{"id":48,"date":"2021-05-13T00:29:44","date_gmt":"2021-05-13T00:29:44","guid":{"rendered":"https:\/\/itsan.net\/?page_id=48"},"modified":"2021-05-13T23:37:21","modified_gmt":"2021-05-13T23:37:21","slug":"topical-steroids-101","status":"publish","type":"page","link":"https:\/\/www.itsan.org\/us\/topical-steroids-101\/","title":{"rendered":"Topical Steroids 101"},"content":{"rendered":"\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_two_third-15d750bd1b332b34c6e70b077ebbccdf\">\n.flex_column.av-av_two_third-15d750bd1b332b34c6e70b077ebbccdf{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-av_two_third-15d750bd1b332b34c6e70b077ebbccdf av_two_third  avia-builder-el-0  el_before_av_one_third  avia-builder-el-first  first flex_column_div av-zero-column-padding  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-67e790f6bf20a9613d8fa0f53a9f3b79\">\n#top .av-special-heading.av-av_heading-67e790f6bf20a9613d8fa0f53a9f3b79{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-67e790f6bf20a9613d8fa0f53a9f3b79 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-67e790f6bf20a9613d8fa0f53a9f3b79 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-67e790f6bf20a9613d8fa0f53a9f3b79 av-special-heading-h1 blockquote modern-quote  avia-builder-el-1  el_before_av_heading  avia-builder-el-first '><h1 class='av-special-heading-tag'  itemprop=\"headline\"  >Topical Steroids 101<\/h1><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-d916266fff39c0fd23cfca694502980b\">\n#top .av-special-heading.av-av_heading-d916266fff39c0fd23cfca694502980b{\npadding-bottom:10px;\ncolor:#0a0a0a;\n}\nbody .av-special-heading.av-av_heading-d916266fff39c0fd23cfca694502980b .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-d916266fff39c0fd23cfca694502980b .special-heading-inner-border{\nborder-color:#0a0a0a;\n}\n.av-special-heading.av-av_heading-d916266fff39c0fd23cfca694502980b .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-d916266fff39c0fd23cfca694502980b av-special-heading-h3 custom-color-heading blockquote modern-quote  avia-builder-el-2  el_after_av_heading  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >What does <span class='special_amp'>\u201c<\/span>topical<span class='special_amp'>\u201d<\/span> mean?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Prescription instructions for any medication include the route in which the medication is meant to be administered. \u00a0Some examples of routes are: oral, inhaled, under the tongue, injected, etc.<\/p>\n<p>The definition of\u00a0<a href=\"http:\/\/www.fda.gov\/Drugs\/DevelopmentApprovalProcess\/FormsSubmissionRequirements\/ElectronicSubmissions\/DataStandardsManualmonographs\/ucm071667.htm\" target=\"_blank\" rel=\"noopener noreferrer\">topical<\/a>\u00a0is, \u201ca medication that is administered to a\u00a0<i>particular spot<\/i>\u00a0on the outer surface of the body.\u201d\u00a0Outer surfaces of the body include skin and mucous membranes.<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-1952920aa10301e34f9eb0f1eb81d646\">\n#top .av-special-heading.av-av_heading-1952920aa10301e34f9eb0f1eb81d646{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-1952920aa10301e34f9eb0f1eb81d646 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-1952920aa10301e34f9eb0f1eb81d646 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-1952920aa10301e34f9eb0f1eb81d646 av-special-heading-h3 blockquote modern-quote  avia-builder-el-4  el_after_av_textblock  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >What are Topical Steroids?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><a href=\"http:\/\/www.nhs.uk\/conditions\/Corticosteroid-(drugs)\/Pages\/Introduction.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">Corticosteroids<\/a>, often known as steroids, are an anti-inflammatory medication prescribed for a wide range of conditions. They are a synthetic, or man-made, version of hormones normally produced by the adrenal glands (two small glands that sit on top of the kidneys).<\/p>\n<div>\n<p>Steroids mimic natural hormones produced in the body, including glucocorticoids (such as cortisol) and mineralocorticoids (such as aldosterone).\u00a0 Topical steroids vary in structure depending the type of synthetic hormone incorporated, whether alone or combined with other adrenal cortex hormones.