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Steriod Creams: Friend or Foe?


By Joshua Ng (Pharmacist, Caring Pharmacy) | Malaysia | Fri Sep 14, 2018 4:47pm

STEROID CREAMS: FRIEND OR FOE?

  1. Introduction
    • In Malaysia, topical corticosteroid is commonly termed as “steroid creams”. It is often prescribed for treating skin conditions such as eczema, seborrhoeic dermatitis, psoriasis, nappy rash and skin irritation due to insect bites, etc.
    • There are opposing views from patients when it comes to steroid creams. Some shun at the suggestion of using steroid creams. Whereas some use steroid creams very frequently and at large amounts.
    • This article is a pharmacists’ perspective when it comes to the use of steroid creams
  2.  

  3. Steroid phobia in Malaysia
    A 2015 study found “steroid phobia” to be prevalent especially among Malaysians with higher education background. The most common reason for this fear is the skin thinning side effect of topical corticosteroids. This fear may result in certain patients not having their skin condition properly treated.
  4.  

  5. Side effects: Common vs. Less common
    The common side effect is stinging sensation. This normally occurs on the initial application of the cream. The other side effects that are less common may include:
    • folliculitis (inflammation of hair follicles)
    • thinning of the skin
    • darkening of skin
    • stretch marks
  6.  

  7. Steroid creams: white but not all equal
    • Topical corticosteroids are available in cream, lotion and ointment formulations. Ointments are generally considered more potent than corticosteroids in cream and lotion formulations.
    • Topical corticosteroids can be categorized by their chemical component as mild strength to potent strength. (e.g. Clobetasol propionate is more potent compared to Hydrocortisone)
    • Potent strength steroid creams are more effective in relieving symptoms but have a higher risk of side effects
    • There are certain potent topical corticosteroids that are classified as safe for use on children.
  8.  

  9. Right dosage: Finger Tip Unit
    • Some doctors or pharmacist may advise you to use a finger tip unit (FTU). To measure 1 FTU, squeeze enough cream to cover the finger tip down to the first finger crease.
    • The FTU needed per application varies between children and adult, as well as body parts, please consult your doctor or pharmacist on how much steroid cream to apply.
  10.  

  11. Conclusion: Use it the right way
  • Steroid creams are safe to use for a short term
  • If your skin condition does not get better after more than 2-4 weeks of steroid cream use, please consult a doctor.
  • Always wash your hands before and after the application of a steroid cream
  • For patients with eczema, doctors would usually prescribe a steroid cream along with a moisturiser. Separate the two treatment applications by 5-10 minutes from each other for better absorption.
  • Do not apply on face, genital area or on children unless advised by a doctor
  • Do not apply a topical corticosteroid on an open or infected wound
  • Steroid creams can be useful but please always consult your doctor or pharmacist before use
 

 

References
  1. Topical corticosteroids. (2016). (web accessed September 2018) Web link: https://www.nhs.uk/conditions/topical-steroids/
  2. Topical Corticosteroid Phobia among Atopic Eczema patients and their caregivers: Survey in two dermatology outpatient clinics in Malaysia Noorlaily MN, Baba R. (2015) Malaysian Journal of Dermatology.
  3. Rational use of topical corticosteroids. G Carlos, P Uribe & P Fernandez. (2013) Australian Prescriber.

 

 






 

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