Steroid cream: How does topical treatment 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, a review in JAMA Dermatology found that up to 4 out of 5 people with eczema who were prescribed a topical steroid were afraid to use it. That’s a lot of people missing out on its intended benefit.

So what are topical corticosteroids? And why are people so leery about using them? Read on.

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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 this system isn’t foolproof. 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 non-threatening things such as allergens. That’s the case with eczema, according to the Mayo Clinic. A gene variation makes it hard for skin to protect itself, so it can become easily irritated and inflamed.

That’s where topical steroids come in.

“The steroid cream stops some of the signals in the body that make the inflammation continue,” says Megan Milne, PharmD. She’s a pharmacist in Midvale, Utah, who specializes in helping people taking prednisone, a kind of steroid. “It’s like putting a dam in the stream, blocking the signal from reaching the parts of the body that would release the redness.”

Steroid creams also narrow the blood vessels in the inner layer of your skin, which reduces swelling.

To be clear: Corticosteroids aren’t a cure. They can’t fix the underlying cause of the inflammation. But they can offer some relief.

Related reading: How to tell the differences among eczema, psoriasis and rosacea.

How are they different from, well, steroids?

When you hear the word “steroid,” you might immediately think about the kind that gets professional athletes into trouble. Those are anabolic steroids, which work very differently from corticosteroids.

“The term ‘steroid’ is a group term, kind of like how the word ‘athlete’ represents all people who compete in sports,” Milne says. “Then anabolic is like saying ‘baseball athlete,’ and corticosteroid is like saying ‘swimming athlete.’”

In general, steroids change how the body processes hormones. Anabolic steroids are synthetic versions of the hormone testosterone, which builds up body tissue. Corticosteroids fight inflammation.

Are all corticosteroid creams the same?

Corticosteroid creams come in different strengths, ranging from very mild (hydrocortisone) to very potent (clobetasol). The strongest topical steroid is 600 to 1,000 times stronger than an over-the-counter hydrocortisone cream, according to the American Osteopathic College of Dermatology. The strength that your doctor prescribes will depend on the type and severity of your condition.

Regardless of the strength, steroid creams “start working within 1 day,” says Corinna Bowser, MD. She’s an allergist and immunologist with Suburban Allergy Consultants in the Philadelphia area. “We usually see a reduction of itchiness, redness and inflammation in 1 to 3 days.”

If you don’t see any improvement within the first week, that’s usually a sign the cream won’t work for you, adds Milne. Make sure you keep your doctor updated on your symptoms.

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Do corticosteroids have side effects?

The simple answer is yes. The more serious side effects typically come after months or years of use. That’s why steroid creams are not meant to be used long term, Milne says. Very potent topical corticosteroids are usually prescribed for up to 3 weeks, while medium-strength ones might be prescribed for up to 12 weeks.

Side effects from topical steroids can include:

• Burning on areas of irritated or broken skin. This is more common with steroid lotions, which contain alcohol, says Dr. Bowser.
• Acne. It can be more of a concern if the topical steroid is used on the face.
• Change of skin color. This can be either extra color or loss of skin color. “Worsening redness can be a sign that you’re having a bad reaction to the steroid, so be sure to mention that to your doctor,” Milne says.
• Eye problems such as glaucoma. That’s especially true when steroid creams are used near the eyes, says Dr. Bowser.
• Skin atrophy. “This is when the skin actually starts breaking down, getting thinner. And it can be quite shocking,” Milne says. “I know someone who made the mistake of using a steroid cream as a hand moisturizer and ended up with thin, gray skin on his fingers.”

The side effects from improper or extended use are typically what scares folks away from topical steroids in the first place. But you can avoid such serious side effects by carefully following the directions on how to use the cream, Milne says. And be sure to know when to stop using it. (It’s usually once the rash, itchiness or swelling has cleared.)

When you stick to your treatment plan, your corticosteroid cream can help you find much-needed relief — with a lot less fear.

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