Appropriate Use of Topical Steroids -National Eczema Association (US)

Updated: Oct 6, 2018


Topical corticosteroids, or topical steroids, have been used in treating eczema and atopic dermatitis for more than 50 years and remain among the most effective and widely used drugs in dermatology. They work directly with the natural system in the body to reduce inflammation, and are closely related to corticosteroids made daily by the adrenal glands.


In the United States, topical corticosteroids are classified by potency levels from 1 (highest) to 7 (lowest). Topical steroids are well absorbed through thin skin areas such as face, neck, and groin and more poorly through thick skin such as that found on the hands and feet. Occluding the skin with compresses, wet wraps, or bandages for example, may increase the absorption of topical corticosteroids. Children may be more susceptible to increased topical corticosteroid absorption from equivalent doses due to their larger skin surface-to-body mass ratios.


According to treatment guidelines recently developed in Europe, Asia, and the United States, topical corticosteroid remain the mainstay of treatment for adults and children with atopic dermatitis, even in severe cases in which they may be used in combination with systemic therapies. Topical corticosteroids are recommended when patients have failed to respond to a consistent eczema skin care regimen, including the regular use of moisturizers (emollients), appropriate anti-bacterial measures, and trying to eliminate any possible allergens that may be contributing to the underlying problem.


Do not use daily TCS continuously for more than two to four weeks - then the frequency should be tapered to twice weekly use.


Your provider should strive to help create a safe and effective long-term treatment plan that does not include daily use of topical corticosteroids, especially on more sensitive areas. Close follow up and careful monitoring with good communication will help ensure this. Do not ask for multiple refills without evaluation or questioning the usage pattern. Side effects are rarely reported with low to mid-potency topical corticosteroids. According to the report, topical corticosteroid withdrawal syndrome generally occurs after inappropriate, prolonged frequent use of high-potency topical corticosteroids. Concern for this side effect should not prevent the appropriate management of patients with chronic inflammatory skin disease. As with all medications, steroids are associated with some risk. However, the potential benefits with use of topical steroids far outweigh the risks of side effects, including steroid withdrawal when used appropriately.




National Eczema Association (US)

https://nationaleczema.org/





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