Are Topical Steroid Treatments Right for You?


 Inflammation was so severe that topical steroids were required.


Eczema and psoriasis are difficult skin conditions to manage. There are multiple treatment options including the widely-prescribed "topical steroids" -- glucocorticoid steroid medicines (the anti inflammatory type of steroids) that come in the form of creams, ointments and lotions. These medications work to reduce itching and to control inflammation, thus helping the user maintain a more comfortable quality of life.   


Topical steroids come in different strengths.  Over-the-counter types are available in very mild potencies while prescription steroids from your healthcare provider range from low to very high potency. You and your doctor can discuss whether or not steroids are right for you. 


Which type should I use? 

The rule of thumb is to use solutions, sprays, gels, foams, lotions, creams, ointments, or treatments of any particular consistency or thickness, on areas as they work best for you. Solutions, gels, foams and sprays are more easily applied to hairy areas like the scalp and tend to be less oily than lotions.  Lotions are usually more appropriate for the face and will usually be less potent than a cream or ointment.  Creams are more moisturizing and generally more potent than lotions and finally, ointments are usually the most moisturizing and potent.  Every product is different and not all work the same for every individual, but keep in mind the following:


In order of Oiliness and Potency:   less to more:

gel, solution, foam, spray---lotion---cream---ointment


Are topical steroids safe? 

When used as directed, lower potency steroid applications typically have no side effects. Higher strength treatments are generally safe but are not without side effects especially when used for an extended period of time. Monitoring by your physician is necessary to ensure that the treatments are helpful and are not creating more problems. 


Steroids do not help to improve the skin barrier and have actually been shown to impair the function and cycling of the skin barrier.  This does not mean that topical steroids should never be used, but rather, they should be used to control inflammation and itching and not to improve the function of the skin barrier.  In my practice, I like to prescribe steroids that are compounded by a compounding pharmacist in a skin barrier optimizing base like TrueLipids ®  lotion, cream or ointment so that the effects of the steroid on the skin barrier may possibly be averted.


Milder side effects of topical steroids include: 

  • Stinging or burning feeling. 
  • Thinning of the skin. 
  • Marks on the skin, bruising, skin discoloration, spider veins. 
  • Accelerated hair growth where applied. (I don’t think I’ve ever really seen this in my practice, but it is in the books! :))
  • Skin irritation. 
  • Allergic reaction. (this is actually relatively common especially in people who have chronic eczema; 7% of six year old children and about 12% of sixteen year olds with eczema are allergic to at least one class of glucocorticoids).
  • Steroid “addiction”.  This is something that I DO see in my practice every so often.  This happens most commonly on the face and is manifest as a flaring of the condition when the steroid is stopped.  I like to focus on skin barrier optimization with the TrueLipids lotion or cream when this happens.


It is possible that steroids will be absorbed through the skin and into the body.  This can create a new set of problems such as: 

  • Abnormal growth in children.  (incredibly rare and only when high dose steroids are used for a very long time)
  • Fluid/water retention. 
  • Hypertension. 
  • Bone thinning. 
  • Cushing's syndrome. 


Side effects are relatively uncommon and the positive effects of topical steroid treatments may make it worth trying if nothing else has helped to control your eczema flares.  


Eczema and psoriasis skin ailments cause severe itching, irritation, even pain and using a topical steroid product can do wonders to calm the inflammation associated with these conditions and to help prevent flare-ups, scratching, and infection. 


Medical professionals recommend that you use the weakest strength possible that works to calm your symptoms and to only increase dosages or strengths if recommended by your doctor. Use the treatment for as long as needed, or until you notice a side effect. Never use topical steroids longer than absolutely necessary.