<\/p>\n<\/div>\n<p dir=\"ltr\">The adrenal hormones of topical steroids are not related to the\u00a0<a href=\"http:\/\/medical-dictionary.thefreedictionary.com\/androgenic\" target=\"_blank\" rel=\"noopener noreferrer\">androgenic<\/a>\u00a0hormones of\u00a0<a href=\"http:\/\/www.drugabuse.gov\/publications\/drugfacts\/anabolic-steroids\" target=\"_blank\" rel=\"noopener noreferrer\">anabolic steroids<\/a>\u00a0\u00a0(often abused by body-builders to increase muscle mass).<\/p>\n<p>Topical steroids can reduce inflammation (redness and swelling), suppress the immune system, and narrow the blood vessels in the skin. Their main purpose is to reduce skin inflammation and irritation.<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-2c8019d0d5c96943c2546adcd83f050c\">\n#top .av-special-heading.av-av_heading-2c8019d0d5c96943c2546adcd83f050c{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-2c8019d0d5c96943c2546adcd83f050c .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-2c8019d0d5c96943c2546adcd83f050c .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-2c8019d0d5c96943c2546adcd83f050c av-special-heading-h3 blockquote modern-quote  avia-builder-el-6  el_after_av_textblock  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >How do they work?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Topical steroids are absorbed into the cells of the skin. The mechanism of the anti-inflammatory activity of the topical steroids, in general, is unclear. \u00a0(source: paragraph 12.1 \u201c<a href=\"https:\/\/www.merck.com\/product\/usa\/pi_circulars\/e\/elocon_cream\/elocon_cream_pi.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">Mechanism of Action<\/a>\u201d\u00a0)<\/p>\n<p>It is believed that topical steroids stop skin cells from producing various inflammation-causing chemicals that are normally released when the skin reacts to allergens or irritation.<\/p>\n<p>These inflammation-causing chemicals, including prostaglandins and leukotrienes, cause blood vessels to widen (vasodilate) and signal other inflammatory substances to arrive. This results in the affected area of skin becoming red, swollen and itchy.<\/p>\n<p>By preventing these inflammatory chemicals from being released in the skin, topical steroids reduce inflammation and relieve related symptoms such as itchiness.\u00a0Learn more about how corticosteroids work\u00a0<a href=\"http:\/\/www.netdoctor.co.uk\/skin_hair\/eczema_corticosteroids_003762.htm#ixzz3Y8tiBpHZ\" target=\"_blank\" rel=\"noopener noreferrer\">here<\/a>.<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-fcf3975e7e29c3a876af8b782b123498\">\n#top .av-special-heading.av-av_heading-fcf3975e7e29c3a876af8b782b123498{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-fcf3975e7e29c3a876af8b782b123498 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-fcf3975e7e29c3a876af8b782b123498 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-fcf3975e7e29c3a876af8b782b123498 av-special-heading-h3 blockquote modern-quote  avia-builder-el-8  el_after_av_textblock  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >Are Topical Steroids considered safer than steroids that are injected or taken by mouth?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Topical medications are thought to have limited absorption, while medications taken by mouth or injected are considered to have systemic absorption. However, absorption of topical steroids can vary greatly depending on many factors:<\/p>\n<ul>\n<li><b>Age<\/b>\u00a0\u2013 The very young and very old have higher rates of absorption due to thinner skin.\u00a0Children also have a\u00a0greater body surface area to weight ratio and are\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4171913\/\" target=\"_blank\" rel=\"noopener noreferrer\">less able to metabolize the drug quickly.<\/a><\/li>\n<\/ul>\n<ul>\n<li><strong><a href=\"http:\/\/dermnetnz.org\/treatments\/topical-steroids.html\" target=\"_blank\" rel=\"noopener noreferrer\">Thickness of the<\/a><a href=\"http:\/\/dermnetnz.org\/treatments\/topical-steroids.html\" target=\"_blank\" rel=\"noopener noreferrer\">\u00a0s<\/a><a href=\"http:\/\/dermnetnz.org\/treatments\/topical-steroids.html\" target=\"_blank\" rel=\"noopener noreferrer\">kin<\/a><\/strong>\u00a0\u2013 Thin skin is able to absorb more steroids than thick skin. Skin thickness varies with age and region of the body. Areas of thinner skin include: eyelids, face or genitals. Skin can also become thinner with high potency or long-term steroid use, or both.