What Are Topical Corticosteroids?

Topical corticosteroids are a primary treatment for flares of atopic dermatitis (AD) for those individuals whose eczema does not respond to good skin care and the use of moisturizers alone. 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.

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 AD 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 topical corticosteroids 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 AD 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 AD, topical corticosteroids also decrease itchiness.2,3

Different preparations of topical corticosteroids

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

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

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

Lotions and gels 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 gels are usually beneficial for hairy areas of the skin or scalp.1,4

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 AD, 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

Dosing

Topical corticosteroids are generally applied once or twice daily. 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 AD, a maintenance regimen of once or twice a week application to areas of skin that frequently have relapses can reduce outbreaks.1,2

Topical corticosteroids should be used as directed by a doctor or pharmacist. To control the quantity of medicine applied, many doctors recommend an amount equal to the last segment of an adult fingertip for an area equal to two adult palms. 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

Wet-wrap therapy may be used with topical corticosteroids, particularly for individuals with moderate to severe AD. 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

Side effects of topical corticosteroids

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

Emily Downward | June 2017
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