Topical steroids

Topical corticosteroids revolutionised the management of inflammatory skin disease when they were introduced in the 1950's. They are used as first-line or adjunctive treatment in several inflammatory dermatoses (1) (particularly beneficial for eczema and psoriasis), and have a place in the treatment of other dermatoses e.g. alopecia areata, keloid scars and non-infected granulomas.

• in addition to the anti inflammatory property, topical corticosteroids also exert their effect through vasoconstrictive, anti-proliferative and immunosuppressive properties (1)
• because they are not targeting the disease process, generally only symptomatic relief is obtained
• rebound exacerbation of the condition may occur on cessation of the corticosteroid agent (2)

They are not beneficial in urticaria or pruritus of unknown cause and they exacerbate rosacea, acne and ulceration (2). Systemic side effects may be serious.

Topical corticosteroids come in a variety of strengths. A good rule is to use the least potent drug at the lowest strength possible for a therapeutic effect.

Reference:

• (1) Tadicherla S et al. Topical corticosteroids in dermatology. J Drugs Dermatol. 2009;8(12):1093-105
• (2) MeReC. Using topical corticosteroids in general practice. MeReC Bulletin 1999;10(6), 21-24.