How to Use Topical Steroids

Maximize Results, Minimize Side Effects

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Topical steroids are effective in treating many inflammatory skin conditions, including atopic dermatitis, psoriasis, seborrhea and contact dermatitis. Though their track record is impressive, it's important to know they have significant side effects. These guidelines will help you get the most out of using a topical steroid while minimizing the risk of side effects.

Topical Steroid Application

Topical steroid creams and ointments should be applied in a thin layer and massaged into the affected area one to four times a day.

For most skin conditions, this regimen should continue until the rash resolves. Chronic skin conditions that wax and wane, such as psoriasis or eczema, benefit from the intermittent application of a topical steroid to prevent recurrences. Because topical steroids can cause side effects, the spacing of intermittent applications should be discussed with a health care provider before proceeding.

The Strength of Topical Steroids

Different surfaces of the skin absorb topical steroids differently. Therefore the strength of the steroid should correspond to the type of skin where it is to be applied. The greater the steroid group number, the greater the risk of side effects. The skin on the eyelids and face is thin and absorbs topical steroids rapidly. A group VI or VII steroid should be applied in these sensitive areas.

Skin on the palms of the hands and soles of the feet is tough and thick. It acts as a barrier than makes it more difficult for topical steroids to penetrate, so a more potent steroid is necessary.

Parts of the body where skin touches skin - the groin, rectal area, armpits - absorb topical steroids rapidly, requiring a low-potency steroid. Infants and young children have skin that absorbs topical steroids more readily, also requiring a low-potency steroid.

Topical Steroids Under Occlusion

A topical steroid can be absorbed into the skin more quickly through a process known as occlusion.

Occlusion involves applying the topical steroid to the affected area and wrapping it in plastic wrap or cloth and securing it with tape. The plastic wrap keeps perspiration close to the skin and hydrates the stratum corneum, the top layer of the epidermis. Hydrated skin is able to absorb topical medication much more efficiently than dry skin, providing faster relief.

Occlusion dressings need to be left on for at least 2 hours at a time. Because of this, they are usually applied at bedtime. The occlusion method should only be used under the care of a health care provider since it significantly increases the potency of a topical steroid. Because occlusion promotes a moist environment, it increases the risk of developing bacterial infections and should not be utilized more than 3 days in a row.

Intermittent Dosing of Topical Steroids

A common side effect of topical steroid treatment is tachyphylaxis. Tachyphylaxis is essentially a tolerance to the vasoconstrictive action of a steroid. It is the rapid decrease in response to a topical steroid following its initial use.

After repeated use of topical steroids, capillaries in the skin do not constrict as well, requiring higher doses and more frequent application.

It is sometimes more useful to apply topical steroids in intermittent doses. If a topical steroid loses its effectiveness, it should be discontinued for 4 to 7 days, and then restarted.

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