<\/li>\n<\/ul>\n<ul>\n<li><b>Condition of the skin<\/b>\u00a0\u2013 Absorption is increased on open, cracked, or raw skin, or skin that has lesions. The type of lesion topical steroids are applied to also play a part in absorption.<\/li>\n<\/ul>\n<ul>\n<li><b>Percentage of the body surface area treated<\/b>\u00a0\u2013 Treating large areas of the body allows for greater absorption, especially in children where there is a higher ratio of skin surface area to body mass. For instance, topical steroid drug inserts state, \u201cPediatric patients applying topical corticosteroids to greater than 20% of body surface are at higher risk of HPA axis suppression\u201d(source: Momemtasone furoate cream 0.1%\u00a0<a href=\"https:\/\/www.merck.com\/product\/usa\/pi_circulars\/e\/elocon_cream\/elocon_cream_pi.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">prescription information<\/a>, paragraph 8.4)<\/li>\n<\/ul>\n<ul>\n<li><b>Time frame used<\/b>\u00a0\u2013 Usage for longer periods of time, especially without breaks, increases absorption. \u201cDo not use daily TCS [topical corticosteroids] continuously for more than two to four weeks . . . Your provider should strive to help create a safe and effective long-term treatment plan that\u00a0<i>does not include daily use of TCS<\/i>, especially on more sensitive areas.<b>\u201d<\/b>\u00a0\u00a0source:\u00a0<a href=\"http:\/\/nationaleczema.org\/education-announcement-topical-corticosteroids-eczema\/\" target=\"_blank\" rel=\"noopener noreferrer\">National Eczema Association<\/a><\/li>\n<\/ul>\n<ul>\n<li><b>Vehicle<\/b>\u00a0\u2013 Ointments are absorbed more than creams, creams more than lotions, etc.<\/li>\n<\/ul>\n<ul>\n<li><b>Occlusion<\/b>\u00a0\u2013 Topical steroid-treated areas covered by tight-fitting pajamas or clothes, gauze wraps, bandages, diapers, or any other means of occlusion, increases the level of absorption.<\/li>\n<\/ul>\n<ul>\n<li><strong><a href=\"https:\/\/www.nursingcenter.com\/journalarticle?Article_ID=1181266&amp;Journal_ID=417221&amp;Issue_ID=1181101\" target=\"_blank\" rel=\"noopener noreferrer\">Site treated<\/a><\/strong>\u00a0\u2013 Certain areas of skin absorb more than others, such as areas that rub together (between the thighs or buttocks or under the breasts), as well as the face, genitals, eyelids and underarms (axilla).<\/li>\n<\/ul>\n<ul>\n<li><strong>Concurrent use of multiple steroid preparations<\/strong>\u00a0\u2013 Topical corticosteroids can be prescribed by many different practitioners at the same time (General Practitioner, Pediatrician, Allergist, Dermatologist, etc.) without being reconciled by each prescribing physician. Also, many patients are simultaneously prescribed other corticosteroid preparations in addition to topical steroids:\u00a0<a href=\"https:\/\/www.mayoclinic.org\/steroids\/art-20045692\" target=\"_blank\" rel=\"noopener noreferrer\">oral steroids<\/a>, inhalers, nebulizers, nasal sprays, eye drops, etc. Using multiple steroids at once, whether over-the-counter or prescription, has a cumulative effect.<\/li>\n<\/ul>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-686f0b1d3e5f3b6dc8e7722e3ac45581\">\n#top .av-special-heading.av-av_heading-686f0b1d3e5f3b6dc8e7722e3ac45581{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-686f0b1d3e5f3b6dc8e7722e3ac45581 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-686f0b1d3e5f3b6dc8e7722e3ac45581 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-686f0b1d3e5f3b6dc8e7722e3ac45581 av-special-heading-h3 blockquote modern-quote  avia-builder-el-10  el_after_av_textblock  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >What about topical steroid potency? What does potency mean?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Potency_(pharmacology)\" target=\"_blank\" rel=\"noopener noreferrer\">Potency<\/a>\u00a0is a measure of drug activity expressed in terms of the amount required to produce an effect of given intensity.\u00a0A highly potent drug evokes a larger response at low concentrations, while a drug of lower potency evokes a small response at low concentrations.<\/p>\n<p><a href=\"https:\/\/www.psoriasis.org\/about-psoriasis\/treatments\/topicals\/steroids\/potency-chart\" target=\"_blank\" rel=\"noopener noreferrer\">Topical steroids are classified by potency\u00a0<\/a>ranging from Class\u00a01 \u201cSuper Potent\u201d to\u00a0Class 7 \u201cLeast Potent\u201d topical steroids. Class 1 topical steroids such as Clobetasol propionate 0.05% or \u00a0Betamethasone dipropionate 0.05%, are up to\u00a0<a href=\"http:\/\/dermnetnz.org\/treatments\/topical-steroids.html\" target=\"_blank\" rel=\"noopener noreferrer\">600 times as potent<\/a>\u00a0as Class 7 Hydrocortisone.