August 12, 2024 • 15 mins
“...some people are concerned about topical steroids and I believe rightly so. And for some people, not only do they not work all that well, but they can actually cause quite dramatic and devastating inflammation in the skin.” Dr George Moncrieff
In this 15-minute podcast, your hosts Dr George Moncrieff and Dr Roger Henderson will discuss some of the problems associated with topical steroids. They give an insight into why doctors might prescribe them, along with what advice you should receive before using your topical steroid.
Other key points they cover include:
- The benefits and pitfalls of topical steroids.
- How long you should be using a topical steroid for.
- How topical steroids affect the skin.
- How using the fingertip unit can help you apply the right amount of topical steroid.
- Can you be allergic to topical steroids?
- What skin conditions can be made worse by a topical steroid?
Thank you to our kind sponsor AproDerm, who provide a range of emollients designed for the management of dry skin conditions, including eczema, psoriasis and ichthyosis.
Everyone’s skin is unique and what works for one person, may not work for another. That’s why AproDerm has developed the AproDerm Emollient Starter Pack. This pack contains all four of their emollients varying in their formulation, consistency and hydration, giving you the choice to find a routine that suits you.
Find out more here.
IG: https://www.instagram.com/aproderm/
FB: https://www.facebook.com/AproDerm
We hope you find this podcast interesting and helpful. Please leave us a review or email info@aproderm.com with any feedback on this episode or suggestions on dermatology topics that you would like to hear about in future podcasts.
The views expressed in this podcast are of Dr George Moncrieff and Dr Roger Henderson. Fontus Health has not influenced, participated, or been involved in the programme, materials, or delivery of educational content.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:07):
Hello and welcome again to this Skin Deeppodcast where we look at skin-related
issues, conditions and treatments inan interesting and informative way.
I'm Dr Roger Henderson.
I've been a doctor in the NHSfor about 40 years and I've
got a long-standing interest inthis particular area of health.
And I'm Dr George Moncrieff.
I was a GP although I've now retiredfrom my practice and I am a primary care
(00:30):
advisor to the National Eczema Society.
And I am a former Chair of theDermatology Council for England.
Now, many of you listening to ustoday may be using topical steroids.
Today, George and I are going to betalking about these, in particular,
(00:51):
some of the problems that canbe associated with their use.
But I think right at the start ofthis podcast, George and I are really
quite keen to say that we are bothenormous fans of using topical steroids.
And I don't think either ofus could have ever practised
dermatology without using them.
And I think that's probablyright, isn't it, George?
(01:12):
It would be impossible.
They are amazing treatments for somany really unpleasant skin conditions.
And the vast majority of people who use atopical steroid gain enormous benefit and
experience no significant side effects.
So we don't want to get acrossthe impression for a moment that
(01:34):
we are anti topical steroids.
They have a fundamental role,a cornerstone of the management
of so much skin disease.
And yeah, the idea of trying to practisemedicine without them would be untenable.
So yes, they do work for a lot of peoplewhen they're used correctly and sensibly.
However, some people are concerned abouttopical steroids and I believe rightly so.
(01:59):
And for some people, not only do theynot work all that well, but they can
actually cause quite dramatic anddevastating inflammation in the skin.
And this is an area I believereally needs much more research
and better understanding bythe profession in particular.
Largely because of thedevastating consequences this
can have for these individuals.
(02:20):
Absolutely, and this is something thatwe're going to be exploring in much
more detail with our special guestBriana Banos in the second of these
episodes on topical steroid concerns.
And so that's a thread that's goingto be running through all this
podcast with George and myself.
Um, but certainly my experience whenI'm prescribing a topical steroid,
(02:41):
one of the comments that sometimesa patient will say to me is, "oh,
don't they thin the skin, Doctor?"
And technically that is correct.
Although for the vast majority ofpeople, they don't use the steroids for
long enough for that to be an impact.
But we can't pretend itdoesn't happen, can we?
No we certainly can't.
(03:01):
They do thin the skin and that is animportant, really important, point.
Topical steroids are notintended to be used long-term.
But that doesn't mean they don'tend up being needed long-term.
For example, if you've got moderateatopic eczema, the chances are you're
going to have about 9 flares a year.
(03:22):
And each time you have a flare, youmay well need to use a topical steroid
for, well, a minimum two weeks,probably four weeks, maybe longer.
So you can see how you can endup using a topical steroid on and
off for months and months on end.
And we do know that the skin startsto show signs of thinning and
that can start after six weeks ofsteroid use and in some cases can
(03:45):
happen in as little as two weeks.
Particularly, if you put it on areasof skin that are already quite thin.
