Topical treatment

This term describes any form of medication which contains corticosteroids that are used to treat a range of skin conditions such as eczema, rosacea and psoriasis. These are often referred to as ‘topical steroids’ or steroid creams.

Topical corticosteroids

These are a synthetic version of hormones, e.g. cortisol, which is naturally produced by the body’s adrenal glands. But do not confuse these with anabolic steroids which aid with muscle growth and development.

These are known as ‘topical’ in that they are directly applied to the skin.

How topical corticosteroids work

Corticosteroids are not a cure but they ease the symptoms of skin conditions which is especially useful when you have a flare up. They reduce any swelling and irritation caused by the condition and suppresses an overactive immune system – if required. Plus they are a safe form of treatment with only a small risk of side effects.

Types of topical corticosteroids

There is more than one type of corticosteroid which includes:

  • Creams
  • Ointments
  • Gels
  • Lotions
  • Water or alcohol based solutions

Creams are prescribed for skin which has blistered and is oozing liquid. These are a thicker consistency than lotions or gels.

Ointments are smooth, oil based substances which also makes them greasy. They are ideally suited to dry, itchy, flaky skin.

Gels are thicker, solidified type of substances which are applied to areas of skin which are hairy, for example the scalp.

Lotions are a smooth, thick type of liquid which are used on large areas of infected skin.

Water or alcohol based solutions are colourless fluids which are easy to use and non-greasy but can result in dry skin.

Non-topical corticosteroids

These include tablets (oral corticosteroids), inhalers, sprays and injections.

Tablets are a popular form of oral medication. But these must be taken as per instructions and followed through to the end.

Inhalers/sprays are easy to use and suitable as a long term form of treatment. But there is an increased risk of thrush (oral version).

Injections are administered with care as there is a risk of tissue damage. They are given once every 3 or 6 months. But there are alternatives if these fail to work.

Different strengths of topical corticosteroids

Topical corticosteroids are available in different strengths which range from mild through to very strong.

These are:

  • Mild: an example of this is hydrocortisone which is suitable for conditions such as contact dermatitis.
  • Moderate: a slightly stronger medication, one example being clobetasone butyrate. Useful at treating eczema.
  • Potent (strong): an example of this is betamethasone dipropionate. Used to poorly responding conditions such as psoriasis.
  • Very potent (very strong): Example of this is clobetasone propionate. This is used for unresponsive symptoms or severe flare ups.

We mentioned about a small risk of side effects: these are more likely to occur in strong/very strong types of corticosteroids. But your GP will advise you about these.

Your GP will start you off with a mild corticosteroid but if that fails to work then will progress through the different strengths. The aim is to control your symptoms.

Using a topical corticosteroid

You apply a small amount – no bigger than a fingertip length – to the affected area. Do this once or twice daily but do not exceed this.

If you have a chronic skin condition, e.g. eczema then a mild or moderate topical corticosteroid can be used on a long term basis. But most people only need to use a topical corticosteroid whenever they have a flare up of their symptoms.

Strong (potent) and very strong (very potent) type of topical corticosteroids should only be used for a maximum of 7 days. Do not use them after this timescale. If your condition has not improved then you will be referred to a dermatologist.

Issues when using topical corticosteroids

There are few issues to consider when using corticosteroids which include:

  • Potent and very potent corticosteroids must not be used during pregnancy. There is a similar concern when breastfeeding. Ask your GP for advice.
  • Do not apply topical corticosteroids to parts of the body which are affected by bacteria, yeast or a virus as this will worsen the symptoms.
  • Potent and very potent topical corticosteroids are not advisable for children. They carry a greater risk of side effects in children as compared to adults.

Side effects of topical corticosteroids

These depend upon the strength of the corticosteroid, the extent of your condition, timescale of your treatment and, your age.

The more serious the skin condition the greater the risk of side effects. This risk also applies for chronic conditions, children and the elderly and the area of skin to be treated.

There are 2 types of side effects: local and systemic.

Local side effects include:

  • Burning or stinging feeling on the skin
  • Stretch marks
  • Skin becomes thinner: this more of a risk in older people as their skin tends to be more fragile.
  • Changes the colour of your skin
  • Increased hair growth

Plus these can worsen the symptoms of your condition, e.g. increase the number of spots in an acne outbreak.

Systemic side effects mean those which affect other parts of the body. These include:

  • Lower calcium levels
  • High blood pressure
  • Swelling in the legs caused by a build up of fluid
  • Bone damage
  • Stunted growth – in children

These side effects will be discussed between you and your GP. Follow any instructions given and contact your GP if you experience any adverse effects from topical steroids.