Close-up of hair on a mans hand

 

What Are Adrenal Glands and What Is Their Function?

There is a little chunk of tissue over each of your kidneys called adrenal glands. Of the adrenal glands’ many functions, one of which is to make the titular adrenaline, another is to make corticosteroids, so named because they are made in your adrenal’s cortex (tissue). Steroids are manufactured by the adrenal to tone down your immune response, to temper it, so it doesn’t go wild, and the first one isolated was cortisone (hydrocortisone), which snagged a Nobel Prize.

 

Topical Steroids

How Do Topical Steroids Work?

Topical steroids work by being absorbed through the skin to its cells and into each nucleus where they affect the synthesis—either positively or negatively—of proteins there. In this way, proteins are manipulated so that inflammatory processes can be inhibited and anti-inflammatory processes enhancedi.

Medicinal Use For Eczema and Psoriasis

Topical steroids are an important stock item in any pharmacy. This is because they are used to treat not only disease—infection, allergies, and autoimmune conditions—but the cosmetic presentations of these as well. Topical steroids—and all steroids—tone down your body’s inflammatory response, which can become exaggerated and interfere with normal functioning. It is hard to concentrate on your job if you’re itching and scratching non-stop. An ugly rash can ruin the loveliest prom dress. Secondary infections from the initial skin condition can complicate any treatment. Examples of a runaway, faulty immune system are eczema, psoriasis, and even sunburn.

How Effective Are Topical Steroids?

The effectiveness of topical preparations is determined by two things, the absorption success and the actual active ingredient.

Absorption

The absorption depends on the volume applied, its concentration, and the skin thickness. (A more concentrated mild steroid may be just as effective as a less concentrated stronger steroid. More volume, that is, the more you slap on an area, adds up—mere arithmetic. Thin skin areas such as eyelids, genitals, and skin creases present a danger of absorption deeper than the skin, getting into you system; thick skin such as your palms or soles may make the milder steroids ineffective.)ii

What Active Ingredient

The second property, the actual ingredient, has an inherent potency. For the sake of comparison, hydrocortisone acetate is the standard unit of comparison. For example, cobetasone butyrate and triamcinolone can be several times—up to 25 times—more potent. Clobetasol proprionate, betamethasone dipropionate , betamehasone valerate, hydrocortisone 17-butyrate, and methylprednisolone can be a hundred to hundreds of times more potent than the acetate of hydrocortisone. See helpful chart at Chrousosiii.

 

Topical Steroid Side Effects

Topical steroids only rarely have side effects, although prolonged use can cause thinning of the skin, bruised appearance, enlarged blood vessels (telangiectasia), chronic dermatitis, and increased hairiness (hirsutism).

Although used to tone down the inflammatory response, this can be a disadvantage in infections where you might lose a potent weapon against it (your own immune system). Sometimes infections (bacterial, fungal, and viral) can go wild while not looking that progressive—until you stop the steroid and get the nasty surprise.

 

Allergies To Creams and Ointments

You can be allergic to the cream or lotion, which seems counterintuitive for a medicine designed to tone down your immune system; more likely will be an allergy to one of the other ingredients, since topical steroids are often bundled with other things, like antibiotics, antifungals, and inert ingredients for its lotion, cream, or gel properties.

 

Cushing Syndrome

Should a person in fact absorb too large an amount of steroid into his or her system by applying large amounts over a long term, it can lead to Cushing Syndrome, the same condition you would have were you overproduce your own steroids. Either way, undesirable effects such as weight gain, stretch marks, fragile and thin skin, easy bruising, delayed healing, and acne can present. Increased facial and body hair, especially in women, can accompany their irregular or absent menstrual periods.

Erectile Dysfunction and Topical Steroids

Men may have a decreased sex drive and fertility and even erectile dysfunction. Fatigue and muscle weakness, mood changes, bone loss, and mental changes can occuriv.

Some FAQs About Topical Steroids

Who Shouldn’t Use Steroids?

It’s not a matter of who shouldn’t, but who should be cautious when using. Topical steroids are very useful medications, but using them on the eyelids can increase the risk of glaucoma and cataracts. Pregnant patients, although topical steroids have been generally proven safe, should avoid applying a lot of it on large areas. Patients with diabetes may find their blood sugars are affected by topical steroids if some of it is absorbed enough for systemic effects.

Most importantly, topical steroids should not be used in the absence of a valid diagnosis. You can’t treat something if you don’t know what it is.

 

Can They Be Mixed With Other Medications?

They often are. It’s called having your cake and eating it, too, for instance, when you can both treat an infection while simultaneously decreasing the pain created by your immune response to it. Antibiotics for bacterial infections or antifungals for fungal infections are common co-ingredients. Compounding pharmacies are very talented at mixing diverse ingredients into a unique gumbo for any complicated skin illness.

 

Are There Alternatives To Topical Steroids?

Yes. NSAIDS (non-steroidal anti-inflammatories) are non-steroid alternatives, given either orally or transdermally (through the skin). The NSAIDs such as ibuprofen (Motrin, Advil), indomethacin (Indocin), celecoxib (Celebrex), naproxen (Aleve, Anaprox, Naprosyn), piroxicam (Feldene), and others can be prepared by a compounding pharmacist in a lotion or cream with a transdermal agent to allow absorption directly into the skinv.

 

Are Topical Steroids Used For Just Cosmetic Reasons?

If so, is this ethical, considering the rare, but possible side effects? Yes. And yes. No discussion about topical steroids is complete without discussing the psychological impact from a skin condition that makes someone feel unattractive. Such a feeling of vulnerability can be devastating, especially to those who are already insecure. Even to those who are secure, there is a breaking point to the stares and under-the-breath comments they must endure. As with any medicine, risk vs. benefit is the mantra when considering using topical steroids. The psychological benefit, however, is not just fluff, narcissism, or vanity. The heartache of standing out in a perceived unattractive way can be severe. And although it is magnified, that doesn’t make the pain any less.

What Are Some Of The Most Popular Topical Steroid Medications?

 

Thank You For Reading!

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Resources

i https://www.ncbi.nlm.nih.gov/pubmed/2533778

ii https://www.dermnetnz.org/topics/topical-steroids/

iii Chrousos G, Pavlaki AN, Magiakou MA (2011). "Glucocorticoid Therapy and Adrenal Suppression". 

iv http://www.mayoclinic.org/diseases-conditions/cushing-syndrome/symptoms-causes/dxc-20197177

v https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2700785/

More Reading

  • Pelt AC (2011). Glucocorticoids: effects, action mechanisms, and therapeutic uses. Hauppauge, N.Y.: Nova Science. 
  • Klein NC, Go CH, Cunha BA (Jun 2001). "Infections associated with steroid use". Infectious Disease Clinics of North America. 15 (2): 423–32, viii.

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