Steroid ointments.

Steroidal topical ointments are the most commonly prescribed treatment for dermatitis. All steroid ointments, except hydrocortisone cream, need to be prescribed by your doctor. They come in various strengths and are rated I (strongest) through VII (weakest).

These creams work by constricting the blood vessels in the upper layer of the dermis. This constriction reduces the itching and inflammation associated with dermatitis. When the itching and inflammation subside, so do most of the other symptoms. The stronger the cream, the more the blood vessels will be constricted.

Steroid creams are effective in reducing the symptoms of dermatitis; however, they do not come without side effects. Working closely with your doctor and being fully aware of these side effects is the best way to minimize your risk and get the best results from this type of treatment. Some of the most common side effects are:

Tachyphylaxis – When the skin builds up a tolerance to the strength of steroid you are using, it can lead to an inability of the blood vessels to constrict, and you may then require a stronger prescription. This can occur after four or more days of continued applications three times per day. Stopping use for four or more days will generally allow your blood vessels to regain their ability to constrict.

Steroid rosacea – Fair-skinned people are the most commonly affected by this side effect. It occurs when a tolerance to the steroid is built up in the skin, leading to a return of the facial flushing and the need for a stronger prescribed cream. Any attempt to cut back or stop the steroid generally leads to a return of the flushing.

Skin atrophy – Repeated use of steroid cream in the same area leads to progressive thinning of the skin. The skin can become lax, wrinkled, shiny and depressed below normal levels. Stopping the steroid will reverse most of these effects, but it can take months for the skin to re-thicken.

Striae/stretch marks – These occur when steroid cream is applied to areas of the body where skin touches skin, e.g., armpits or groin. Once stretch marks of the skin appear they are irreversible, and oftentimes become irritated to the point where they need their own treatment. The best approach when this happens is to stop the use of steroidal cream to arrest further damage.

Topical steroid allergy – Testing has revealed that 4–5% of people with dermatitis who are prescribed steroidal creams experience an allergy to components of the cream itself. Those using multiple prescriptions or over-the-counter medications who have chronic skin conditions are at greater risk for an allergic response to topical steroids. It is recommended that the use of these creams be stopped if you experience an allergic reaction.

Alteration of immunity – Steroids alter the way your immune system works, so the skin can become more vulnerable to bacterial or fungal infection with their use. If the cream is then applied to skin overtop a bacterial or fungal infection, it can cause it to become more irritated.

Glaucoma – There are isolated reports of links between steroids (even topical kinds) and glaucoma. Glaucoma is an infection inside the eye which causes increased pressures on the optic nerve and if left untreated can lead to blindness.