Corticosteroid Fears Can Interfere with Treatment

Atopic dermatitis is typically treated in a multi-faceted way: with good hygiene, emollients, and topical steroids. Yet many people who have, or care for children with atopic dermatitis are afraid to use the corticosteroid creams and ointments that can help soothe uncomfortable symptoms. These creams, in use for more than 50 years, have received a lot of negative media coverage.

According to Dr. Richard Antaya, Director of Pediatric Dermatology at the Yale School of Medicine, steroids have developed a poor reputation because of potential side effects that come with improper or chronic use.¹ But, a lot has been learned in recent years about the use of these corticosteroids and how they can be applied safely with beneficial therapeutic effect.

What are Corticosteroids?

Steroids are chemical compounds naturally produced by the human body. They have a particular molecular structure and are present in some hormones and vitamins. Drug companies also manufacture steroids that are used in different kinds of drugs and hormones. For people with eczema and atopic dermatitis, the most important function they play is in reducing swelling and fighting inflammation.

Atopic dermatitis is a chronic immunologic skin condition that results in dry, itchy and scaly patches on the skin. It can range from mild to severe. It often runs in families and can be an allergic response to something that aggravates the skin’s immune system.

Topical steroid treatments applied at targeted areas on the skin work by interacting with immune cells and individual body chemistry.

Corticosteroids can be manufactured in multiple forms. For atopic dermatitis topical creams and ointments are the most common preparation. However, they also can be taken by mouth or injection for other inflammatory conditions like asthma, arthritis, and irritable bowel disease. The negative stories about side effects can confuse people. They usually relate to long-term systemic use, not for spot treatment with a topical cream or ointment.

What are the side effects of topicals?

Common side effects include:²

• Thinning or thickening of skin at the application site
• Stretch marks
• Change in skin color

Other commonly talked about side effects that are generally related to oral or injectable steroids are:

• Eye changes (glaucoma or cataracts)
• Bone fractures
• Infections
• Puffiness and weight gain

How does fear affect treatment?

Studies show that a high percentage of people who fear the side effects of steroids don’t follow the prescribed treatment regimen for their condition.³ There is limited evidence of harm due to the topical application of corticosteroids. Overuse of topical steroids can develop an increased tolerance or dependence on these topicals. Users can experience painful withdrawal when trying to discontinue use. Others fear that steroid use will affect the growth and development of their children.

Misinformation about corticosteroids bolsters this fear. Incorrect or inaccurate information can come from friends and family, articles in the media, the Internet and any number of other sources. Phobias about using prescribed medications may interfere with effective treatment. This results in a condition that is generally worse than the experience of any side effects.

Talk to the doctor

To be sure you are using creams and ointments effectively, talk to your doctor about specific prescribing information. The instruction inserts for different brands or potencies of medications use different descriptions for application. With a little help from a medical professional, doctor or nurse, you can be clear on how to follow the directions and get the most benefit from treatments.

The risks from short-term, low potency steroids is significantly lower than those from long-term use of high-potency steroids.⁴ If you have specific concerns due to something you have read or heard about, just ask. There are a lot of myths associated with the use of corticosteroids and treatment of atopic dermatitis, especially in children. If you are the caregiver, it can be a dilemma as to whether to apply the creams and ointments to achieve the reduction in itching, swelling, or rash, vs. the fear that you might be doing long-lasting harm to a child.

Remember, long-lasting itching and discomfort can have negative side effects as well. It can interfere with sleep, socialization, and education. Targeted intervention and education can make a difference in compliance and result in more positive treatment outcomes.⁵ A dermatologist can reassure you and monitor the progress of your condition. There are many formulations and medications that can be used in the treatment of atopic dermatitis; it can take a few adjustments to get the right one at the right time.⁶