So yes, they do thin the skin,and that is really concerning.
And I think patients are right tobring that to attention and right
to be alert to that possibility.
They do get absorbed a bitand we'll come on to that.
(04:05):
In the deeper layers of the skin, you havea very important protein called collagen.
And one of the functions of collagenis to provide support for the skin.
If you haven't got that support, theskin can stretch, you get stretch marks.
And blood vessels aren'tas well supported.
So if you knock those, theycan bruise under the skin.
(04:26):
The steroids have many othereffects on the skin, weakening
what we call the skin barrier.
The skin barrier is thisimportant outer part of our body
that prevents water escaping.
Without it, we would die ina few hours from dehydration.
And it prevents bad things likebacteria and allergens getting
through the skin and causing problems.
(04:47):
But there are a lot of really quitesophisticated things going on in
that barrier which steroids mess up.
For example, they raise the pH,rendering the skin alkaline.
Normally, the surface ofthe skin is slightly acidic.
And that's not by chance, it's by design.
And if you raise the pH, rendering italkaline, you alter the activity of a
(05:10):
number of things going on in the skin.
Which make the skin barriereven more vulnerable and weaker.
And of course, all these issuesto do with the barrier are more
worrying in the areas of the bodywhere you've got very thin skin.
Where the barrier already is vulnerable.
But that's where you get eczema,and that's where you therefore
need to put the steroids.
(05:32):
Older people, and even more importantlyin infants, the skin is particularly thin.
And so, if it's starting off thinand vulnerable, putting a steroid on
there is potentially more worrying.
So that is a real cause for concern.
And I think when people say thatto us, they're absolutely right.
That's why we need to be using themresponsibly and ideally for just short
(05:55):
bursts for a couple of weeks when we can.
Agreed.
And one of the beauties thatwe like as doctors is that
they are very easily absorbed.
They're quite small molecules youget in the topical steroids, so
the skin soaks them up very fast.
But again, we can run intoa bit of a double whammy, if
(06:15):
we're not too careful here.
If you've got skin that's got a littlebit thinner from using them and the skin
is absorbing them quite fast, it canstart to absorb more steroid than perhaps
we might want that patient to be using.
Yeah, and get down into that deeperlayer of the skin or occasionally
(06:36):
get absorbed into the body.
And we do know that, for example,in infants who have a very large
surface area compared to theirbodyweight when compared to adults,
that ratio is not in their favour.
If you treat large areas of skin inan infant, the amount of steroid that
they absorb can have an effect on theirbody's ability to make normal steroids.
(06:57):
And that can be worrying, or it canhave more side effects generally.
The other thing to bear in mind is thatif you're putting a steroid onto thin
skin areas, like around the eye, andthat's where you get eczema, and that's
where you often need to use a steroid.
Up to 30% of that steroid getsthrough the skin and into the body.
I've even heard doctors saysteroids aren't absorbed.
(07:18):
They're wrong.
They are absorbed.
And of course, these thin skinareas are even more, as I was just
saying earlier, a bigger issue forthe very young and the very old.
Um, so it is something we needto think about, particularly with
the more potent topical steroids.
And as you say, it is a vicious cycle.
The steroid is thinning theskin, causing more absorption,
(07:38):
which causes more thinning.
So, it is something to be aware of.
Going back to what I said right at thebeginning though, the vast majority
of people who use a topical steroiddo not run into these problems.
But it can happen, and it'ssomething we need to think about.
Absolutely, and I think, again, inprevious podcasts, you and I have often
talked about the importance of languagewhen you're trying to explain either skin
(08:01):
conditions or treatments to patients.
And I think topical steroids is areally good example of this, because
some people looking at their steroidpack today may see things like 'use
very sparingly' or 'avoid broken skin'.
What does 'sparingly' mean?
And is it a tiny dab behind theear once a week or is it lathered
(08:23):
over you in one go in one day?
So, we can run the risk of topicalsteroids being underused and then
almost being between a rock anda hard place where no one gets
better and no one is very happy.
And that's a reallyfrustrating scenario, isn't it?
One tip I'd share with you, is ifyou're going to see a doctor about
(08:44):
your skin, why don't you put all yourtreatments in a large carrier bag?
All the treatments you're using.
The things you're using to wash yourselfwith, your hair with, the emollients
you're using, and most importantly,the treatments that you've been
prescribed or buying over-the-counter.
And take with you, for example,the topical steroid treatments.
Because I've seen patients who havebeen prescribed a topical steroid,
(09:06):
6 months ago, and they bring it withthem and it's barely been touched.
And they're saying, "why isn'tmy condition getting better?"
I look at them and say, "haveyou been using the treatment?"
