Which topical steroids is the right one for me?
I have previously blogged about Steroid Fear and The do's and don't of using topical steroids in eczema. Before I start on how to choose the right topical steroids, I cannot stress enough that the success of using topical steroids starts from an accurate diagnosis, which means using it in the indicated and right situation.
Common conditions treatable with topical steroids include eczema, psoriasis and lichen planus.
There are many topical steroids in the market. They vary in potencies and preparations. Some even comes in combination with antifungals and antibiotics. Generally combinations of topical steroids and antifungals is not recommended as it may lead to persistent fungal infection.
Preparations (vehicles)
Steroids comes in various preparations, generally the ""heavier" the preparation, the "stronger" the strength of the same steroids it carries. One example is that 1% hydrocortisone ointment is stronger than 1% hydrocortisone cream.
Ointment provides occlusion and enhanced absorption of the steroid that it carries. However, some patients may not like the greasy feeling it leaves on the skin. You may want to avoid using it on skin folds and hairy areas. Best timing to use it will be right after a shower or bath.
Creams is good to hydrate the skin and patients love it because they get absorbed after a while. However, creams do not provide occlusives effect. They often contain preservatives and some people can have allergic contact dermatitis to creams.
Lotions are even less greasy than creams. Lotions contain alcohol. Lotions are good for hairy skin because they can penetrate through the hair easily and do not leave much residue on the hair.
Gels are jelly-like. They are good for acne-prone skin. Typically gels dry up very quickly so even if you apply it on hairy area, it does not give matting of hairs.
Other preparations of medications include foams, mousses, shampoos and powder.
Strength of steroids (potency)
In laboratory, the strength of steroids is assessed based on how much it causes blanching (due to constriction of blood vessels) in normal and healthy people. This does not always translate to how strong a particular steroids' anti-inflammatory effects on a patient. However, generally the strength of clobetasol propionate is higher than betamethasone dipropionate than betamethasone valerate than hydrocortisone.
Lower potency steroids are safer for using in large surface area, longer term, thinner skin area and in children.
Superpotent steroids should not be used on face and under occlusion, unless for a very short duration.
Superpotent steroids such as clobetasol propionate are typically not recommended for continuous use longer than 3 weeks, other steroids are typically not recommended for continuous use longer than 3 months.
Summary
Things to consider when choosing the most suitable topical steroids of the right strength and right preparation include:
You might be interested to read about:
Steroid fear
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Food and Eczema
Color cosmetics and Eczema
Acne and Eczema
Common conditions treatable with topical steroids include eczema, psoriasis and lichen planus.
There are many topical steroids in the market. They vary in potencies and preparations. Some even comes in combination with antifungals and antibiotics. Generally combinations of topical steroids and antifungals is not recommended as it may lead to persistent fungal infection.
Preparations (vehicles)
Steroids comes in various preparations, generally the ""heavier" the preparation, the "stronger" the strength of the same steroids it carries. One example is that 1% hydrocortisone ointment is stronger than 1% hydrocortisone cream.
Ointment provides occlusion and enhanced absorption of the steroid that it carries. However, some patients may not like the greasy feeling it leaves on the skin. You may want to avoid using it on skin folds and hairy areas. Best timing to use it will be right after a shower or bath.
Creams is good to hydrate the skin and patients love it because they get absorbed after a while. However, creams do not provide occlusives effect. They often contain preservatives and some people can have allergic contact dermatitis to creams.
Lotions are even less greasy than creams. Lotions contain alcohol. Lotions are good for hairy skin because they can penetrate through the hair easily and do not leave much residue on the hair.
Gels are jelly-like. They are good for acne-prone skin. Typically gels dry up very quickly so even if you apply it on hairy area, it does not give matting of hairs.
Other preparations of medications include foams, mousses, shampoos and powder.
Strength of steroids (potency)
In laboratory, the strength of steroids is assessed based on how much it causes blanching (due to constriction of blood vessels) in normal and healthy people. This does not always translate to how strong a particular steroids' anti-inflammatory effects on a patient. However, generally the strength of clobetasol propionate is higher than betamethasone dipropionate than betamethasone valerate than hydrocortisone.
Lower potency steroids are safer for using in large surface area, longer term, thinner skin area and in children.
Superpotent steroids should not be used on face and under occlusion, unless for a very short duration.
Superpotent steroids such as clobetasol propionate are typically not recommended for continuous use longer than 3 weeks, other steroids are typically not recommended for continuous use longer than 3 months.
Summary
Things to consider when choosing the most suitable topical steroids of the right strength and right preparation include:
- The diagnosis
- Condition of the skin intended to apply (acne prone? very dry?)
- Site intended to apply (thin skin area? skin folds? hairy area?)
- Surface area intended to apply
- Duration intended to use
- Age (children? elderly?)
- Pregnancy
- Allergy (contact dermatitis to preservatives?)
- Personal preference
You might be interested to read about:
Steroid fear
Do's and Don'ts of Using Topical Steroids
Bathing in Eczema
Food and Eczema
Color cosmetics and Eczema
Acne and Eczema
