosteroids typically have less systemic absorption compared to oral steroids, so gentler is better for the adrenals.
A topical corticosteroid is a beneficial tool in treating such skin conditions as eczema. They are available at different strengths and care should be taken to ensure that they are used properly. You increase your risk of adverse effects with prolonged use, using a higher potency, or if it's applied to a large area. Corticosteroid cream can be bought over-the-counter, or with a doctor's prescription. If you have any questions about topical corticosteroid use, be sure to reach out to Dr. Lam's dedicated team at +1 (626) 571-1234 for more information.
For enhanced bone support, resiliency, and vitality
Axon, Emma, et al. "Original Research: Safety of Topical Corticosteroids in Atopic Eczema: an Umbrella Review." BMJ Open, vol. 11, no. 7, 2021, https://doi.org/10.1136/bmjopen-2020-046476. Accessed 28 Mar. 2024.
De Pessemier, Britta, et al. “Gut-Skin Axis: Current Knowledge of the Interrelationship between Microbial Dysbiosis and Skin Conditions.” Microorganisms, vol. 9, no. 2, 2021, doi:10.3390/microorganisms9020353.
Stacey, Stephen K., and Mark McEleney. “Topical Corticosteroids: Choice and Application.” https://pubmed.ncbi.nlm.nih.gov/33719380
A topical corticosteroid is a synthetic (man-made) corticosteroid medication that is used to address skin conditions like eczema. It's available in several applications, like creams, gels, foams, lotions, oils, shampoos, pads, and sprays. Side effects can include worsening skin infection, spreading of the infection, inflamed hair follicles (folliculitis), and thinning of the skin.