<\/p>\n<p>Potency is determined by\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3076132\" target=\"_blank\" rel=\"noopener noreferrer\">various\u00a0techniques.<\/a>\u00a0During\u00a0the\u00a0<a href=\"https:\/\/link.springer.com\/chapter\/10.1007%2F978-1-4899-1262-6_8\" target=\"_blank\" rel=\"noopener noreferrer\">vasoconstrictor assay<\/a>\u00a0the application of topical corticosteroid blanches the skin by constricting dermal blood vessels, and this level of blanching is evaluated to determine the potency of the steroid.\u00a0The\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/3076132\" target=\"_blank\" rel=\"noopener noreferrer\">mitotic index suppression method<\/a>\u00a0assesses anti-proliferative activity of skin cells that have been treated with topical steroids, resulting in less mitosis or cell division.\u00a0The\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20051715\" target=\"_blank\" rel=\"noopener noreferrer\">atrophogenic potential assay<\/a>\u00a0shows the ability of a compound to cause skin atrophy by measuring thickness of the skin before and after treatment with corticosteroids. (See table in sidebar.)<\/p>\n<p>The age of the patient is a major consideration for\u00a0determining the appropriate class and potency level. See sidebar for more information on topical steroid potency and age guidelines.<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_heading-298a5dac2ae1026c36e4afb351c77790\">\n#top .av-special-heading.av-av_heading-298a5dac2ae1026c36e4afb351c77790{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-av_heading-298a5dac2ae1026c36e4afb351c77790 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-av_heading-298a5dac2ae1026c36e4afb351c77790 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-av_heading-298a5dac2ae1026c36e4afb351c77790 av-special-heading-h3 blockquote modern-quote  avia-builder-el-12  el_after_av_textblock  el_before_av_textblock '><h3 class='av-special-heading-tag'  itemprop=\"headline\"  >What are some of the side effects of Topical Steroids?<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Side effects of topical steroid use fall into two categories: Systemic side effects and local side effects.<\/p>\n<p><a href=\"https:\/\/www.sciencedirect.com\/topics\/chemistry\/systemic-effect\" target=\"_blank\" rel=\"noopener noreferrer\">Systemic side effects<\/a>\u00a00ccur\u00a0in tissues distant from the site of contact. Topical\u00a0steroids become absorbed into the bloodstream and affect other\u00a0systems\u00a0of the body,\u00a0such as the eyes,\u00a0endocrine, immune, skeletal, and gastrointestinal systems, in addition to the integumentary system.<\/p>\n<p><a href=\"https:\/\/medical-dictionary.thefreedictionary.com\/drug+action?fbclid=IwAR2PT0nT54CzBY5IJ9-AAVyPsCZI70GB1gXimeUM16kSVUbY2dDrVgtDgKYmyNA\" target=\"_blank\" rel=\"noopener noreferrer\">Local side effects<\/a>\u00a0are those that adversely impact the skin at the site of application.<\/p>\n<\/div><\/section><br \/>\n<div  class='tabcontainer av-av_tab_container-0bacd910096d11a3cec6dfb538798966 top_tab  avia-builder-el-14  el_after_av_textblock  el_before_av_textblock ' role='tablist'>\n<section class='av_tab_section av_tab_section av-av_tab-d793b3a7f433be419716aef6565e1e20'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='tab active_tab' role='tab' tabindex='0' data-fake-id='#tab-id-1' aria-controls='tab-id-1-content'  itemprop=\"headline\" >Systemic side effects<\/div><div id='tab-id-1-content' class='tab_content active_tab_content' aria-hidden=\"false\"><div class='tab_inner_content invers-color'  itemprop=\"text\" ><p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4171913\/\" target=\"_blank\" rel=\"noopener noreferrer\">Systemic side effects<\/a>\u00a0occur\u00a0in tissues distant from the site of contact. Topical\u00a0steroids become absorbed into the bloodstream and affect other\u00a0systems\u00a0of the body,\u00a0such as the eyes,\u00a0endocrine, immune, skeletal, and gastrointestinal systems, in addition to the integumentary system.<\/p>\n<ul>\n<li><a href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/ency\/article\/000410.