WARNING - Read This Before Using Steroid Creams for Eczema

Topical Steroids for Eczema

Topical steroids are external corticosteroid preparations used to reduce inflammation on the skin and also to treat a number of skin diseases.

Corticosteroid is the term used to describe steroid hormones naturally produced in the adrenal cortex as well as the synthetic analogs of these hormones.

In humans, corticosteroids are closely tied to stress hormones as well as the immune system. They are involved in inflammation, protein and carbohydrate metabolism as well as electrolyte balance.

Besides cream, topical steroids are also formulated as lotions, sprays, shampoos, and ointments.

Typically, steroid creams are applied to moist or weeping lesions on the skin; steroid ointments are used on dry, thickened or callused areas of the skin; and lotions and shampoos are usually reserved for the scalp. Besides the skin, topical steroids are also applied to the eye and mucous membranes.

In the treatment of eczema, topical steroids are only recommended to be used for short therapies. Prolonged use of these products can cause serious adverse effects on the skin.

Topical Steroids Therapy: Finding the Right Compromise

Topical steroids are commonly divided into different classes depending on their potencies. These classes roughly correspond to mildly potent, moderately potent, potent and very potent.

The most popular topical steroid, 1% hydrocortisone cream, is only mildly potent. The more potent a topical steroid is, the more effective it is at reducing inflammation. However, the frequency and severity of side effects also increase with potency.

Currently, doctors prefer to prescribe high-strength and very potent topical steroids for mild to moderate eczema for a short duration (3 days).

This is because potent steroids work faster and the short duration may be convenient and possibly safer than longer therapy with mild topical steroids.

Short-duration therapy is also commonly prescribed for those who experience regular flare-ups of eczema. This type of therapy is also known as weekend therapy because the topical steroid is applied to the skin for only 2 days every week.

Topical steroid therapy for eczema has a considerable failure rate. This is often blamed on using too little of the cream or ointment.

However, using too much may produce excellent results but also harsh adverse reactions on the skin.

How Topical Steroids Work

Topical steroids reduce inflammation in the areas of the skin on which they are applied. The exact mechanism involved is complicated but involves certain changes in the immune system and even at the DNA level.

The following 4 mechanisms are the major ways by which topical steroids help relieve eczema.

Blocking Pro-inflammatory Immune Factors

Once absorbed through the skin, topical steroids enter the nuclei of skin cells where the active steroid molecule switches off certain DNA factors.

This interaction prompts skin cells to synthesize a group of chemicals known as lipocortins.

Lipocortins inhibit the arachidonic pathway. Arachidonic acid is the starter molecule used for the generation of a number of pro-inflammatory compounds including prostaglandins and leukotrienes.

By blocking the production and release of these compounds, topical steroids (through lipocortins) can reduce local inflammation on the skin.

Blocking Histamine Release

Topical steroids can also block the release of histamine from a group of connective tissue cells known as mast cells.

The release of histamine from mast cells is usually a local reaction that occurs in the skin. Mast cells are ruptured during injury, inflammation and allergic reactions such as the ones that happen to the skin in eczema flare-ups.

The release of histamine in the skin is responsible for the itching that accompanies eczema.

By blocking histamine release, topical steroids can relieve the itching along with inflammation associated with eczema.

Constricting Blood Vessels

Topical steroids can also constrict the blood vessels supplying the skin. This constriction reduces blood flow to the capillaries feeding skin cells.

The result is a reduction in redness and swelling associated with eczema.

Suppressing the Immune System

Corticosteroids are major immunosuppressant drugs and topical steroids are no exceptions.

Topical steroids can alter the functions of certain immune cells. For example, topical steroids reduce the activities of white blood cells and antibodies. Because these immune cells are involved in allergic reactions, this action of topical steroids can reduce the symptoms of eczema.

Unfortunately, inhibiting white blood cells also impairs other functions of the immune system and specifically reduces its ability to fight infections and remove toxins.

Dangers of Topical Steroids

There are a number of reasons why topical steroids are not recommended for use for longer than a week.

Most of the adverse effects of topical steroids are due to the changes they make to the immune system and the arachidonic acid pathway.

Although blocking the arachidonic acid pathway provides an immediate gain in the form of significant reduction of inflammation, the chemicals (leukotrienes and prostaglandins) synthesized from this pathway are also required for other essential processes in the body.

Therefore, when topical steroids block their syntheses, the processes that depend on them are also inhibited.

The suppression of the immune system is another major problem with topical steroids. Just as it provides immediate gains, prolonged suppression of the immune system can leave the skin open to local infections.

Another aspect of the immune suppression caused by topical steroids is the paradoxical allergic reaction that it triggers as the body tries to compensate for the inhibition of certain immune cells.

Therefore, although topical steroids are used to treat atopic eczema, an allergy disease, it can also raise the risk of allergic contact dermatitis and acne rosacea.

This ability to trigger allergic reactions and other skin diseases is the reason why the American Contact Dermatitis Society named corticosteroids as Allergen of the Year in 2005.

As an allergen, both topical and oral corticosteroids can cause immediate and delayed hypersensitivity reactions.

Besides the risk of rebound allergies, common side effects associated with topical steroids include burning and stinging sensations in the first few days of use, thinning of the skin, permanent stretch marks and abnormal hair growth in the areas regularly covered with the steroid.

