Topical Steroid Mythbusters

A lot of people may have reservations about topical steroids based on incorrect information. Read on for common myths on topical steroids and find out why they're not true:

1. MYTH: Topical steroids are absorbed by the body and may potentially cause serious side effects.

High and ultra-potent topical steroids may be absorbed by the body and cause adverse effects like suppression of hypothalamic-pituitary-adrenal (HPA) axis and Cushing's disease. There are also reports of topical steroids causing growth retardation in children. Using topical steroids over large surface areas, under occlusion, and in higher concentrations increase the risk of adverse events in adults and children. There are however, some measures patients can take to avoid things like these from happening. Make sure to follow your doctor's instructions for application of the medication.  Limit the use of topical steroids to short periods and on limited areas only, avoiding areas where skin is thinner (as in the face, groin, and genitals). Lastly, discontinue the use of a topical steroid when your skin does not improve and consult your doctor.

2. MYTH: If you use a good moisturizer, there is no need to use topical steroids to control eczema flares.

One of the underlying problems in eczema is the weakened natural barrier function of the skin. Emollients can help restore the skin in this way. Mild eczema flare ups may respond well to emollients alone. However, patients with moderate to severe flares with very inflamed skin need an anti-inflammatory to calm the skin, reduce the itching and redness.  This is where topical steroids come into play and remain the first-line of care for managing these flare-ups.

3. MYTH: Increasing the frequency and quantity of a topical steroid will lead to faster results.

Topical steroids are applied either once a day or twice a day.  Frequent application does not hasten improvement of rashes and may increase the risk for side effects. Be sure to follow instructions given by your doctor and read the product information before using a topical steroid 

4. MYTH: Topical steroids can cause changes in the body such as increase in lean muscle mass and excessive body hair.

When some patients hear the word "steroid," they think of effects seen with anabolic steroids and the picture that comes to mind is big bulky muscles, hair growth in places where you normally won't expect them to be, etc… Anabolic steroids are totally different from the type of steroids in topical preparations. These side effects are rarely seen with topical steroids.

5. MYTH: Topical steroids can lead to thinning of skin and stretch marks.

Topical steroids inhibit the proliferation of fibroblasts which are cells that produce collagen in the skin. Our skin's elasticity largely depends on collagen.  When this is lost or decreased, our skin loses elasticity and becomes more prone to damage, e.g. thinning, stretch marks, wrinkling, etc…

Potent topical steroids are usually the culprits for these unwanted side effects.  Patients need to know however, that with proper use, these unwanted side effects may be avoided. It is also wise to check the safety profile of potent topical steroids which vary depending on the type that is used.  Some potent topical steroids have a similar safety profile as with a milder topical steroid.