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Cushing syndrome<\/a>: A condition that occurs from exposure to high cortisol levels for an extended period of time (such as long term exposure to cortisol present in\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/18183788\" target=\"_blank\" rel=\"noopener noreferrer\">topical steroids<\/a>).<\/li>\n<li><a href=\"https:\/\/en.wikipedia.org\/wiki\/Hypothalamic%E2%80%93pituitary%E2%80%93adrenal_axis\" target=\"_blank\" rel=\"noopener noreferrer\">Hypothalamic-Pituitary-Adrenal (HPA) axis suppression<\/a>: \u00a0the\u00a0<a href=\"http:\/\/test.classconnection.s3.amazonaws.com\/144\/flashcards\/127144\/png\/hpa_axis.png\">HPA axis<\/a>\u00a0is a highly interdependent endocrine unit which monitors various hormone levels and responds by releasing appropriate stimulatory or inhibitory hormones.\u00a0<a href=\"https:\/\/www.medpagetoday.org\/dermatology\/steroids\/777\" target=\"_blank\" rel=\"noopener noreferrer\">Depressed HPA activity<\/a>\u00a0is characterized by decreased levels of cortisol production, and can occur due to the supplementation of synthetic cortisol in topical steroid preparations. Impairment may be confined solely to adrenals or extend to the hypothalamus and pituitary glands and their respective hormones.<\/li>\n<li><a href=\"http:\/\/www.diabetes.co.uk\/steroid-induced-diabetes.html\" target=\"_blank\" rel=\"noopener noreferrer\">Hyperglycemia\/Type 2 diabetes:<\/a>\u00a0Corticosteroids increase insulin resistance thus allowing blood glucose levels to rise and remain higher.<\/li>\n<li><a href=\"http:\/\/www.mayoclinic.org\/diseases-conditions\/high-blood-pressure\/basics\/definition\/con-20019580\" target=\"_blank\" rel=\"noopener noreferrer\">Hypertension<\/a>: elevated blood pressure<\/li>\n<li><a href=\"http:\/\/www.mayoclinic.org\/diseases-conditions\/hirsutism\/basics\/definition\/con-20028919\" target=\"_blank\" rel=\"noopener noreferrer\">Hypertrichosis\/hirsutism<\/a>: excessive hair growth, or male patterned hair growth in women.<\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/2807493\" target=\"_blank\" rel=\"noopener noreferrer\">Ocular changes<\/a>:\u00a0<a href=\"https:\/\/www.nei.nih.gov\/health\/cataract\/cataract_facts\" target=\"_blank\" rel=\"noopener noreferrer\">cataracts<\/a>,\u00a0<a href=\"https:\/\/www.nei.nih.gov\/health\/glaucoma\/glaucoma_facts\" target=\"_blank\" rel=\"noopener noreferrer\">glaucoma<\/a>,\u00a0<a href=\"http:\/\/www.allaboutvision.com\/conditions\/hypertension.htm\" target=\"_blank\" rel=\"noopener noreferrer\">occular hypertension<\/a><\/li>\n<li><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3383483\/\" target=\"_blank\" rel=\"noopener noreferrer\">Osteoporosis<\/a>: bones become weak or brittle<\/li>\n<li><a href=\"http:\/\/adc.bmj.com\/content\/87\/2\/93.long\" target=\"_blank\" rel=\"noopener noreferrer\">Linear Growth Retardation<\/a>: suppression of the pituitary gland (due to HPA axis suppression) leads to stunted growth in children.<\/li>\n<li><a href=\"https:\/\/www.itsan.org\/us\/what-is-tsw-syndrome\/\" target=\"_blank\" rel=\"noopener noreferrer\">Topical Steroid Withdrawal Syndrome:<\/a>\u00a0also known as Topical Steroid Addiction (TSA) or Red Skin Syndrome (RSS), can arise from topical steroids being applied to the skin for medical or cosmetic purposes. Characterized by red, itchy, stinging, burning skin which appears after ceasing topical steroid treatments, or even between treatments. As topical steroid therapy is withdrawn to effectively treat\u00a0TSWS, multiple local and systemic symptoms emerge and\u00a0eventually\u00a0resolve\u00a0over a long period of\u00a0time.<\/li>\n<\/ul>\n<\/div><\/div><\/section>\n<section class='av_tab_section av_tab_section av-av_tab-fd94ff0236ce2612309b4ceb5505191d'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='tab' role='tab' tabindex='0' data-fake-id='#tab-id-2' aria-controls='tab-id-2-content'  itemprop=\"headline\" >Local side effects<\/div><div id='tab-id-2-content' class='tab_content' aria-hidden=\"true\"><div class='tab_inner_content invers-color'  itemprop=\"text\" ><p><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4228634\/\" target=\"_blank\" rel=\"noopener noreferrer\">Local side effects:<\/a>\u00a0are those that adversely impact the skin at the site of application.