Are steroids safe to use?

The controversy I have chosen to discuss centres around the use of corticosteroids to treat atopic eczema.

Mild cortisone (or steroid) cream or ointment are often prescribed to control the symptoms of atopic eczema by reducing the inflammation and promoting healing.

In 1952, Sulzberger and Witten70 published a report which promoted the use of a new topical drug in dermatology,5 17 hydroxycortisonee 21 acetate. Improvement was judged after 1 week based on clinical criteria, namely decreased pruritus, diminished erythema, and reduced scaling. Since its first use in dermatology, TCS therapy has been developed so success-fully that dermatology cannot be envisaged without TCS. (1) 

Therefore, steriods have proven to be effective in most cases and most doctors would recommend a mild steroid together with moisturizers as a standard treatment for eczema sufferers.

However, concern over the side effects has caused some people reject the use of cortisone for eczema entirely. Side effects associated with corticocosterioid use include skin atrophy, meaning that the skin is thinned out and more vulnerable. When large amounts are applied and absorbed into the body, it may cause hypothalamic-pituitary-adrenal axis suppression, where the functioning of the endocrine system is affected. Steroids may also cause glaucoma if they enter the eye.

I personally feel that these fears are exaggerated and with proper use, steroids can aid in the treatment of eczema without those nasty side effects.

This is the recommended treatment found in an academic journal about management of eczema:

• topical steroids -- helpful in inflammatory atopic eczema. Potent steroid preparations should be used only to get the eczema under control, and should not be used on the face. They can safely be followed by a mild steroid. Steroids under wet tube gauze (wet wrap) will sometimes be effective, and prevent scratching. (2)

This video here from the National Eczema Association talks about the use of topical medications from 6:10. It says that "When used correctly, these medications are safe and effective."

Easing Eczema and Soothing Sensitive Skin

Topical steroids can be used but patients should take heed of those warnings and use it in a thin layer over affected areas only. The first line of defense would still be to moisturize.

References

1. G, T., D, W., & A, T. (2007). Topical therapy of atopic dermatitis: controversies from Hippocrates to topical immunomodulators. Journal Of The American Academy Of Dermatology, 56(2), pp. 295-301.

2. Watkins, J. (2009). Eczema: types, presentation, causes and management. Practice Nurse, 38(4), p11-18.