If you have eczema, the chances are that you’ve been prescribed steroid cream along the way. Maybe you have used it and maybe you haven’t. Maybe you’re reading this to get a little more information before you step into the world of topical steroid creams.
Well, I’m glad you’ve found this article, because there’s a lot about steroid creams that isn’t spoken about in the doctor’s office.
Topical steroid creams work by reducing inflammatory responses. The exact mechanism of action is actually still unknown, believe it or not! But generally, when you throw steroids on anything, redness and inflammation reduces.
Steroid creams are addictive for those that suffer with eczema, because they are so efficient in how they work, and I completely understand how blissful it is to go without itchy and red skin for a few days while the steroid creams do their job.
But, the more people I treat in the clinic with eczema, the more I realise how little they know about steroid creams, which is something I am passionate about changing, considering the long-term effects these creams can have.
Things I wish everyone knew about steroid creams:
One
Steroid creams are only effective for so long. They are not an efficient or safe long-term treatment and should only ever be used for short periods to reduce associated side effects.
Two
Steroid creams thin the skin, compromising the structure and function of the skin, and damage skin barrier function; all of which are already compromised in those with eczema.
Three
Considering the damage that steroid creams do to the skin, they should be applied in a very particular way to reduce damage to surrounding skin. It is advisable to wear gloves to protect the hands, and to avoid touching the affected area so that the cream is not translocated to other areas (especially the face!).
Four
Steroid creams increase your risk of fungal and bacterial infections, due to the damage done to the skin and also changes to the microbiome of the skin
Five
Long-term use of steroid cream can cause suppression of the adrenals/HPA axis. This is because our adrenals are supposed to produce cortisol, and when cortisone is applied topically (or internally for that matter), then our adrenals receive feedback that there’s already enough steroid hormone in the body. This means the adrenals reduce their function. Simple tests can reveal if this is a problem (urinary cortisol and ACTH (adrenocorticotrophic releasing hormone)). This is why fatigue is a listed side effect of cortisone medications and creams.
Six
Be aware of the side effects of steroid creams, which include:
Burning
Itching
Irritation
Dryness
Folliculitis (inflammation of the hair follicle - looks like little red spots all over the skin)
Hypertrichosis (excess hair growth due to the increased cortisone)
Acneiform eruptions (similar appearance to acne)
Hypopigmentation (light patches on the skin)
Perioral dermatitis (dermatitis around the mouth)
Allergic contact dermatitis (…seriously so ironic considering it’s used for dermatitis!?)
Maceration of the skin (softening and break down of the skin)
Secondary infection (due to changes to skin function and microbiome)
Skin atrophy (break down of skin tissue)
Striae (indented, reddened streaks on the skin, similar in appearance to stretch marks)
Miliaria (heat rash)
Seven
Withdrawal from long-term steroid cream use is often worse than the eczema or skin problem that it’s been used to treat.
Most eczema sufferers who have found relief from their steroid creams will turn to it each time there is a flare. For some, this is once in a blue moon, but for others this might be several times a week - hence the long-term application of the steroid cream can appear to creep up on them, as they aren’t thinking twice about the frequency of its application.
Depending on the concentration/strength of the steroid cream being used, how frequently it’s being applied and how long it’s been used for, eventually you may end up with three of the following problems:
The cortisone cream isn’t really working anymore, so you have no choice now but to go through withdrawal and the symptoms associated with it
You end up with red, itchy, inflamed skin whenever you don’t use the steroid cream… which is actually less likely to be eczema/dermatitis and more likely to be due to withdrawal from steroid cream
You stop using the steroid cream and will inevitably experience withdrawal symptoms.
Withdrawal symptoms from steroid cream can include:
Burning skin
Itchy skin
Red skin
Increased risk of fungal and bacterial infection
This is a rebound reaction to prolonged steroid cream use, called Red Skin Syndrome, (which is how I first got into treating eczema!). Red Skin Syndrome is an intense and severe reaction to the withdrawal of steroid creams, often more painful and damaging than the original eczema.
Although steroid creams work effectively in reducing redness, itch and the irritation surrounding eczema, the short and long-term effects are quite disturbing and the patient is rarely informed about them.
This is why we avoid the use of steroid creams in the clinic, and opt for natural remedies to reduce itching, redness and irritation that do not carry harmful side effects.
We want to be building and supporting the function and structure of the skin… not tearing it down on a regular basis! This will only leave you with more things to fix in the long run.
Some of our favourite retail available items for topical use for eczema are:
Weleda Rose-Calendula Creme
Moo Goo Eczema Cream
We also make up our own bespoke creams in the clinic, usually favouring beautiful herbs like Calendula, Licorice and Nettle to help soothe the skin.
There is also the fabulous OleoGel by Dermaviduals which helps to mimic the skin barrier function, which is so diminished in those suffering with eczema.
And for those who do not have dairy allergies, we prescribe our special practitioner-only Eczema Relief Cream which has soothing herbs as well as probiotic strains to help improve the skin microbiome.
Another go-to home remedy to reduce the itch is an oat bath - simply put a cup of organic oats into a stocking, tie it up, and pop it in the bath. Beta-glucans from oats can help to reduce itch, and is a quick and simple remedy to use for bubs and adults alike.
So, there are other options when it comes to topical assistance for eczema. Ones that carry far less disturbing side effects and consequences!
Remember, eczema, like many problem skin issues, needs to be treated from the inside out.
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