<\/p>\n<ul>\n<li>Redness, stinging, sensitivity<\/li>\n<li><a href=\"http:\/\/dermskinhealth.com\/services\/perioral-dermatitis\" target=\"_blank\" rel=\"noopener noreferrer\">Perioral<\/a>\u00a0dermatitis\/<a href=\"http:\/\/dermnetnz.org\/acne\/perioral-dermatitis.html\" target=\"_blank\" rel=\"noopener noreferrer\">periocular<\/a>\u00a0dermatitis \u2013 redness, small red bumps, and\/or mild peeling, accompanied by mild itching and\/or burning occurring around the mouth or eyes; secondary to topical steroids being applied to the face, whether intentionally or accidentally transferred.<\/li>\n<li><a href=\"http:\/\/www.rosacea.org\/weblog\/great-impostor-steroid-induced-rosacea\" target=\"_blank\" rel=\"noopener noreferrer\">Rosacea aggravation or induction<\/a><\/li>\n<li>Exacerbation of bacterial and fungal skin infections:\u00a0<a href=\"http:\/\/www.webmd.com\/skin-problems-and-treatments\/guide\/understanding-impetigo-basics\" target=\"_blank\" rel=\"noopener noreferrer\">Impetigo<\/a>,\u00a0<a href=\"http:\/\/www.mayoclinic.org\/diseases-conditions\/mrsa\/basics\/definition\/con-20024479\" target=\"_blank\" rel=\"noopener noreferrer\">MRSA<\/a>,\u00a0<a href=\"https:\/\/dermnetnz.org\/topics\/tinea-incognita\/\" target=\"_blank\" rel=\"noopener noreferrer\">Tinea incognito<\/a>, and others.<\/li>\n<li><a href=\"http:\/\/dermnetnz.org\/dermatitis\/corticosteroid-allergy.html\" target=\"_blank\" rel=\"noopener noreferrer\">Contact dermatitis<\/a>: primarily due to preservatives, lanolin, or other vehicle components.<\/li>\n<li>Delayed wound healing: topical steroids suppress the immune response to treat inflammation, but this also affects the ability to heal.<\/li>\n<li>Hyper- or Hypo-pigmentation: changes in skin color, with either a temporary darkening or bleaching effect on the skin.<\/li>\n<li>Skin atrophy: loss of skin tone<\/li>\n<li>Thinning, fragile skin<\/li>\n<li>Easy bruising<\/li>\n<li><a href=\"https:\/\/dermnetnz.org\/topics\/stretch-marks-striae\/\" target=\"_blank\" rel=\"noopener noreferrer\">Striae<\/a>: permanent stretch marks \u2013 narrow, streak-like, shiny lines in the skin.<\/li>\n<li><a href=\"https:\/\/medlineplus.gov\/ency\/article\/003284.htm\" target=\"_blank\" rel=\"noopener noreferrer\">Telangiectasia<\/a>: dilated capillaries of the skin, often appearing as small red or purple clusters, often spidery in appearance.<\/li>\n<\/ul>\n<\/div><\/div><\/section>\n<\/div><br \/>\n<section  class='av_textblock_section av-av_textblock-2de302bf1aa3cf4c9157dbe6f50ac7eb '   itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class='avia_textblock'  itemprop=\"text\" ><p>Source: Meyler\u2019s Side Effects of Endocrine and Metabolic Drugs, Jeffrey K. Aronson, Elsevier 2009, page 93.<\/p>\n<p>View\u00a0a\u00a0<a href=\"https:\/\/books.google.com\/books?id=BWMeSwVwfTkC&amp;pg=PA93&amp;lpg=PA93&amp;dq=is+cataracts+from+topical+steroids+a+systemic+side+effect?&amp;source=bl&amp;ots=W8g1qhqx6F&amp;sig=cbO0234xP4_UbewMZyPEIbl8J7E&amp;hl=en&amp;sa=X&amp;ei=L889VZWCIM_ToASMvoHYDg&amp;ved=0CGgQ6AEwCQ#v=onepage&amp;q=is%20cataracts%20from%20topical%20steroids%20a%20systemic%20side%20effect%3F&amp;f=false\" target=\"_blank\" rel=\"noopener noreferrer\">full list of local and systemic side effects here<\/a>.<\/p>\n<h5 data-fontsize=\"12\" data-lineheight=\"21\">Please keep in mind\u00a0that\u00a0\u00a0ITSAN does not provide medical advice. We\u00a0ask that you always\u00a0consult your doctor for questions, or when making decisions\u00a0about\u00a0your medical treatment.<\/h5>\n<\/div><\/section><\/p><\/div>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_one_third-c8fc129dc35fd1ae2a1e410224d39ea8\">\n.flex_column.av-av_one_third-c8fc129dc35fd1ae2a1e410224d39ea8{\nborder-radius:0px 0px 0px 0px;\npadding:0px 0px 0px 0px;\n}\n<\/style>\n<div  class='flex_column av-av_one_third-c8fc129dc35fd1ae2a1e410224d39ea8 av_one_third  avia-builder-el-16  el_after_av_two_third  avia-builder-el-last  flex_column_div av-zero-column-padding  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-av_image-06856791d0616cacfa93334ba753cff7\">\n.avia-image-container.av-av_image-06856791d0616cacfa93334ba753cff7 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-av_image-06856791d0616cacfa93334ba753cff7 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-av_image-06856791d0616cacfa93334ba753cff7 av-styling-circle avia-align-center  avia-builder-el-17  el_before_av_icon_box  