"Yes, I've been using it sparingly."
When we talk about topical steroids,we describe how much we expect people
to use, and we use the fingertip unit.
You squeeze it out and the distance fromthe end of the crease on the index finger
(09:28):
to the tip of the finger is half a gram.
And that should beenough to cover 2 palms.
So, if you're using it the way I'dexpect you to use it, you'd have got
through that tube in 2 and a half weeks.
And here we are 6 monthslater, it hasn't gone.
So yeah, the words like 'avoid brokenskin', well, eczema is broken skin and
that's where you've got to put it on.
(09:49):
And 'sparingly' justdoesn't mean anything.
So it is really frustrating when peopleare given well-intentioned, but misguided
advice to underuse their topical steroids.
And I don't want our advicetoday to fall into that trap.
They are superb treatments, butthey've got to be used responsibly.
(10:11):
Absolutely.
And if anyone listening is thinking,I'm not quite sure if I'm using
my topical steroid correctlyor how I should be using it.
What I would say, the real messagefrom the wayside pulpit here today is
just go and ask your pharmacist, askyour doctor, ask your practice nurse.
There is no such thing asa stupid question, ever.
So, do please get your mindclear as to how you should be
(10:34):
using your topical steroid.
And one other thing when you were justtalking there, George, that sort of
sprang into my head, patients willnot only talk about thinning of skin.
Increasingly over the last decade, Ifound the awareness of allergy being
much greater than it ever used to be.
And I've also heard healthcareprofessionals say to patients, "you
(10:56):
can't be allergic to topical steroids."
That couldn't be more wrong, could it?
It couldn't be more wrong, no.
Allergy to the topical steroidmolecule is well-documented, it was
first described in the last century.
And I think it's much more commonthan we as a profession recognise.
In fact, studies from Europe and theUSA have shown the incidence from
(11:20):
patch test clinic patients rangesfrom just 0.5% to over 10%, 10.7%.
So there's certainly a measurablenumber of patients who are allergic.
So it does exist.
Creams have a high-water contentand so need preservatives, which
is one of the reasons why I prefergenerally to prescribe ointments.
(11:41):
They have no water and sodon't need preservatives.
And allergies to the preservativesthat are used and other ingredients
in creams are even more commonthan allergy to topical steroids.
So you can imagine a realnightmare scenario there.
You've got an allergic conditioncaused by your topical steroid, which
a topical steroid should make better,but it's just adding fuel to that fire.
(12:03):
And so, you've got a real problemtrying to sort that all out.
It is an issue and we shouldn't dismissit and we need to take that seriously.
But we also mustn't forget thattopical steroids themselves
can affect our immune system.
They're powerfulimmune-suppressing agents.
Our immune system is really amarker of how well we can remain.
(12:24):
And I think that can also be aplus and a minus in their use.
Yes, topical steroids are prettypowerful broad immune-suppressing
agents, and that's how they work.
When the immune system is misbehaving,as it does in eczema, you can calm that
down and the eczema gets better usually.
(12:44):
But when you're depending on thatimmune system to keep an infection
at bay, as for example a fungalinfection, putting a steroid on that
just drives the fungus down deeper.
It drives it down into thedeeper layers of the skin.
And because it's now no longer onthe surface, it doesn't look scaly.
It's more difficult to diagnose andit's a lot more difficult to treat.
Putting a steroid on when there's someinfections can be an absolute disaster.
(13:09):
And then finally, there are a number ofskin conditions that I have never seen in
somebody who doesn't use topical steroids.
A classic example is perioraldermatitis, a not uncommon
condition usually in young women.
When they get spots or an eczematousrash around the mouth, strangely,
steroids initially seem to make that abit better, but then make it much worse.
(13:32):
So they use a stronger steroid,which makes it a bit better.
But then it gets even worse andyou're into this vicious cycle and
the only way of managing that inthe long run is to keep steroids
completely away from the face.
It also makes rosacea worse.
So there are some skin conditions, whichwe don't understand entirely why, but they
(13:52):
are caused and driven by topical steroids.
That's a nice place tocome full circle to.
And also just to remind everyonelistening to what we said right
at the top of this podcast.
That it's quite unusual, the vast majorityof people using topical steroids, um,
(14:14):
have no problems with them whatsoever.
They do what they say on the tin,they are safe, they are effective,
and much of what we've talked abouttoday doesn't actually happen.
But it is worthwhile, now in thisday and age, to just mention the
possibilities that people mayhave, especially if they're using
topical steroids in the longer-term.
(14:35):
And I do hope that you foundwhat George and I have said
today interesting and helpful.
