HOW DO TOPICAL CORTICOSTEROIDS WORK?

Topical corticosteroids are synthetic (man-made) steroid medications used to treat skin conditions and reduce inflammation and irritation. Topical corticosteroids are grouped according to their potency: Topical corticosteroids have anti-inflammatory actions and suppress the immune response. They are used based on their potency, the area of the body to which they will be applied, and the type of skin condition being treated.

Topical corticosteroids work through different mechanisms:

Steroids (naturally occurring hormones produced by the body) are released whenever the body experiences stress, disease, or trauma. They interact with the DNA in the cell to produce proteins called "lipocortin," and these proteins, in turn, block the chemical necessary for inflammatory response "arachidonic acid," leading to less inflammation.

Immune cells fight infections with the help of defensive cells (meant to neutralize invading viruses and bacteria). They also release toxins in the body, causing more inflammation. Corticosteroids hinder this action and prevent tissue damage that can be caused by excessive inflammation.

Inflammation leads to dilatation of blood vessels around the infected site; topical corticosteroids constrict the capillaries (smallest blood vessels) and reduce swelling and pain.

Topical corticosteroids are usually used once or twice a day (as prescribed by the physician). Gently rub the cream or ointment on the affected site and then wash your hands properly.

• Anti-inflammatory (blocking of chemical reactions that cause inflammation)
• Immunosuppressive
• Vasoconstrictive (they constrict the blood vessels)

These are used in various dermatological conditions, such as:

• Atopic eczema (a condition that makes skin red and itchy)
• Contact dermatitis (dandruff and scaly patches on the skin)
• Psoriasis (a chronic disease that causes a thick, patchy red rash with silvery-white scales on the skin)
• Rash
• Vitiligo (loss of skin color in patches)
• Lichen planus (small shiny reddish bumps on the skin)
• Lichen simplex chronicus (dry patchy areas of skin that are scaly and thick)
• Discoid lupus erythematosus (a chronic skin condition of sores with inflammation and scarring)
• Lichen sclerosus (patchy white skin that appears thinner than normal)
• Seborrheic dermatitis (scaly patches and stubborn dandruff)
• Diaper rashes
• Acute radiation dermatitis (side effect of radiation therapy)

The risk of side effects depends on the potency of the steroid, location, and duration of use. Many of the side effects resolve on their own after stopping the medication.

Common side effects include:

• Itching
• Burning/stinging sensation
• Redness and dryness
• Atrophy (thinning of the skin)
• Striae (stretch marks) in the armpit or groin
• Easy bruising and tearing of the skin
• Telangiectasia (enlarged blood vessels often called "spider veins")
• Hypertrichosis (localized excessive hair growth)
• Perioral dermatitis (infection around the mouth)
• Acne-like rashes
• Purpura (purple-colored spots on the skin due to hemorrhage from small blood vessels)

Other rare side effects include:

• Suppression of adrenal gland (leading to diabetes, high blood pressure, fluid retention, and osteoporosis)
• Rosacea (a condition that causes the face to become red and flushed)
• Changes in skin color (more noticeable in people with dark skin)
• Delayed wound healing
• Localized pustular psoriasis (white bumps filled with pus)
• Cushing’s syndrome (a metabolic disorder caused by overproduction of corticosteroid hormones by the adrenal cortex and often involving obesity and high blood pressure)
• Growth retardation in young children
• Glaucoma (damage to the eye's optic nerve)
• Cataracts (clouding of eye lens)

The information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Drug names include:

• Hydrocortisone (alacort, alascalpt, calmurid cream, cetacort, dermacort, lacticare, nutracort, westcort, hytone)
• Aclometasone (aclovate)
• Prednicarbate (dermatop)
• Fluocinonide (lyderm, tiamol, lidemol, lidex, topactin, vanos)
• Flucinolone (fluoderm, capex, synalar)
• Pramoxine (procort, pramosone)
• Desoximetasone (topicort)
• Halobetasol (ultravate, lexette)
• Urea/hydrocortisone (U-cort)
• Triamcinolone (triacet, trianex)
• Hydrocortisone probutate (pandel)
• Clobetasol (cormax, olux)
• Halcinonide (halog)