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" class='wp-image-52 avia-img-lazy-loading-not-52 avia_image ' src=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/hand.jpg\" alt='' title='Man Uses Hand Cream'  height=\"400\" width=\"600\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/hand.jpg 600w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/hand-300x200.jpg 300w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/hand-450x300.jpg 450w\" sizes=\"(max-width: 600px) 100vw, 600px\" \/><\/div><\/div><\/div><br \/>\n<article  class='iconbox iconbox_left av-av_icon_box-c85547da61c3ae2a05006194de7d8857  avia-builder-el-18  el_after_av_image  el_before_av_icon_box '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconbox_content\"><header class=\"entry-content-header\"><div class=\"iconbox_icon heading-color\" aria-hidden='true' data-av_icon='\ue81f' data-av_iconfont='entypo-fontello'><\/div><h3 class='iconbox_content_title '  itemprop=\"headline\" >Structural classification<\/h3><\/header><div class='iconbox_content_container '  itemprop=\"text\" ><p>Topical steroids are categorized by\u00a0<a href=\"https:\/\/www.dermatitisacademy.com\/wp-content\/uploads\/2016\/06\/DrugGuide1006.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">structural class<\/a>:\u00a0Different structural classes of steroids will cross-react with each other to cause hypersensitivity reactions.<\/p>\n<div class=\"fusion-table table-2\">\n<table>\n<tbody>\n<tr>\n<td width=\"35%\">Class A:<\/td>\n<td>hydrocortisone type<\/td>\n<\/tr>\n<tr>\n<td>Class B:<\/td>\n<td>triamcinolone acetonide type<\/td>\n<\/tr>\n<tr>\n<td>Class C:<\/td>\n<td>betamethasone type<\/td>\n<\/tr>\n<tr>\n<td>Class D1:<\/td>\n<td>betamethasone dipropionate type<\/td>\n<\/tr>\n<tr>\n<td>Class D2:<\/td>\n<td>methylprednisolone aceponate type<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><br \/>\n<article  class='iconbox iconbox_left av-av_icon_box-c32add1891eab96a674390c3b723daa8  avia-builder-el-19  el_after_av_icon_box  el_before_av_icon_box '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconbox_content\"><header class=\"entry-content-header\"><div class=\"iconbox_icon heading-color\" aria-hidden='true' data-av_icon='\ue81f' data-av_iconfont='entypo-fontello'><\/div><h3 class='iconbox_content_title '  itemprop=\"headline\" >Age guidelines<\/h3><\/header><div class='iconbox_content_container '  itemprop=\"text\" ><p>Age guidelines\u00a0for topical steroids (source\u00a0<a href=\"http:\/\/nationaleczema.org\/eczema\/treatment\/topical-corticosteroids\/basics-of-topical-corticosteroids\/\" target=\"_blank\" rel=\"noopener noreferrer\">NEA<\/a>). Click to enlarge:<\/p>\n<p><a href=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_02.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-53\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_02.jpg\" alt=\"\" width=\"412\" height=\"267\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_02.jpg 412w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_02-300x194.jpg 300w\" sizes=\"auto, (max-width: 412px) 100vw, 412px\" \/><\/a><\/p>\n<\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><br \/>\n<article  class='iconbox iconbox_left av-av_icon_box-adc92aa020cd7b36a8572dcf6c16d358  avia-builder-el-20  el_after_av_icon_box  el_before_av_icon_box '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconbox_content\"><header class=\"entry-content-header\"><div class=\"iconbox_icon heading-color\" aria-hidden='true' data-av_icon='\ue81f' data-av_iconfont='entypo-fontello'><\/div><h3 class='iconbox_content_title '  itemprop=\"headline\" >Absorption<\/h3><\/header><div class='iconbox_content_container '  itemprop=\"text\" ><p>Different parts of the body absorb topical steroids at different rates.<\/p>\n<p><a href=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/body_absorption.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-58\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/body_absorption.jpg\" alt=\"\" width=\"500\" height=\"600\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/body_absorption.jpg 500w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/body_absorption-250x300.jpg 250w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/body_absorption-450x540.jpg 450w\" sizes=\"auto, (max-width: 500px) 100vw, 500px\" \/><\/a><\/p>\n<p>Source: Walden, Pamela BSN, RN, OCN, Hardaway, Ann MSN, RN, Petrus, Brenda BSN, RN, OCN\u00a0\u201c<a href=\"https:\/\/www.nursingcenter.com\/journalarticle?Article_ID=1181266&amp;Journal_ID=417221&amp;Issue_ID=1181101\">Med Check: Not just skin deep: Topical steroids<\/a>\u201d,\u00a0<i>Nursing Made Incredibly Easy!