I have been seeing a lot of posts online from other eczema sufferers and their experience with topical steroids. Some have sworn by these things that their doctors have prescribed them. Others are not so happy with how their skin turned out after using them improperly for a long time and stopping them.
Some discouraged people share their poor experience with topical steroids, saying that they were the cause of their worsening eczema. Some say that the skin medicines are “poison” or “evil”. These stories can persuade others to stop using or avoid them completely.
I believe this is a huge problem that can turn out to seriously harm people with the skin disorder. To resolve this issue, education about topical steroids and the consequences of their improper usages must be improved and promoted more. To start, let us look at the basics behind these skin medicines.
How Exactly Do Topical Steroids Work?
If you are a person with eczema, you probably already know this: Topical steroids are creams, ointments, etc. used to treat eczema and other skin conditions. You can get ones with mild strength over-the-counter, such as hydrocortisone. Stronger corticosteroids are usually prescribed by your doctor if you have moderate to severe eczema.
Steroids occur naturally in the body, helping our body regulate growth and immune function. Corticosteroids are the type of steroids used to help reduce the inflammation that worsens eczema. They contain synthetically-made cortisol, which is made to mimic naturally-produced cortisol. The hormone, produced by the adrenal glands, is immunosuppressive. This means it prevents the release of substances in the body that causes swelling and redness in the skin. Sounds like the perfect thing to use for eczema, doesn’t it?
What Are The Side Effects Of Topical Steroids?
As with any other medication, there are potential side effects from using topical steroids. Most side effects are reported because of prolonged or inappropriate use of an unnecessarily potent topical steroid. These include:
- folliculitis
- thinning of the skin
- stretch marks
- contact dermatitis
- acne, or worsening of existing acne
- rosacea
- Cushing’s Syndrome
- glaucoma
- cataracts
- adrenal suppression
As long as you apply topical steroids appropriately and correctly, you are unlikely to experience these adverse effects.
Debunking Myths About Topical Steroids
There are so many lies and myths about corticosteroids that are being spread around.
Myth #1 – Topical Steroids Cause Stunted Growth and Development.
It is important to know that corticosteroids are not the same as anabolic steroids (what some athletes use to build their muscles). Also, prolonged or inappropriate use of topical corticosteroids can decrease growth in babies and very young children. It can also weaken their immune responses. It is highly critical to follow a doctor’s advice when applying topical steroids on babies and young infants. Otherwise, as long as you apply them appropriately, your growth and your body’s ability to fight infections are unlikely to be affected.
Myth #2 – Topical Steroids Cause Skin Discoloration
Lightening or darkening in the skin is more likely caused by the actual eczema itself, not the topical steroids used. Skin discoloration caused by topical steroids is rare. If this occurs, the skin color should turn back to normal when the treatment is stopped.
Myth #3 – Topical Steroids Cause An Increase In Hair Growth
If topical steroids are used for a long time, they can occasionally cause a temporary, slight increase in fine hair growth in treated areas, although this is rare.
Myth #4 – Topical Steroids Will Extend The Duration of Eczema
There is zero evidence out there stating that topical steroids will prolong the skin disease.
Myth #5 – Topical Steroids Decreases The Chances Of Improvement With Age
Like Myth #4, there is absolutely no evidence for this.
Reasons People Stop Or Avoid Using Topical Steroids
Some people with eczema decide to stop or avoid using topical steroids because they are simply skeptical about medicine in general. They believe Big Pharma and doctors (who study their chosen field for years) keep prescribing topical steroids for the purpose of either secret harm or more money. These same people flock to other things that have less (or none at all) backed-up scientific research than corticosteroids (as if essential oils and homeopathic remedies are not produced from money-hungry people!). Instead of “anti-vaxxers” (whom they somewhat remind me of), they are “anti-sterrers” (yes, I made that word up).
Many people with eczema decide to stop or avoid using topical steroids because of the fear of developing adverse side effects (the main reason why I hesitated to try them in the first place). For example, improper use of potent corticosteroids can hinder the natural production of cortisol (AKA adrenal suppression) in the body, which is known to cause fatigue, nausea, and other symptoms.
