The Pros and Cons of Using Topical Steroids
Topical steroids are the mainstay in treating atopic dermatitis. They have been studied and used in dermatology for over 60 years.1 As with any medicine, there are pros and cons in using topical steroids. As a dermatology provider, my opinion is there are more pros than cons in using topical steroids when used correctly. Communication and follow-ups with a dermatology provider are key to have success with topical steroids.
They are effective at halting a flare in its tracks quickly and reducing itchiness. In general, topical steroids are safe to use for two weeks consistently at a time. They may stop the flare before the 2-week mark; therefore, I typically advise my patients to stop using the topical steroid cream once the flare and itchiness have resolved, even if it is less than 14 days. This reduces the potential side effects of topical steroid cream use.
In addition to treating active atopic dermatitis flares, topical steroids can be used to prevent flare-ups of atopic dermatitis. Also called a "holiday treatment" they can be used two days a week in those with moderate atopic dermatitis to reduce flares.2
Accessibility and functionality
Accessibility and functionality is another pro for topical steroids. There are many topical steroid creams a provider can choose from to prescribe with different potencies. The less potent steroid creams are used for sensitive areas like the face, neck, and groin.1 Both brand and generic topical steroids are safe and effective. There are many generics that are covered under insurance.
There are many vehicles for the delivery of topical steroids: cream, ointment, foam, spray, solution, lotion, tape, etc. This helps for tough areas on the body to apply a topical. For example, a foam or solution based steroid is best for the scalp.1
Steroid topicals are not safe for long term use. As stated earlier, a pulsed duration of 2 weeks is safest. If used for long periods of time, the skin can become thin with stretch marks, telangiectasia, and bruising.1 They can also affect the natural cortisol levels in the body. If used for a prolonged time on the face, the face can break out in an acne-like flare that is difficult to treat.
Topical steroids need to be used in caution around the eyes, and people with a history of increased intraocular pressure or glaucoma should not use them near or on the eyelids.
Resistance and allergies
Sometimes, the skin can build resistance to topical steroids, and they stop working. When topical steroids stop working, other treatment options need to be explored.
Allergic contact dermatitis can occur with topical steroids if a person is allergic to one of its ingredients like propylene glycol or to the topical steroid itself.2 This can be diagnosed by patch testing. This is suspected if a topical steroid is not working for a patient.
Overall, topical steroids are safe and effective when used correctly. Successful treatment outcomes with topical steroids depend on the dermatology provider explaining the above with close follow up, especially when topical steroids are new to the patient and the patient understanding and sharing any concerns.
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