Topical steriods – double edged sword

Topical corticosteroids (TC) are perhaps the most widely used therapeutic agents
in modern dermatologic therapy. They provide rapid symptomatic relief in almost
all inflammatory dermatoses, especially in the short term. Even incorrect use, for
instance in infectious dermatoses, produces an initial improvement in the
symptoms.
All these can lead to significant local adverse effects if TCs are used
indiscriminately. Use of TCs on the face produces peculiar adverse effects in
addition to those seen elsewhere, viz. steroid rosacea, acneiform eruption,
hypertrichosis, demodicidosis, etc. Another adverse effect seen predominantly on
the face has been variously called steroid addiction,
However the usefulness of these has become a double edged sword with constantly
rising instances of abuse and misuse leading to serious local, systemic and
psychological side effects. Dr sneh thadani explains the side effects and correct
ways to use a topical steroidal cream
Local side effects of topical steroids may arise when potent topical steroids are
applied daily for long periods of time (months). Most reports of side effects
describe prolonged use of unnecessarily potent topical steroids for inappropriate
indications.
 Skin thinning (atrophy)
 Stretch marks ( striae ) in armpits or groin
 Easy bruising (senile/solar purpura) and tearing of the skin.
 Enlarged blood vessels ( telangiectasia )
 Localised increased hair thickness and length ( hypertrichosis )
Potent topical steroids applied for weeks to months or longer can lead to:
 Periorificial dermatitis (common)
 Steroid rosacea
 Symptoms due to topical corticosteroid withdrawal
 Pustular psoriasis


Steroids are a prescribed topical medication for many skin disorder, the over use of
the steroidal cream is leading to a huge steroid addiction
Giving rise to increase in various side effects like thinning of facial skin to
excessive hair growth on the face
These are all avoidable side effects if we can create awareness regarding the
amount of cream , the duration and the potency to be used
Only and only when a dermatologist prescribes a steroids cream , one should be
able to purchase it from the pharmacy
A lot of over the counter creams- which claim to be fast relief or fairness creams
have this highly potent steroids, which if used without supervision can give rise to
very dangerous side effects
Below given is the right way to use the cream
How to use topical steroids
Topical steroid is applied once daily (usually at night) to inflamed skin for a course
of 5 days to several weeks. After that, it is usually stopped, or the strength or
frequency of application is reduced.
Emollients can be applied before or after the application of topical steroid, to
relieve irritation and dryness or as a barrier preparation. Infection may need
additional treatment.

Fingertip units
Fingertip units guide the amount of topical steroid to be applied to a body site. One
unit describes the amount of cream squeezed out of its tube onto the volar aspect of
the terminal phalanx of the index finger.
The quantity of cream in a fingertip unit varies with age:
 Adult male: one fingertip unit provides 0.5 g
 Adult female: one fingertip unit provides 0.4 g
 Child aged 4 years: approximately 1/3 of adult amount
 Infant 6 months to 1 year: approximately 1/4 of adult amount
The amount of cream that should be used varies with the body part:
 One hand: apply 1 fingertip unit
 One arm: apply 3 fingertip units
 One foot: apply 2 fingertip units
 One leg: apply 6 fingertip units
 Face and neck: apply 2.5 fingertip units
 Trunk, front & back: 14 fingertip units
 Entire body: about 40 units
Hope this article created awareness regarding the over use of topical steroidal
cream and its related side effects