\u00a0<\/i>July\/August 2011, Volume :9 Number 4, page 49 \u2013 50.<\/p>\n<\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><br \/>\n<article  class='iconbox iconbox_left av-av_icon_box-93e9ef6ba232e3c3f3e299426627f791  avia-builder-el-21  el_after_av_icon_box  el_before_av_icon_box '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconbox_content\"><header class=\"entry-content-header\"><div class=\"iconbox_icon heading-color\" aria-hidden='true' data-av_icon='\ue81f' data-av_iconfont='entypo-fontello'><\/div><h3 class='iconbox_content_title '  itemprop=\"headline\" >Potency classification<\/h3><\/header><div class='iconbox_content_container '  itemprop=\"text\" ><p>Common topical steroids by potency class (source\u00a0<a href=\"http:\/\/nationaleczema.org\/eczema\/treatment\/topical-corticosteroids\/basics-of-topical-corticosteroids\/\" target=\"_blank\" rel=\"noopener noreferrer\">NEA<\/a>, see also\u00a0<a href=\"https:\/\/www.psoriasis.org\/about-psoriasis\/treatments\/topicals\/steroids\/potency-chart\" target=\"_blank\" rel=\"noopener noreferrer\">psoriasis.org<\/a>). Click to enlarge:<\/p>\n<p><a href=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_01.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-55\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_01.jpg\" alt=\"\" width=\"412\" height=\"772\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_01.jpg 412w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_01-160x300.jpg 160w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/topical_corticosteroids_table_01-376x705.jpg 376w\" sizes=\"auto, (max-width: 412px) 100vw, 412px\" \/><\/a><\/p>\n<\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><br \/>\n<article  class='iconbox iconbox_left av-av_icon_box-ce5693fe3835439569207ec4666509cf  avia-builder-el-22  el_after_av_icon_box  avia-builder-el-last '  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/CreativeWork\" ><div class=\"iconbox_content\"><header class=\"entry-content-header\"><div class=\"iconbox_icon heading-color\" aria-hidden='true' data-av_icon='\ue81f' data-av_iconfont='entypo-fontello'><\/div><h3 class='iconbox_content_title '  itemprop=\"headline\" >How Potency is Established<\/h3><\/header><div class='iconbox_content_container '  itemprop=\"text\" ><p>Click to enlarge:<\/p>\n<p><a href=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-56\" src=\"https:\/\/itsan.net\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established.png\" alt=\"\" width=\"1280\" height=\"540\" srcset=\"https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established.png 1280w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established-300x127.png 300w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established-1030x435.png 1030w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established-768x324.png 768w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established-705x297.png 705w, https:\/\/www.itsan.org\/us\/wp-content\/uploads\/2021\/05\/How-Potency-is-Established-450x190.png 450w\" sizes=\"auto, (max-width: 1280px) 100vw, 1280px\" \/><\/a><\/p>\n<p>Source: Goa, K.L. Clinical Pharmacology and Pharmacokinetic Properties of Topically Applied Corticosteroids.\u00a0<i>Drugs<\/i>\u00a036, 51\u201361 (1988).\u00a0<a href=\"https:\/\/doi.org\/10.2165\/00003495-198800365-00011\">https:\/\/doi.org\/10.2165\/00003495-198800365-00011<\/a><\/p>\n<\/div><\/div><footer class=\"entry-footer\"><\/footer><\/article><\/p><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"give_campaign_id":0,"footnotes":""},"class_list":["post-48","page","type-page","status-publish","hentry"],"campaignId":"","_links":{"self":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/48","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/comments?post=48"}],"version-history":[{"count":5,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/48\/revisions"}],"predecessor-version":[{"id":51,"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/pages\/48\/revisions\/51"}],"wp:attachment":[{"href":"https:\/\/www.itsan.org\/us\/wp-json\/wp\/v2\/media?parent=48"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}