And as always, if you do have anyquestions about your use of topical
steroids, do discuss them with yourdoctor or healthcare professional.
So I endorse everything thatRoger's just said there.
I couldn't practice dermatologywithout using topical steroids.
(14:57):
They are really wonder drugs,but they have these problems.
And there's a further problem theycause, which we're going to talk about in
another podcast, called Topical SteroidWithdrawal Syndrome, which is ghastly.
So we're going to devotea whole podcast to that.
So we do hope you'll join us next time.
We'd also like to thank our sponsor,AproDerm®, for their help in putting
these Skin Deep podcasts together.
(15:19):
We couldn't have done it without them.
And finally, if you do enjoy thesepodcasts, and I know many of you are
and that's fantastic to hear, do rateand review us because it really does
help us in putting them together.
And send us some feedback wereally do love to hear from you.
Until the next time we speakit's goodbye from George.
Goodbye.
(15:40):
And it's goodbye from me.
Goodbye
Hello and welcome again to this Skin Deeppodcast where we look at skin-related
issues, conditions and treatments inan interesting and informative way.
I'm Dr Roger Henderson.
I've been a doctor in the NHSfor about 40 years and I've
got a long-standing interest inthis particular area of health.
And I'm Dr George Moncrieff.
I was a GP although I've now retiredfrom my practice and I am a primary care
(00:30):
advisor to the National Eczema Society.
And I am a former Chair of theDermatology Council for England.
Now, many of you listening to ustoday may be using topical steroids.
Today, George and I are going to betalking about these, in particular,
(00:51):
some of the problems that canbe associated with their use.
But I think right at the start ofthis podcast, George and I are really
quite keen to say that we are bothenormous fans of using topical steroids.
And I don't think either ofus could have ever practised
dermatology without using them.
And I think that's probablyright, isn't it, George?
(01:12):
It would be impossible.
They are amazing treatments for somany really unpleasant skin conditions.
And the vast majority of people who use atopical steroid gain enormous benefit and
experience no significant side effects.
So we don't want to get acrossthe impression for a moment that
(01:34):
we are anti topical steroids.
They have a fundamental role,a cornerstone of the management
of so much skin disease.
And yeah, the idea of trying to practisemedicine without them would be untenable.
So yes, they do work for a lot of peoplewhen they're used correctly and sensibly.
However, some people are concerned abouttopical steroids and I believe rightly so.
(01:59):
And for some people, not only do theynot work all that well, but they can
actually cause quite dramatic anddevastating inflammation in the skin.
And this is an area I believereally needs much more research
and better understanding bythe profession in particular.
Largely because of thedevastating consequences this
can have for these individuals.
(02:20):
Absolutely, and this is something thatwe're going to be exploring in much
more detail with our special guestBriana Banos in the second of these
episodes on topical steroid concerns.
And so that's a thread that's goingto be running through all this
podcast with George and myself.
Um, but certainly my experience whenI'm prescribing a topical steroid,
(02:41):
one of the comments that sometimesa patient will say to me is, "oh,
don't they thin the skin, Doctor?"
And technically that is correct.
Although for the vast majority ofpeople, they don't use the steroids for
long enough for that to be an impact.
But we can't pretend itdoesn't happen, can we?
No we certainly can't.
(03:01):
They do thin the skin and that is animportant, really important, point.
Topical steroids are notintended to be used long-term.
But that doesn't mean they don'tend up being needed long-term.
For example, if you've got moderateatopic eczema, the chances are you're
going to have about 9 flares a year.
(03:22):
And each time you have a flare, youmay well need to use a topical steroid
for, well, a minimum two weeks,probably four weeks, maybe longer.
So you can see how you can endup using a topical steroid on and
off for months and months on end.
And we do know that the skin startsto show signs of thinning and
that can start after six weeks ofsteroid use and in some cases can
(03:45):
happen in as little as two weeks.
Particularly, if you put it on areasof skin that are already quite thin.
So yes, they do thin the skin,and that is really concerning.
And I think patients are right tobring that to attention and right
to be alert to that possibility.
They do get absorbed a bitand we'll come on to that.
(04:05):
In the deeper layers of the skin, you havea very important protein called collagen.
And one of the functions of collagenis to provide support for the skin.
If you haven't got that support, theskin can stretch, you get stretch marks.
And blood vessels aren'tas well supported.
So if you knock those, theycan bruise under the skin.
(04:26):
The steroids have many othereffects on the skin, weakening
what we call the skin barrier.
The skin barrier is thisimportant outer part of our body
that prevents water escaping.
Without it, we would die ina few hours from dehydration.
And it prevents bad things likebacteria and allergens getting
through the skin and causing problems.
