Steroid creams and ointments are an effective method of treating many different inflammatory skin conditions. However they are not suitable to treat inflammation due to infection caused by bacteria and fungi, otherwise the condition may get even worse and more difficult to control.

The function of steroid cream is to suppress the immune system from reacting, whether appropriately or not, but it cannot cure the source leading to the inflammation. When it is stopped, the inflammation will get worse again, unless the source has been removed, for example the metal earring containing nickel.

They are extremely helpful medicine if used properly. Unfortunately, many of the stronger steroid creams were abused and resulted in side effects such as thinning of the skin and prominent stretch marks. This abuse has given topical steroid creams a bad name.

Steroid cream cannot resolve acute or chronic urticaria. It should not be used for the ordinary acne. It should be kept to a minimum when treating rosacea, because of the short lasting effect, with a possible rebound, which is more severe than before. It should not be used on a large area of skin unlimitedly just to reduce itchiness.

In psoriasis, mild to moderate strength steroid cream can be used with good result. However, it is best to avoid using the strongest preparation, because of the possible rebound after a quick short-lived improvement, which can result in the life threatening pustular psoriasis.

Side Effects

If it is used for a prolonged period, particularly the strong preparations on a large area of skin, ultimately it can be absorbed enough into the body system and cause suppression of the body’s own secretion of steroid from the supra-adrenal glands. Due to the feedback mechanism, the pituitary gland in the brain will shrink as well. The absorption is highest in thinnest skin, the skin folds and occluded areas.

Over absorption in the local area may:

• Thin the dermis, and it may not return to normal even after stopping its use
• Produce irreversible white thin atrophic lines
• Stimulate the blood vessels to expand, causing facial flushing, similar to the rosacea symptoms
• Possibly make the skin even more sensitive to irritation
• Cause contact dermatitis, acne, or peri-oral dermatitis
• Lead to loss of melanin and hypo-pigmentation

Method Of Application

They vary in strength from very mild, mild, moderate to strong. Because of the possible side effects, the strong preparation should only be reserved for the most resistant dermatitis not responding to the milder preparations. When treating the face, unless in special circumstances, only the mildest preparation should be used, usually 0.5% - 1% Hydrocortisone. The frequency of applying it should be one to two times a day, more frequent application is usually not necessary.

Extra caution should be exercised when using it on babies and infants, because they are more susceptible to side effects. Having said that, when it is necessary to use it in, for example atopic eczema, over restriction is not warranted, as long as the strong preparations are avoided and is used for only a short time, otherwise the side effects from the disease itself may be even more damaging.

Very often steroid cream can be mixed with other ingredients, such as urea or salicylic acid, which will enhance the absorption and is particularly useful in thickened skin such as the palms, or after chronic inflammation. Antibiotic is useful in cases with coexisting bacterial infection, while it can reduce the itch from fungal infection when used together with anti-fungal cream. Mixed preparations with both antibiotic and anti-fungal are very often used to cover a broader range of skin problems, but this use tends to be abused.

Attention should be paid to the name of the steroid, and also the suffix, as well as other ingredients. The following are some commonly encountered steroids, antibiotic and anti-fungal preparations:

Very Mild to Mild

• Hydrocortisone 0.5% - 1%
• Methylprednisolone acetate 0.25%

Moderate

• Clobetasone butyrate 0.05%
• Mometasone furoate 0.1%

Strong

• Hydrocortisone butyrate 0.1%
• Fluocinolone acetonide 0.025%
• Fluticasone propionate 0.05%
• Beclomethasone dipropionate 0.025%
• Betamethasone valerate 0.1%
• Betamethasone dipropionate 0.1%
• Triamcinolone acetonide 0.1%

Very Strong

• Clobetasol propionate 0.05%
• Halcinonide 0.1%

Antibiotics:

• Clioquinol
• Fusidic acid
• Gentamycin
• Neomycin
• Oxytetracycline

Anti-fungals:

• Clotrimazole
• Econazole
• Miconazole
• Nystatin