If you’ve ever had a persistent itchy skin rash, you’re probably familiar with topical steroids, aka corticosteroids. Topical steroids are one of the primary treatments for skin conditions like eczema, psoriasis, and atopic dermatitis (AD).

It makes sense – symptoms like redness, irritation, and itchy, flaky skin are annoying and painful. Of course, the first thing you want to do is stop the symptom as quickly as possible! It takes time to heal your skin from the inside-out.

In the meantime, it only makes sense that you’d want the itching to stop.

But that’s just the problem with steroid creams: they may help in the short term, but they’re hardly a treatment, let alone a cure for your rash. Instead, steroid creams are a bandaid with a number of dangerous side effects that most doctors won’t even mention. In fact, topical steroids can make your rash worse!

Before you start depending on steroid creams, make sure you get all the facts. Read on to get all the details about steroid creams and how to heal your skin rash from the inside-out.

Skin creams, gels and ointments

What are topical steroids?

There are seven different classes of topical steroids, which range in strength from Class VII (an over the counter hydrocortisone) to Class I, which are up to 1,000 times more powerful and only available via a prescription (1).

You can find topical steroids as lotions, creams, gels, powders, and ointments, and they can help lessen inflammatory reactions in everything from eczema and psoriasis to athlete’s foot.

Steroid creams are usually the first line of treatment when it comes to itchy skin rashes, but there’s just one problem with that – they don’t treat anything. They simply lessen inflammation for short periods of time, reducing the symptoms but not quite getting to the cure.

How do topical steroids work?

Topical steroids work in a couple of different ways:

1) They block the chemical reactions in your skin cells that cause inflammation. Your body fights foreign pathogens, viruses, and bacteria by pumping out inflammatory compounds and sending them to the infection site. By blocking these compounds with steroids, you might experience temporary relief, but the origin of the infection is still there.

2) Steroids also constrict your blood vessels. The same inflammatory compounds that fight infection also dilate (make larger) tiny blood vessels in your skin called capillaries. That’s what makes your skin red and puffy when you’re having a skin flare. Steroids will help constrict blood vessels, which lessens inflammation and pain. Again, this is temporary and not addressing the root cause of the infection.

You can see from these simple mechanisms exactly how topical steroids can offer some temporary relief, but definitely aren’t getting to the root cause of your skin rash. The bigger problem is when people depend on topical steroids long-term.

Here are five hidden downsides to topical steroids that your doctor may not have told you about.

Surprised woman learning the 5 hidden downsides to topical steroids

5 hidden downsides to topical steroids

Red Burning Skin Syndrome (RBSS) or Topical Steroid Addiction or Withdrawal (TSA or TSW) (2, 3)

RBSS or TSA is a complex condition that some doctors still disagree about. RBSS is common among people who depend on topical steroids for long-term management of their skin rash. Over time, the skin becomes red and increasingly irritated, and the steroids become less and less effective at symptom management.

TSA happens when your skin becomes dependent on the use of topical steroids. That means your rash becomes noticeably worse any time you stop applying corticosteroids.

TSW was coined for those who actually experience worse symptoms once they stop topical steroid use.

The main symptoms of TSW are redness and skin irritation that spreads outside the original treatment site. This can happen while you’re still taking topical steroids or even start as you’re weaning off of them or have already stopped taking them altogether.

Other symptoms may include:

  • Redness that may spread to places where you aren’t using steroid cream
  • Persistent red, itchy, stinging rash
  • Flaky skin
  • Edema (swelling)
  • Papule’s, pustules, nodules, or skin lesions
  • Fever
  • Fatigue
  • Other signs of infection
  • Dry, itchy, sensitive eyes
  • Increase in skin sensitivity
  • Anxiety and depression that comes with chronic pain and skin conditions

Acute steroid withdrawal symptoms may gradually dissipate over a few days or weeks, but it can take months or even years for the skin to heal completely. Skin hypersensitivity can also persist but will improve over time.

Although there is a lack of consensus among conventional dermatology about these conditions, one of the leading theories is that the constant use of topical steroids could potentially shut down cortisol production in skin cells known as keratinocytes (4).