Lastly, topical steroids can cause a condition known as cutaneous addiction. This condition causes itching and ugly lesions but no inflammation.

Oral Corticosteroids for Eczema

Oral corticosteroids are not really alternatives to topical corticosteroids. Oral corticosteroids are only recommended for severe eczema and after topical steroids have failed to improve eczema.

Oral corticosteroids are more effective in the treatment of eczema and can provide quick relief for inflammation and itching. Unfortunately, their rapid onset of action and excellent results come at a price: oral steroids are even more dangerous than topical steroids.

While topical steroids mostly produce local side effects that are restricted to the skin, oral corticosteroids can cause side effects in different parts of the body.

For example, oral corticosteroids can raise blood pressure and intraocular pressure. Therefore, they can increase the risks of high blood pressure and glaucoma.

Furthermore, these oral agents are known to cause mood swings, weight gain, fat deposition around the body and fluid retention in the lower legs.

Long-term oral corticosteroid therapy can also cause cataracts, osteoporosis and bone fractures, high blood sugar, suppression of the adrenal gland, increased risk of infections, erectile dysfunction, depression, anxiety, hypothyroidism, hypogonadism, and retinopathy.

Oral corticosteroids also share some of the side effects of topical steroids such as thinning of the skin and the appearance of spider veins.

Lastly, oral corticosteroids are not recommended for pregnant women because they carry teratogenic risks. The major birth defect caused by these drugs is cleft lips.

Alternatives to Corticosteroids in Eczema Therapy

Although topical steroids are still the most commonly prescribed medications for eczema, there a number of prescription drugs that are also approved for treating eczema.

Tacrolimus and Pimecrolimus

Both tacrolimus and pimecrolimus belong to a class of drugs known as calcineurin inhibitors. Therefore, they are steroid-free alternatives and newer drugs approved for treating eczema.

These drugs also suppress local inflammation in the skin and their activities are equal to mid-potency topical steroids. Because their mechanisms of action are different from those of steroids, tacrolimus and pimecrolimus do not cause some of the side effects related to steroids.

For example, these drugs do not cause skin thinning and can even be safely used on the face and eyelids as well as for children.

In addition, low doses of these drugs can be used for long-term therapy (up to one year).

However, they are also immunosuppressant drugs. Therefore, they also increase the risks of skin infections. These drugs may also cause systemic infections that appear with flu-like symptoms and headaches.

Like topical steroids, users report itching, burning, and stinging sensations when these creams are first used.

While tacrolimus and pimecrolimus do cause skin thinning, they leave the skin more sensitive to sunlight and heat. Therefore, users should limit exposure to natural sunlight or the artificial light used in tanning salons.

Lastly, there is a possible risk of cancer with this drug. Although confirmed in animal studies, the FDA (Food and Drug Administration) is still investigating the possibility of this cancer risk in humans but results from available studies were positive and significant enough for the FDA to issue a warning of this risk in 2005.

Antihistamine Drugs

Antihistamine drugs are also sometimes used to treat eczema because of their usefulness for relieving allergic reactions.

Common antihistamine drugs used in this way are Claritin (loratadine), Allegra (fexofenadine) and Zyrtec (cetirizine).

These drugs can only relieve itching (due to histamine release in the skin) and not inflammation. Therefore, their effectiveness in the treatment of eczema is limited. Even then they are not without their side effects.

Antihistamine drugs can cause dryness of the mouth, nose, and throat. Other side effects include drowsiness, difficulty urinating, blurred vision, and gastrointestinal discomforts.

Natural Alternatives to Corticosteroids

Rather than use topical steroids and other alternative prescription medications to treat your eczema, there are natural supplements as well as dietary and lifestyle changes to be made that can help prevent eczema flare-ups and reduce your symptoms.

The simplest changes to be made involve avoiding irritants and known triggers of your eczema.

For most people, the harsh chemicals found in soaps, detergents, and fabric softeners are known triggers. You may need to cut out these irritants. Switch to natural soaps and hypoallergenic washing products.

In addition, hot water can leave your skin dry and easily irritated. Therefore, choose a gentle moisturizer to lock in moisture in your skin.

You can also control the humidity of your environment by using humidifiers to prevent the air from getting too dry.

You should also try Epsom salt baths and also consider a quick bleach bath for severe eczema. Both baths have been proven to help with eczema.

Sunlight is another great remedy for eczema. The right exposure to the ultraviolet light of sunlight can increase the production of vitamin D in your skin. The anti-inflammatory, antimicrobial and immunomodulatory properties of vitamin D have been repeatedly shown to greatly help eczema.

House mites are another eczema trigger. They may be impossible to eliminate but you can significantly reduce their population by regularly cleaning and airing your rooms and getting rid of dampness.

Dietary changes can also help your eczema. Some foods are known to worsen eczema flare-ups. Any food that triggers an allergic reaction can potentially cause eczema.

Examples of these include wheat, milk and certain dairy products. Switch to healthy foods including vegetables, probiotics, and sources of omega-3 fatty acids.

There are also herbs and homeopathy remedies that can help relieve the symptoms of eczema.

Fermented cod liver oil is an especially effective natural supplement for improving eczema. It is rich in omega-3 fatty acids as well as vitamins A and D. All of these can enhance skin health and contribute to healing your eczema.