What Are Topical Corticosteroids?
Topical corticosteroids are a primary treatment for flares of atopic dermatitis (eczema) for individuals whose eczema does not respond to good skincare and the use of moisturizers alone.
Topical steroid strength and potency
Topical corticosteroids come in a range of potencies, from group 1 (the most potent) to group 7 (the least potent). Some milder forms of topical corticosteroids are available over-the-counter, while the stronger forms are only available with a prescription. In general, the potency of the topical corticosteroid is matched to the severity of the disease.
How is the potency chosen?
The location of active lesions also influences the potency of steroid chosen; certain areas of the body, such as the face and skin folds, are treated with lower potency topical steroids given the risk for greater absorption and potential side effects. For people with chronic atopic dermatitis who have lichenified plaques (areas of skin that are thickened and have discoloration), higher potency topical corticosteroids may be needed for longer periods of time.1,2
How do they work?
Corticosteroids also called steroids, are similar to substances that naturally occur in the body. They are different than the steroid compounds that some athletes abuse. Corticosteroids decrease inflammation and reduce the activity of the immune system. In atopic dermatitis and other forms of eczema, the immune system responds abnormally, causing an abundance of chemicals that cause inflammation, redness, and swelling. Corticosteroids reduce the production of the chemicals that cause inflammation. Several studies have shown that in addition to reducing the acute and chronic symptoms of atopic dermatitis, topical corticosteroids also decrease itchiness.2,3
Different preparations of topical steroids
Topical corticosteroids come in different preparations, including ointments, creams, and lotions. The preparation affects the potency of the product. Ointments provide more lubrication and are more potent than cream formulations.
Ointments are occlusives, which contain a high level of lipid (oil) and create a hydrophobic film on the skin. Some people do not like ointments because they feel greasy. Because of their occlusive properties, ointments provide more lubrication and improve the absorption of corticosteroids.
Creams are a mixture of water and oil and are more readily absorbed into the skin. Cream corticosteroids are less potent than ointments of the same strength, and they frequently include preservatives, which may cause irritation to some people.
Lotions and solutions are the least greasy and usually penetrate the skin easily. As the least occlusive preparation, they have the lowest potency and are least moisturizing. Topical corticosteroids in lotions and solutions are usually beneficial for hairy areas of the skin or scalp.1,4
Solutions, foams, and oils
Some topical corticosteroids also come in a solution, foam, or oil form. These are less frequently used and mainly reserved for areas of the body where other preparations may be less tolerable. Several factors are considered when choosing a particular topical corticosteroid for the treatment of atopic dermatitis, including the patient’s age, the areas of the body where the medication will be applied, the degree of xerosis (dry skin), the patient’s preference, and the cost of the medication.2
How often should they be applied?
Topical corticosteroids are generally applied once or twice daily. If topical corticosteroids are used for too long, they may worsen the condition after discontinued use. Prescribers will indicate the proper length of time for use along with a specified amount of time to discontinue the medication before starting use again. In general, prescription corticosteroids should be used daily while acute symptoms are present and discontinued once symptoms have improved. However, in people who have chronic moderate to severe atopic dermatitis, a maintenance regimen of once or twice a week application to skin areas that frequently have relapses can reduce outbreaks.1,2
How much should be applied?
Topical corticosteroids should be used as directed by a doctor or pharmacist. Many doctors recommend an amount equal to the last segment of an adult fingertip for an area equal to two adult palms to control the quantity of medicine applied. For example, a fingertip’s worth of topical corticosteroid could cover a small child’s legs and feet. Children have a higher degree of absorption because of the ratio of their skin to their weight, and care must be taken to avoid using too much medication, which increases the risk of side effects.1,2
Wet-wrap therapy may be used with topical corticosteroids, particularly for individuals with moderate to severe atopic dermatitis. Wet-wrap therapy involves applying the medication and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.2 Only use wet wrap therapy under your doctor's direction. They will be able to instruct you on the proper dosage and frequency of using wet-wrap therapy.
Side effects from topical corticosteroids are generally rare and are more common with higher potencies and doses and prolonged usage. Side effects from topical corticosteroids often resolve after use of the medication has discontinued, although it may take months for side effects to completely disappear. However, some side effects may be permanent. Common side effects with topical corticosteroids include thinning of the skin (atrophy), stretch marks, dilated blood vessels, or lightening or darkening of the skin.2 Consult your doctor or pharmacist for a complete list of side effects for your prescribed medication.