Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribedtopical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities.[1] There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price.
For treating atopic dermatitis, newer (second generation) corticosteroids, such as fluticasone propionate and mometasone furoate, are more effective and safer than older ones. They are also generally safe and do not cause skin thinning when used intermittently to treat atopic dermatitis flare-ups. They are also safe when used twice a week for preventing flares (also known as weekend treatment).[6][7][8] Applying once daily is enough as it is as effective as twice or more daily application.[9]
To prevent tachyphylaxis, a topical steroid is often prescribed to be used on a week on, week off routine. Some recommend using the topical steroid for 3 consecutive days on, followed by 4 consecutive days off.[10] Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility.[11]
The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.
Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses.[15] Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days' rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy.
Using topical steroids as intended during pregnancy is safe and does not cause miscarriage, birth defects or any pregnancy-related problems.[17][18][19]
The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching. Class I is the strongest, or superpotent. Class VII is the weakest and mildest.[20]
Class I
Very potent: up to 600 times stronger than hydrocortisone
The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids.[22] When one is allergic to one group, one is allergic to all steroids in that group.
^Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L (December 2023). "Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials". The Journal of Allergy and Clinical Immunology. 152 (6): 1493–1519. doi:10.1016/j.jaci.2023.08.030. hdl:10576/50632. PMID37678572. S2CID261610152.
^Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L (December 2023). "Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials". The Journal of Allergy and Clinical Immunology. 152 (6): 1493–1519. doi:10.1016/j.jaci.2023.08.030. hdl:10576/50632. PMID37678572. S2CID261610152.
^Lebreton, O.; Weber, M. (2011). "Complications ophtalmologiques des corticoïdes systémiques". La Revue de Médecine Interne. 32 (8): 506–512. doi:10.1016/j.revmed.2011.01.003. PMID21330017.
^Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia: W.B. Saunders Company. pp. 562–563. ISBN0-7216-7728-2.
^Wolverton, Stephen E. (2001). Comprehensive Dermatologic Drug Therapy. Philadelphia: W.B. Saunders Company. pp. 562–563. ISBN0-7216-7728-2.
^"Topical Corticosteroids", Mother To Baby | Fact Sheets, Brentwood (TN): Organization of Teratology Information Specialists, April 2022, PMID35952259, retrieved 2024-07-29
^Habif, Thomas P. (1990). Clinical dermatology: a color guide to diagnosis and therapy (2nd ed.). St. Louis: Mosby. p. Inside front cover. ISBN0-8016-2465-7.