The Dermatology Practice.

#topicalsteroids #eczema #psoriasis

Topical steroids, also known as topical corticosteroids, are a class of medications widely used to treat various skin conditions. They are available in different potencies and formulations, including creams, ointments, lotions, and gels. In this article, we will discuss the indications, potency, and side effects of topical steroids, as well as alternative treatments like topical calcineurin inhibitors and PDE4 inhibitors.

Indications for Topical Steroids

Topical steroids are commonly used to treat a range of skin conditions, including:

  1. Atopic dermatitis (eczema): Topical steroids are often used to reduce inflammation and itching associated with eczema
  2. Psoriasis: Topical steroids can help reduce inflammation and slow down skin cell growth in psoriasis
  3. Contact dermatitis: Topical steroids can help reduce inflammation and itching caused by skin allergies or irritants
  4. Seborrheic dermatitis: Topical steroids can help reduce inflammation and flaking associated with seborrheic dermatitis. Sometimes, having an added anti fungal coverage may have a synergistic effect
  5. Skin allergies: Topical steroids can help reduce inflammation and itching caused by skin allergies

Potency of Topical Steroids

Topical steroids are classified into seven potency categories, ranging from Class I (superpotent) to Class VII (least potent). The potency of a topical steroid is determined by its ability to suppress inflammation and immune responses. Superpotent and potent steroids should be used under clear direction from healthcare professionals. Do note that the consistency e.g. lotions, ointments do have an effect on the potency of the steroids.

  1. Class I (superpotent): Examples include clobetasol propionate
  2. Class II (potent)
  3. Class III (upper mid-strength)
  4. Class IV (mid-strength): Examples include betamethasone valerate and triamcinolone acetonide
  5. Class V (lower mid-strength)
  6. Class VI (mild): Examples include hydrocortisone acetate and desonide
  7. Class VII (least potent): Examples include hydrocortisone

Side Effects of Topical Steroids

While topical steroids are generally safe and effective, they can cause side effects, especially with prolonged use or high-potency formulations. Common side effects include:

  1. Skin thinning (atrophy)
  2. Stretch marks (striae)
  3. Rosacea-like symptoms
  4. Acne-like symptoms
  5. Folliculitis
  6. Hypopigmentation
  7. Hypertrichosis

Topical Calcineurin Inhibitors

Topical calcineurin inhibitors are a class of medications that can be used as an alternative to topical steroids. They work by inhibiting the activity of calcineurin, a protein that plays a key role in the immune response. Examples of topical calcineurin inhibitors include:

  1. Tacrolimus
  2. Pimecrolimus

Topical calcineurin inhibitors are commonly used to treat atopic dermatitis, psoriasis, and vitiligo. They are generally well-tolerated and can be used for prolonged periods without the risk of skin thinning or other side effects associated with topical steroids.
Nonetheless, they may cause skin irritation on initial use, where patients report a ‘burning’ sensation.

Topical PDE4 Inhibitors

Topical PDE4 inhibitors are a new class of medications that have been approved for the treatment of atopic dermatitis. They work by inhibiting the activity of phosphodiesterase 4 (PDE4), an enzyme that plays a key role in the inflammatory response. Examples of topical PDE4 inhibitors include:

  1. Crisaborole

Topical PDE4 inhibitors have been shown to be effective in reducing inflammation and itching associated with atopic dermatitis. Similar to topical calcineurin inhibitors, they may elicit a skin reaction or sensation on initial use.

Conclusion

Topical steroids are a widely used treatment for various skin conditions, including atopic dermatitis, psoriasis, and contact dermatitis. However, there needs to be a balance in its duration of use and strict monitoring. Other topical anti inflammatories can be useful adjuncts in the appropriate context. Always speak to your healthcare provider and be judicious in their use!

References

  1. National Eczema Association. (2020). Topical Corticosteroids.
  2. British Journal of Dermatology. (2018). Topical corticosteroids: A systematic review.
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