People are often wary of steroid use. This is because we have heard a lot of news and experiences about side effects in the past, but I think that the use of steroids is necessary to treat severe eczema. However, we need to know better about ways to reduce side effects. I believe that dermatologists give the right prescription for eczema patients with this knowledge. However, the patients or the children's parents must also know this knowledge and use it correctly to reduce side effects. Steroid treatment, specifically topical corticosteroids, are a common and effective way to manage eczema flare-ups. First, let’s learn about the effects, types, and side effects.
Effects:
Topical corticosteroids work by reducing inflammation and itching associated with eczema. They can significantly improve the comfort and appearance of the affected skin.
Types:
There are over 30 topical steroids for the treatment of eczema. There are significant differences between them in terms of intensity of effect (efficacy). Generally, they can be divided into four groups according to their efficacy.
Low-efficacy: hydrocortisone and prednisolone
Moderate-efficacy: prednicarbate, methylprednisolone and triamcinolone.
High-efficacy: betamethasone and mometasone.
Ultra-high-efficacy: clobetasol
Side Effects:
While topical corticosteroids are generally safe when used as directed, there can be some side effects, especially with prolonged use. These can include:
Thinning of the skin
Increased risk of skin infections
Stretch marks
Changes in skin color
Tolerance:
With long-term use, the skin can develop a tolerance to topical corticosteroids, meaning they become less effective over time. This is why it's important to use them for short periods and only as directed by your doctor.
Rebound Symptoms:
When stopping topical corticosteroids abruptly, especially after long-term use, you may experience rebound symptoms. These can include a worsening of eczema flare-ups and may even be more severe than the original condition. To avoid this, it's important to taper off the medication gradually under your doctor's supervision.
While you can't completely eliminate the possibility of side effects from topical corticosteroids used for eczema, there are ways to minimize the risk and manage them effectively:
Correct Usage:
This is the key principle. Follow your doctor's instructions precisely regarding dosage and duration. Don't use the medication more frequently or for longer than prescribed.
(Information from https://www.ncbi.nlm.nih.gov/books/NBK424899/)
Start Low, Go Slow:
Whenever possible, doctors will prescribe the lowest potency steroid effective for your needs. This reduces the risk of side effects.
Target Specific Areas:
Apply the medication only to the affected areas of eczema, not healthy surrounding skin. This minimizes the amount of steroid absorbed by your body.
Apply Correctly:
Follow application instructions carefully. A thin layer is sufficient. Rub it gently into the skin without overdoing it.
Moisturize Alongside:
Regularly using fragrance-free emollients helps strengthen the skin barrier, making it less susceptible to the thinning effects of steroids.
Communicate with Doctor:
Report any side effects you experience to your doctor. They may adjust the medication or recommend alternative treatments.
Consider Alternatives:
For mild eczema flare-ups, discuss non-steroidal options with your doctor. These might include ointments with calcineurin inhibitors or coal tar.
Gradual Tapering:
When your eczema improves and you're nearing the end of the prescribed treatment period, talk to your doctor about tapering off gradually. This helps prevent rebound symptoms.
Reference
2. Ulf Darsow, Andreas Wollenberg, Dagmar Simon, Alain Taïeb, Thomas Werfel, Arnold Oranje, Carlo Gelmetti, Ake Svensson, Mette Deleuran, Anne-Marie Calza, Francesca Giusti, Jann Lübbe, Stefania Seidenari, and Johannes Ring, the European Task Force on Atopic Dermatitis / EADV Eczema Task Force. Difficult to control atopic dermatitis. World Allergy Organ J. 2013; 6(1): 6.
3. Cochrane Skin Group, Stephanie J Lax,corresponding author Jane Harvey, Emma Axon, Laura Howells, Miriam Santer, Matthew J Ridd, Sandra Lawton, Sinéad Langan, Amanda Roberts, Amina Ahmed, Ingrid Muller, Long Chiau Ming, Saumya Panda, Pavel Chernyshov, Ben Carter, Hywel C Williams, Kim S Thomas, and Joanne R Chalmers. Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database Syst Rev. 2022; 2022(3): CD013356.
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