Topical Steroids

What are topical steroids?

Steroids (also known as cortisone or corticosteroids) are hormones that occur naturally in the body. Steroid medicines are man-made and are similar to the natural hormones made in the body. The type of steroids used to treat disease are called corticosteroids. They are different to the anabolic steroids which some athletes and bodybuilders use. Anabolic steroids have very different effects.

Topical steroids available in the UK include: alclometasone, betamethasone, budesonide, clobetasone, diflucortolone, fluocinolone, fluticasone, fludroxycortide, hydrocortisone, mometasone, and prednisolone.

They come in various different brand names. Topical steroids are available as creams, ointments, lotions, suppositories, drops for the eyes nose and ears, sprays for the nose and inhalers for the lungs. Some topical steroid preparations are also combined with other medicines such as antibacterial and antifungal medicines.

Topical steroids mainly work by reducing inflammation in the part of the body they are applied to. They also work by:

  • Suppressing the body’s immune system.
  • Blocking DNA from being made.
  • Blocking a chemical called histamine which is released during an allergic reaction.

This leaflet gives an overview of topical steroids, including their main possible side-effects as well as other important information if you use topical steroids. There are separate leaflets called Topical Steroids for Eczema and Fingertip Units for Topical Steroids.

What types of topical steroids are there?

There are many types and brands of topical steroid. However, they are generally grouped into four categories depending on their strength – mild, moderately potent, potent and very potent. There are various brands and types in each category. For example, hydrocortisone cream 1% is a commonly used steroid cream and is classed as a mild topical steroid. The greater the strength (potency), the more effect it has on reducing inflammation but the greater the risk of side-effects with continued use.

When are topical steroids prescribed?

Topical steroids are prescribed to treat a large number of conditions. Some examples include conditions that affect the:

  • Skin, such as eczema, contact dermatitis, and psoriasis.
  • Nose, such as allergic rhinitis (blocked, itchy, and runny nose), nasal polyps (non-cancerous swellings that grow inside the nose or sinuses), and hay fever.
  • Lungs, such as asthma, and chronic obstructive pulmonary disease (COPD) – in which airflow to the lungs is restricted.
  • Eyes, such as inflammation of the eye that may occur after you have eye surgery, an injury to the eye or an allergy affecting the eye.
  • Ear, such as otitis externa (inflammation of the ear canal).
  • Gut, such as inflammation of the gut cause by ulcerative colitis, Crohn’s disease, and proctitis (inflammation of the rectum).

Which topical steroid is usually prescribed?

Which strength of topical steroid is prescribed depends upon the condition being treated, and how severe the condition is. For example, if you have severe psoriasis, your doctor may prescribe a more potent steroid such as betamethasone. But, if you have mild dermatitis or psoriasis on your face, a weaker topical steroid is usually prescribed – for example, hydrocortisone 1%.

Topical steroid creams that also contain an antifungal medicine are sometimes prescribed if you have a fungal infection as well as inflammation. Steroid creams that contain an antibacterial medicine may be prescribed if you have a bacterial infection of the skin as well as inflammation.

If you have asthma it is thought that all the inhaled steroids are as effective as one another. This is also the case for topical steroid nasal sprays used for hay fever. Your doctor, nurse or pharmacist will discuss which type of inhaled steroid or steroid spray is best for you.

Creams are usually best to treat moist or weeping areas of skin. Ointments are usually best to treat areas of skin which are dry or thickened. Lotions may be useful to treat hairy areas such as the scalp.

How often are topical steroids usually applied?

How often topical steroids are applied will depend upon the condition you have and how severe it is. For most conditions, topical steroids are normally applied or used once or twice a day. For example, people who have eczema or psoriasis usually apply their steroid creams or ointments once or twice a day; people with asthma typically use their steroid inhaler twice a day.

Some topical steroids can be applied more often. For example, dexamethasone eye drops are usually applied 4-6 times a day if you have inflammation of the eye.

For more information see the leaflet that comes with your medicine.

What is the usual length of treatment?

Most doctors prefer to prescribe topical steroids for as short a period of time as possible, in particular, those applied to the skin. This is because topical steroids can have a number of side-effects. However, the length of treatment normally depends on the condition being treated and how severe the condition is. Some people need to use topical steroids in the long term (for example, steroid inhalers used for asthma or COPD). Other people may only need to use them for a week or so (for example, for mild dermatitis). Some people need to use them for months (for example, a cream for psoriasis or a spray for hay fever).

Stopping topical corticosteroids

If you use a potent topical steroid for a long period of time you will usually need to reduce the amount you use over a period of weeks and then stop. For example, if you have been using a potent steroid cream to treat psoriasis. This is because when it is stopped suddenly your condition may come back quickly. If topical steroids have only been used for a short time they can usually be stopped abruptly.

Can you buy topical corticosteroids?

You can buy some topical corticosteroids. For example, for dermatitis, you can buy the steroid cream called hydrocortisone 1% from your pharmacy. Do not apply this to your face unless your doctor has told you to do so. This is because it may trigger acne or rosacea (a skin condition affecting the face). You can also buy some steroid nasal sprays to treat hay fever – for example, beclometasone nasal spray and fluticasone nasal spray.

What are the side-effects of topical steroids?

Most people who use topical steroids have no side effects, or very few. How likely you are to have side-effects depends on how long you use the medicine for, how much is used or applied, and how potent the steroid is.

It is not possible to list all the side-effects here, but listed below are some of the more common and important ones. For a full list of side-effects see the leaflet that comes with your medicine.

  • Creams and ointments – burning and stinging may occur in the first two days but usually get better after this. Other side-effects that have been reported include: thinning of the skin, permanent stretch marks, allergic contact dermatitis, acne, rosacea, and hair growth at the site of application. However, the more serious of these would normally only affect you if you use a potent or very potent steroid cream or ointment for long periods.
  • Nasal sprays and drops – dryness and irritation of the nose, as well as nosebleeds have been reported. You may have to stop your nasal spray for a while if any of these occur. Other side-effects include: reddening of the skin, rash, itching, and headache. Some people have reported that their sense of smell and taste is disturbed after using a nasal steroids.
  • Eye drops – increased pressure inside the eye, cataracts, and blurred vision have been reported. Blurred vision clears very quickly after using an eye drop. People using steroid eye drops are also more likely to have eye infections and inflammation.
  • Inhalers – oral thrush, sore mouth, and hoarseness (especially with high doses) have been reported. In addition, wheezing after using an inhaled steroid can occur but this is very rare and usually mild. If wheezing is severe, the steroid should be stopped and you should speak to your doctor.

Some topical steroid gets through the skin and into the bloodstream. The amount is usually small and usually causes no problems unless strong topical steroids are used regularly on large areas of the skin. The main concern is with children who need frequent courses of strong topical steroids. The steroid can have an effect on growth. Therefore, children who need repeated courses of strong topical steroids should have their growth monitored.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme.

You can report side-effects that:

  • Are not discussed in the leaflet that came with your medicine.
  • Cause problems that interfere with your everyday activities.
  • Happen if you take more than one medicine.

You can do this online at the following web address: http://yellowcard.mhra.gov.uk

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that your medicines may have caused. If you wish to report a side-effect you will need to provide basic information about:

  • The side-effect.
  • The name of the medicine which you think caused it.
  • Information about the person who had the side-effect.
  • Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.

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