In Korea, steroid ointments are often negatively perceived as 'strong medication' or 'medication with many side effects.' Many people even believe that any medication containing steroids should be avoided at all costs. However, steroids are highly effective in treating inflammatory skin conditions, and when used correctly, they can achieve good therapeutic effects while minimizing side effects. Today, we will learn in detail about the correct usage of steroid ointments as advised by a dermatologist.
What kind of medication are steroids?
Steroids are drugs with a structure similar to hormones produced by various organs in our body, such as the adrenal glands. Their effectiveness became widely known when they began to be used in the treatment of rheumatic diseases in the early 1950s.
Steroids act directly within cells, influencing gene expression in the nucleus to suppress inflammatory responses, making them a key anti-inflammatory drug. They are often confused with anabolic steroids that are misused for muscle enhancement, leading to reluctance. However, corticosteroids used in dermatology are medications for treating inflammation, and their components are similar to hormones naturally produced in our body.
How do various topical steroids differ?
Topical steroids used in dermatology are categorized widely based on their potency. Furthermore, even with the same active ingredient, the absorption rate and feel can vary depending on the formulation.
- Characteristics by Formulation:
- Ointment: Rich in oil, it forms a protective barrier on the skin and generally has a high drug absorption rate. It is mainly used for dry and thickened lesions.
- Cream: Less oily than ointment and spreads well. It is suitable for use on relatively large areas such as the face or folded skin areas.
- Lotion/Solution: Thin and easy to apply to large areas or hairy areas (such as the scalp).
- Selection by Potency: The appropriate strength of steroid ointment should be chosen based on the severity of the condition, the affected area, and the patient's age. Generally, thinner formulations are known to have weaker effects and fewer side effects. Weaker steroids may be used for the face or sensitive areas, while stronger steroids may be used for areas with thicker skin, such as hands and feet.
Why are topical steroids used?
The most important effect of topical steroids is their anti-inflammatory action.
They alleviate inflammatory responses by constricting blood vessels in inflamed skin areas, inhibiting the formation of inflammatory mediators, and reducing cell proliferation, thereby improving symptoms such as itching, redness, and swelling. They are essential medications used in the treatment of various inflammatory skin conditions, including atopic dermatitis, eczema, and contact dermatitis.
"When used well, they yield good results, and every dermatologist has this medication."
Are there any side effects of topical steroids?
Topical steroids do not have high systemic absorption like oral medications, so severe systemic side effects are rare. However, local side effects can occur with misuse, so caution is necessary.
- Major Local Side Effects:
- Skin Atrophy: The skin may become thin and fragile.
- Telangiectasia: Skin blood vessels may dilate, appearing red.
- Skin Color Changes: Discoloration or hyperpigmentation may occur.
- Acne, Hypertrichosis: Folliculitis, acne, or increased hair growth may occur.
- Worsening of Infection: If bacterial or fungal infections are present, using only steroids can worsen the infection.
- Use around the Eyes: Long-term use may increase the risk of glaucoma or cataracts, so particular caution is required.
5 Guidelines for Safe Use of Topical Steroids
To use steroid ointments safely and effectively, it is crucial to follow the instructions of a dermatologist. Please remember these five guidelines:
1. Accurate diagnosis and prescription are paramount
Skin conditions are diverse, and even if symptoms appear similar, their causes and treatments can differ. Especially if bacterial or fungal infections are present, using only steroids can worsen symptoms. Therefore, it is important to receive an accurate diagnosis and appropriate medication prescription.
2. Follow the correct dosage and usage instructions
The amount of ointment can be estimated using the FTU (Finger-Tip Unit).
- What is FTU? Squeezing ointment along the first joint of an adult's index finger yields approximately 0.5g, which is enough to cover an area twice the size of an adult's palm.
- It is essential to precisely follow the frequency, duration, and amount instructed by the dermatologist. Applying too little may result in minimal effect, while applying too much can increase the risk of side effects.
3. Occlusive dressing technique should be applied cautiously
Most steroids are fat-soluble, leading to high skin absorption. The Occlusive Dressing Technique (ODT), which involves covering the applied ointment with plastic wrap or gloves, can increase drug absorption and enhance its effect. However, this also increases the risk of side effects, so ODT should not be used arbitrarily without a doctor's instruction.
4. Gradually reduce use with 'tapering'
If steroid ointment has been used for a long period, sudden discontinuation can lead to a rebound phenomenon (worsening of symptoms). This may be due to a decrease in steroid production in the body. Therefore, it is necessary to undergo a tapering process, gradually reducing the strength or frequency of the medication in consultation with a specialist.
5. Consult before reusing previous prescriptions
It is dangerous to arbitrarily reuse leftover steroid ointment from a previous prescription. Skin conditions can change over time, and other infections may also be present. It is essential to consult a specialist again to confirm if the medication is appropriate for your current condition. Even with weak steroids, long-term use for more than 2-3 weeks without a doctor's instruction should be avoided.
Use steroid ointments wisely
Steroid ointment is a 'medicine,' not a 'poison.' Many people miss crucial treatment periods due to misinformation or vague reluctance, or worsen their symptoms by arbitrarily using medication based solely on internet information.
When used correctly under the accurate diagnosis and instructions of a dermatologist, steroid ointment can be a valuable medication that effectively treats skin conditions and significantly improves quality of life. Do not hesitate to consult a specialist.