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.
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.
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
- Intense fatigue
- Insomnia
- Hair loss
- Inability to regulate your body temperature
- 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.
LISTEN TO MORE ABOUT TOPICAL STEROID WITHDRAWAL
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.
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.
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 obvious 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.
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/
Jennifer Fugo, MS, CNS
Jennifer Fugo, MS, CNS is an integrative Clinical Nutritionist and the founder of Skinterrupt. She works with women who are fed up with chronic gut and skin rash issues discover the root causes and create a plan to get them back to a fuller, richer life.
I was prescribed trimacinalone for a rash around my mouth and chin in 2016. It worked for a few months but would come back. With repeated use, eventually my face flared up with tiny pustules with intense burning and itching. I went to see a new dr a year later and she prescribed me a different ointment to treat the effects and my rash went away. Recently this spring the redness returned and I used the ointment again and it had the same effect. I have an appointment to get a refill of the secondary medication to relieve the reaction from the steroid cream.
what was the name of the cream that was prescribed that helped you
I was put on Clobetasol for 7 months for genital Lichen sclerosis and it only helped minimally. I reduced usage after bout 3 months but remined on it in spite of weight gain, fatigue, water retention and still itching! I actually found a clinical trial online after going off Clobetasol that was going to use Progesterone vs Clobetasol. I purchased Progesterone crème and almost immediately had some relief of itching. Never total relief, but definitely better. The trial was cancelled for lack of recipients. I now have the purplish bumpy skin and lessened itching, but my concern is visual progression of the congestive purplish skin. Can’t find a doctor who seems to really know about specific treatment. I’ve fought this for nine years. Yuk!
I have used some sort of topical steroid for my itchy skin condition for over 20 years off and on. My rash presents in various places. I have a patch on each jawline just under the earlobe that has been hanging on for 2 years. I have a new patch that is on my forearm under my elbow and the top of my hand on opposite side. My latest eruption is on the inside of my wrist to mid forearm and my neck is angry. the itching is intense and the topicals and creams irritate the sites, they burn and initially increase the symptoms. they ebb and flow with no particular pattern. I have been diagnosed with lichen planus for over 20 years but its been presenting in my gums and has been well controlled for years with periodontal visits.
The itching is highly annoying and effects my work and social schedule .
Any advise you can offer would be greatly appreciated.
Hi Sabrina, great question! I’d highly recommend that you check out this post (I actually specifically mention lichen planus of the mouth) – https://www.skinterrupt.com/h-pylori-skin-rash-connection/. Also, you should consider potential microbiome issues both at the level of the skin and internally. I recognize that this particular case is highlighting eczema, but it could still apply — https://www.skinterrupt.com/eczema-triggered-by-hidden-infections/
I contracted a case of poison ivy. It was on my legs, arms and chest. I was given a shot and oral steroids. The rash as subsided, but now a new rash has appeared. It is very itchy. I have tried topical steroids, lotions etc. Nothing works. The itch is disrupting my life. It presents itself as a series of small bumps and then in small round patches. Is there anything that I can try?
Sherry, as always, it’s good to get the new rash looked at to see what is going on. The way forward can differ depending on the presentation and symptoms YOU experience because everyone’s rash experience is different. The itchiness can be due to hidden infections or dysbiosis. I’d suggestion checking out this post: https://www.skinterrupt.com/eczema-triggered-by-hidden-infections/
You could try Indigo Calm Balm and see if that potentially helps. But it sounds to me like you might have to dig deeper to know exactly what’s driving the issue and not see your skin issue as ONLY a skin issue.
i using a momate cream (Mometasone furoate ) more than a yeay and it resulted in black colour near eyebrows and under eye area and also it resulted in acne scars all over the face. and i stop using it. now my face is fully damaged and too black. is there is cureable plz suggest some measures to get my old skin back 🙁
Hi John Paul, have you asked your dermatologist why the cream caused these issues for you?
I’ve been prescribed a steroid cream (UK)
for an itch on my upper arms…. ( feels like it’s under the skin) I’ve been using for 3 days and it stinks some time after application….
I have been dealing with chronic urticaria (Hives) for a few years now and NOTHInG works! Any cream or antihistamine seems to make the flare worse, only thing that helps is steroids but then it comes back.
I am pretty sure that I have a phytophotodermatitis, from some kind of plant toxin exposure. I got this once before; it seems tied in with outdoor activity, weed eating, or chainsawing. Last time, I got a script for an oral steroid, after 2 weeks of at home herbal self treatment failed to stop it.
I have recently started using the otc 1% cortisol cream for my 4 month old baby as per her pediatrician’s advice. But I would like to totally avoid it and find the root cause. I have already switched to a milder washing detergent and reduced the frequency of body wash to 1-2 times a week. I am breastfeeding her and would like to find out if anything in my diet could be triggering the flare ups. Can you advise on that please? Thank You.
I’d personally be really careful before you start removing foods from your diet because you must remember that your baby needs nutrients that come from diverse sources. Some limited eliminations being trialed could help, but you may want to get some help from a nutritionist who works with young children and breastfeeding moms like Jennifer Brand (who has been on the Healthy Skin Show before) so you don’t inadvertently create another problem in the process. I personally think elimination diets should be used during breastfeeding with careful guidance and gravitating towards more nutrient-rich whole foods. Something like dairy or eggs could be eliminated for a couple of weeks to see if that helps, but if you start removing a lot of other foods, that’s where trouble can start. I don’t work with young children so I’m not the best person to give advice on this which is why I’d suggest connecting with someone who does so that you can take appropriate steps but also keep in mind that young children can also have gut microbiome issues as well (despite their young age) which is not something that food will fix.
I think there is a typo in the article
“ Ditch anti-inflammatory foods. Replace inflammatory foods like gluten, sugar, and other highly processed foods with gut-friendly”
Don’t you want to ditch the inflammatory foods?
You are right! It is a typo. I just fixed it. Thanks for letting me know!!