Keratinocytes make up about 95% of your skin cells and are the first line of defense against pathogens and toxins from the environment. When these are damaged or aren’t functioning properly, infection and inflammation can take over until your skin heals.

Thinning of the skin

Steroid creams were never meant to use long-term. However, some doctors and patients don’t know what else to turn to for relief. If you’ve used topical steroids for longer than two weeks, it’s likely you’re experiencing some skin thinning.

Thinner skin can cause telangiectasia (more on that in #3), skin hypersensitivity, skin discoloration, and make your skin rash even worse over time (5).

Telangiectasia (red or purple spider veins)

Telangiectasia is a condition where tiny blood vessels called venules form patterns on the surface of your skin. Also known as spider veins, they’re common on areas of the body where your skin is already thinner – around the nose and cheeks or on your hands.

In the case of telangiectasia via topical steroid use, you may see them on other parts of the body due to thinner and more sensitive skin.

Many people regard spider veins as harmless (albeit unattractive), but they can cause some discomfort, usually pain and itching.

Skin discoloration and scarring

Discoloration can suppress melanin production, mostly on darker skinned individuals. Luckily, discoloration can correct over time.

However, scarring is also possible with prolonged topical steroid use, especially when combined with sun exposure. This is likely due to the loss of structural compounds in the skin that comes with long-term steroid use.

Woman with adrenal suppression and fatigue

Adrenal suppression

What goes on your skin is also absorbed into your body! Long-term topical steroid use can absolutely affect your internal health, and it’s usually your adrenal glands that take the hit.

Adrenal suppression happens when steroids block the production of cortisol (your main stress hormone) over a prolonged period. Over time, your adrenals will get the signal that they no longer have to produce cortisol, which results in cortisol insufficiency and adrenal atrophy (6).

Symptoms of adrenal suppression include:

  • Low blood pressure
  • Fatigue
  • Weakness
  • Muscle and joint pain
  • Headaches
  • Nausea
  • Abdominal pain

Anyone who takes steroids for longer than two weeks is at risk, and children are even more susceptible than adults.

Healthy food like this can help with topical steroid cream side-effects

How to avoid topical steroid cream side effects

Use them sparingly! Topical steroids may help with inflammation and symptom control, but over time, they can make your rash even worse and cause other health issues.

Reduce usage over time. If you’re already dependent on topical steroids, don’t quit cold turkey. Instead, slowly reduce your usage over time or work with your doctor to taper use.

Try topical CBD. Replace your topical steroids with non-psychoactive CBD balm. CBD contains anti-inflammatory and protective properties that may be able to control chronic flares from conditions like eczema and psoriasis (7, 8).

Minimize fermented foods. Fermented foods are high in histamines, which can cause flares or exacerbate itchy skin. You can minimize reactions to high histamine foods with a natural anti-histamine like Quercitin.

Ditch anti-inflammatory foods. Replace inflammatory foods like gluten, sugar, and other highly processed foods with gut-friendly vegetables, bone broth, healthy fats, and pastured or wild-caught protein sources. Inflammatory foods only make your inflammatory response worse.

All of these tips will work if you’re looking to manage your symptoms, but if you want your rash to go away for good, you’ll have to address the root cause of your skin issues.

Start with my List of Root Cause Skin Test and learn every single test you’ll need to find out the root cause of your skin issues. It’s the free resource I wish I had when I was navigating the complex world of irritating and painful skin rashes.

Have you used topical steroid creams? Are you still using them to manage your skin rash symptoms? Let me know in the comments below!

References:

1) https://www.jaad.org/article/S0190-9622(05)04955-8/fulltext

2) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207549/

3) https://www.ncbi.nlm.nih.gov/pubmed/24290431

4) https://www.ncbi.nlm.nih.gov/pubmed/26838582

5) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171912/

6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4171913/

7) https://www.practiceupdate.com/content/aad-2018-topical-cannabidiol-recommended-as-adjunct-treatment-for-acne-eczema-and-psoriasis/64728

8) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757311/