Topical steroids are effective for many inflammatory skin conditions such as atopic dermatitis, psoriasis, seborrhea, and contact dermatitis, but they can have significant side effects. Below are some guidelines to help you get the most benefit from using a topical steroid while minimizing the risk of the side effects.
Application of Topical Steroids
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 be continued until the rash resolves. Some chronic skin conditions that wax and wane such as psoriasis
benefit from intermittent application of a topical steroid to prevent recurrences. The spacing of this intermittent application should be discussed with a health-care provider since repeated use of topical steroids can cause side effects.
Topical Steroid Strengths
Various skin surfaces absorb topical steroids differently; therefore, the steroid strength
should correspond to the type of skin. The thin skin of the eyelids and face absorb topical steroids rapidly; therefore a group VI or VII steroid should be used in these areas. Any of the higher groups significantly increase the risk of side effects. On the other hand, the thicker skin on the palms and soles provide a greater barrier to penetration of topical steroids and require a higher potency steroid. Areas where skin touches skin such as the groin, rectal area, and armpits absorb topical steroids rapidly requiring a lower potency steroid. The skin of infants and young children absorb topical steroids more readily, also requiring a lower potency steroid.
Topical Steroids Under Occlusion
Applying a topical steroid to the skin and then occluding it with a plastic dressing enhances the absorption of the steroid. The plastic dressing holds perspiration close to the skin, hydrating the top layer of the epidermis
, the stratum corneum
. Topical medications are absorbed into a moist stratum corneum 10-100 times more efficiently than with dry skin. A common method of occlusion is to apply plastic wrap to the affected area and secure it on all sides with tape. Occlusion should be used only under the advice of a health-care provider since it significantly increases the potency of the topical steroid. Occlusive dressings should be left on for at least 2 hours and often are applied at bedtime so as not to interfere with daytime activities. Because occluded areas remain moist, they are at risk of developing bacterial infections. In general, occlusion therapy should not be used for more than 3 days in a row.
Intermittent Dosing of Topical Steroids
Because a common side effect of topical steroid therapy is tachyphylaxis
, or tolerance to the vasoconstrictive action of the steroid, it is sometimes more useful to apply topical steroids in pulse doses. If a topical steroid looses its effectiveness, it should be discontinued for 4-7 days, and then restarted.