Some stop and start to avoid topical steroids because they believe that topical steroids are the cause of their worsening eczema. The constant need for stronger corticosteroids strengthens their belief that they have an iatrogenic condition called topical steroid addiction (TSA), which can ultimately lead to topical steroid withdrawal/TSW (named for its similarity to drug withdrawal).
TSW (also known as RSS or “red skin syndrome”) is a topic that has been circulating around eczema communities on the worldwide web. It is the condition of having red, burning eczematous skin after discontinuing the use of corticosteroids. Prospective studies are still needed to better understand and define this condition. Some dermatologists do not even know about this. Note that this has not been reported with the CORRECT use of topical steroids.
Why Stopping Topical Steroids Could Actually Be More Harmful Than Helpful
I have seen many series of posts from people who claim to be going through topical steroid withdrawal. They believe that they will get better and eventually heal after stopping corticosteroids for a long time. I have followed some of these people for a long time through their journey online, and if I am going to be honest, a lot of them appear to be suffering without the medicines that were made to treat their eczema. Some do not seem to be healing at all.
Untreated severe eczema can significantly worsen the quality of life. It can lead to:
- Not getting enough sleep (due to constant skin irritation)
- Difficulty concentrating and learning (because of sleep loss)
- Mental Disorders (depression and anxiety due to the struggles that come with the condition)
- Bacterial staph infections (Staphylococcus Aureus, a type of harmful bacteria, enters broken skin easier)
- Day hospitalizations (only if it gets too extreme to function normally in daily routines)
How Topical Steroids Saved My Skin
I have been on topical steroids for about 4 years. Before using any type of corticosteroid, I bought the regular kinds of creams and ointments anyone could get at the local drugstore. I also tried home remedies such as applying honey (which was uncomfortably sticky) and drinking apple cider vinegar (which was not a good idea because it made my throat burn). I did everything I could to no avail; my eczematous skin was still red, crusty, and weepy. I remember hesitating to go to the doctor because I was scared of risking side effects from the steroids.
Severe eczema, as a result, took a toll on me. I was unable to sleep because I could not stop scratching at night. I slathered myself in ointments and moisturizers, which made it even harder to go to bed every evening. It hurt to shower because my skin would always sting from soaps. My self-esteem was at its lowest since almost everyone I came in contact with asked me why my skin was the way it was. It was hard to not notice my red, swollen, and flaky face. I cried almost every day because my skin was significantly affecting the quality of my life and, in turn, my happiness. To put it simply, I was miserable.
I finally resorted to topical steroids. It was the best decision I have ever made. Within a month, my skin has visibly improved. From then on, I was able to live a close-to-normal life. I still could not believe I was stuck with horrible eczema for years that could have been effortlessly eased in a month if I just applied topical steroids. If only I took them earlier, my eczema would not have spread to more places. I would have developed fewer wrinkles and scars.
Final Thoughts
Personally, I believe there is a lot of misinformation being spread about corticosteroids on the Internet. We need more education on how these topical medicines actually work and the consequences of using them incorrectly when prescribed. These things exist because they have been scientifically and successfully tested in clinical trials among huge groups of people with eczema (they beat placebo effects!).
It is important to know that there is no cure for eczema yet. Since there is none as of right now, treatments (such as corticosteroids) for the disease exist. Topical steroids, like other medications, are not perfect. They come with risks and side effects, which are more likely to occur if you use them improperly. When deciding if corticosteroids are good or bad for you, it is necessary to weigh the benefits of treatment against the risks of the disease.
As for topical steroid withdrawal, I honestly do not understand why someone would put themselves through eczema hell and bring themselves to rock-bottom for months (or even years!) for the uncertain chance of their skin becoming clear. If withdrawing from topical steroids actually worked for you, that is fine.
Just don’t go around saying that topical steroids are “poison” or “evil”. What are really “poison” and “evil” are spreading misinformation and false hope among others struggling with eczema.
Sources
- https://www.dermnetnz.org/topics/topical-steroid/
- https://www.dermnetnz.org/topics/topical-corticosteroid-withdrawal/
- https://nationaleczema.org/warnings-for-topical-steroids-eczema/
- https://nationaleczema.org/wp-content/uploads/2015/04/Systematic-Review-TSA.pdf
- https://www.ncbi.nlm.nih.gov/pubmed/25592622
- https://www.nhs.uk/conditions/topical-steroids/