What do steroid creams do, and how do they work?
If you have itchy, red, or inflamed skin from a condition such as eczema or psoriasis, your doctor might prescribe a topical corticosteroid cream. These creams are stronger versions of the hydrocortisone cream you can buy over the counter to battle, say, itchy mosquito bites.
Rubbing these steroid creams on your skin can help relieve irritation and swelling. Yet many people are concerned about the side effects.
In fact, research finds that corticosteroid phobia is common because of concerns about side effects, addiction, and withdrawal. But when used correctly, they can be an effective treatment for your skin condition.
How do corticosteroid creams work?
When your immune system identifies an intruder, such as a virus, your body’s defense system goes on the offense. It sends out inflammatory cells that attack invaders and heal damaged tissue.
But sometimes, our bodies mistakenly attack their own tissue. That can happen in autoimmune conditions such as psoriasis. Other times, the body can be overly sensitive to allergens. Genetic and environmental factors can both play a role. That can often be the case with eczema.
That’s where topical steroids come in.
Steroid creams stop some of the body’s signals that lead to inflammation. They also narrow the blood vessels in the inner layer of your skin, which reduces swelling.
It’s important to remember that corticosteroid creams will not cure your condition. Neither eczema nor psoriasis is currently curable. But steroid creams can help you manage your symptoms and reduce the severity of flare-ups. They can be used in combination with other treatment options like systemic medications.
How are they different from other steroids?
When you hear the word “steroid,” you might immediately think about the kind that professional athletes are not permitted to use. Those are anabolic steroids, which work very differently from corticosteroids.
In general, steroids change how the body processes hormones. Anabolic steroids are synthetic versions of the hormone testosterone, which builds up body tissue. But corticosteroids fight inflammation.
Are all corticosteroid creams the same?
Corticosteroid creams come in different strengths, ranging from very mild to very potent. Some milder ones are available over the counter, while the strongest ones require a doctor or a dermatologist to prescribe them.
Hydrocortisone cream is an example of a product that is available both over the counter (OTC) and by prescription, depending on the strength.
The strongest topical steroid is 600–1,000 times stronger than an OTC hydrocortisone cream, according to the American Osteopathic College of Dermatology. The strength that a doctor prescribes will depend on the type and severity of your condition.
How long do corticosteroids take to work?
How long they take to work depends on you, your condition, and where on the body you’re applying the cream. Most healthcare professionals will recommend trying the cream for a few days to see if it helps. If not, they will likely recommend something else.
For example, if hydrocortisone cream is not working after a few days, a doctor might recommend a higher potency prescription option.
Treatment generally shouldn’t last for longer than 4 weeks at a time, regardless of the potency of the corticosteroid. Very high-potency steroids should be tapered after 2 weeks to help avoid topical steroid withdrawal.
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Do corticosteroids have side effects?
The simple answer is yes. The more serious side effects typically come after long-term use. That’s why steroid creams are not meant to be used long term.
Side effects from topical steroids can include:
- Burning on areas of irritated or broken skin: Irritated skin is common in conditions like eczema. Topical steroids might cause a burning sensation.
- Acne: Acne can be more of a concern if the topical steroid is used on the face.
- Change in skin color: This can be either a deepening of color or loss of skin color.
- Eye problems such as glaucoma: This is especially true when steroid creams are used near the eyes.
- Skin atrophy. This is when the skin starts breaking down and thinning.
Although topical steroid side effects are typically only located in the places you use the cream, long-term use or misuse can cause some systemic (widespread) side effects by affecting your adrenal gland.
The side effects that improper or extended use can cause are typically why people decide not to use topical steroids.
It’s important to note that carefully following the medication directions on how to use the cream under the supervision of a healthcare professional can help you avoid serious side effects and withdrawal symptoms.
Typically, you do not need to stop taking corticosteroids long term. Generally, after taking a short course of topical corticosteroid treatment, doctors will often recommend a short break, usually around 2–4 weeks, before starting treatment again.
Understanding how corticosteroids work, following the instructions on how to use them, and sticking to the treatment plan your healthcare professional prescribes, can help you find much-needed relief and lessen your concerns.
Examples of topical steroids
There are a variety of different topical corticosteroids that a doctor might prescribe. These include:
- betamethasone (Sernivo)
- dexamethasone (Decadron)
- fluocinonide (Vanos)
- hydrocortisone (Cortef)
- prednisone (Prelone)
- triamcinolone (Trivaris)
Most of these are available in different strengths. A healthcare professional like a doctor or dermatologist will be able to prescribe an option that works for you.
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Topical corticosteroids are medicated creams that are commonly prescribed to treat skin conditions like eczema or psoriasis. But a lot of people are wary of using them due to the side effects.
When used correctly, steroid creams can fight the inflammation that’s linked with different skin conditions and can help reduce flare-ups. The most severe side effects are likely to occur when you use the creams long term, so doctors usually advise you only to use them for a few weeks at a time or take breaks during the treatment window.
There are many different types and strengths of corticosteroid creams. You can speak with a doctor about your condition and specific needs and work together to find a treatment that works for you.
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- Ballard A. (2022). Topical steroid withdrawal: What the eczema community needs to know, now. https://nationaleczema.org/blog/tsw-need-to-know/
- Gabros S, et al. (2023). Topical corticosteroids. https://www.ncbi.nlm.nih.gov/books/NBK532940/
- Nemeth V, et al. (2022). Eczema. https://www.ncbi.nlm.nih.gov/books/NBK538209/
- Steroids (topical). (n.d.). https://www.aocd.org/page/SteroidsTopical
- Tan S, et al. (2022). Qualitative analysis of topical corticosteroid concerns, topical steroid addiction, and withdrawal in dermatological patients. https://bmjopen.bmj.com/content/bmjopen/12/3/e060867.full.pdf
- Topical steroids. (n.d.). https://eczema.org/information-and-advice/treatments-for-eczema/topical-corticosteroids/