I was interested to see a piece you wrote recently about corticosteroid used in injectable form. I've been prescribed the same drug in a cream for the treatment of dermatitis of the hands. Can you tell me how steroids work when used in this way?
Corticosteroids are related to the hormones produced by the adrenal glands. Topical steroids are often used to treat skin conditions particularly where inflammation is a prominent symptom.
When the skin becomes inflamed as a result of an allergy or irritant, it provokes white blood cells to release substances which dilate the blood vessels. This in turn makes the skin red, hot and swollen.
When steroids are applied to the affected area they are quickly absorbed into the underlying tissue, where they inhibit the action of the substances that have caused the irritation.
This in turn allows the blood vessels to return to normal with a noticeable reduction in the swelling and irritation.
I know you can get side effects from taking steroids orally, but what about creams? What are the possible side effects?
Skin conditions treated with topical steroids usually respond and improve within a couple of days of starting treatment.
When applied sparingly to the skin they rarely cause serious problems.
However, used in high doses or for long periods of time they may cause side effects. Topical corticosteroids can cause drying and thinning of the skin, making the tiny blood vessels close to the surface of the skin more visible.
Long-term use can also weaken the underlying connective tissue of the dermis, leading to an increased susceptibility to stretch marks.
Dark skinned people can suffer a temporary reduction in pigmentation at the site of the steroid application.
As corticosteroids suppress the immune system, they are not usually used alone in the treatment of bacterial or fungal skin infection.
I was told by my doctor not to stop treatment abruptly. Why was this?
When steroids have been used for a period of time and then abruptly discontinued, it can cause erythroderma, a reddening of the skin.
This, however, can be avoided by gradually reducing the amount of steroid cream used over time.