(04:47):
But there are a lot of really quitesophisticated things going on in
that barrier which steroids mess up.
For example, they raise the pH,rendering the skin alkaline.
Normally, the surface ofthe skin is slightly acidic.
And that's not by chance, it's by design.
And if you raise the pH, rendering italkaline, you alter the activity of a
(05:10):
number of things going on in the skin.
Which make the skin barriereven more vulnerable and weaker.
And of course, all these issuesto do with the barrier are more
worrying in the areas of the bodywhere you've got very thin skin.
Where the barrier already is vulnerable.
But that's where you get eczema,and that's where you therefore
need to put the steroids.
(05:32):
Older people, and even more importantlyin infants, the skin is particularly thin.
And so, if it's starting off thinand vulnerable, putting a steroid on
there is potentially more worrying.
So that is a real cause for concern.
And I think when people say thatto us, they're absolutely right.
That's why we need to be using themresponsibly and ideally for just short
(05:55):
bursts for a couple of weeks when we can.
Agreed.
And one of the beauties thatwe like as doctors is that
they are very easily absorbed.
They're quite small molecules youget in the topical steroids, so
the skin soaks them up very fast.
But again, we can run intoa bit of a double whammy, if
(06:15):
we're not too careful here.
If you've got skin that's got a littlebit thinner from using them and the skin
is absorbing them quite fast, it canstart to absorb more steroid than perhaps
we might want that patient to be using.
Yeah, and get down into that deeperlayer of the skin or occasionally
(06:36):
get absorbed into the body.
And we do know that, for example,in infants who have a very large
surface area compared to theirbodyweight when compared to adults,
that ratio is not in their favour.
If you treat large areas of skin inan infant, the amount of steroid that
they absorb can have an effect on theirbody's ability to make normal steroids.
(06:57):
And that can be worrying, or it canhave more side effects generally.
The other thing to bear in mind is thatif you're putting a steroid onto thin
skin areas, like around the eye, andthat's where you get eczema, and that's
where you often need to use a steroid.
Up to 30% of that steroid getsthrough the skin and into the body.
I've even heard doctors saysteroids aren't absorbed.
(07:18):
They're wrong.
They are absorbed.
And of course, these thin skinareas are even more, as I was just
saying earlier, a bigger issue forthe very young and the very old.
Um, so it is something we needto think about, particularly with
the more potent topical steroids.
And as you say, it is a vicious cycle.
The steroid is thinning theskin, causing more absorption,
(07:38):
which causes more thinning.
So, it is something to be aware of.
Going back to what I said right at thebeginning though, the vast majority
of people who use a topical steroiddo not run into these problems.
But it can happen, and it'ssomething we need to think about.
Absolutely, and I think, again, inprevious podcasts, you and I have often
talked about the importance of languagewhen you're trying to explain either skin
(08:01):
conditions or treatments to patients.
And I think topical steroids is areally good example of this, because
some people looking at their steroidpack today may see things like 'use
very sparingly' or 'avoid broken skin'.
What does 'sparingly' mean?
And is it a tiny dab behind theear once a week or is it lathered
(08:23):
over you in one go in one day?
So, we can run the risk of topicalsteroids being underused and then
almost being between a rock anda hard place where no one gets
better and no one is very happy.
And that's a reallyfrustrating scenario, isn't it?
One tip I'd share with you, is ifyou're going to see a doctor about
(08:44):
your skin, why don't you put all yourtreatments in a large carrier bag?
All the treatments you're using.
The things you're using to wash yourselfwith, your hair with, the emollients
you're using, and most importantly,the treatments that you've been
prescribed or buying over-the-counter.
And take with you, for example,the topical steroid treatments.
Because I've seen patients who havebeen prescribed a topical steroid,
(09:06):
6 months ago, and they bring it withthem and it's barely been touched.
And they're saying, "why isn'tmy condition getting better?"
I look at them and say, "haveyou been using the treatment?"
"Yes, I've been using it sparingly."
When we talk about topical steroids,we describe how much we expect people
to use, and we use the fingertip unit.
You squeeze it out and the distance fromthe end of the crease on the index finger
(09:28):
to the tip of the finger is half a gram.
And that should beenough to cover 2 palms.
So, if you're using it the way I'dexpect you to use it, you'd have got
through that tube in 2 and a half weeks.
And here we are 6 monthslater, it hasn't gone.
So yeah, the words like 'avoid brokenskin', well, eczema is broken skin and
that's where you've got to put it on.
(09:49):
And 'sparingly' justdoesn't mean anything.
So it is really frustrating when peopleare given well-intentioned, but misguided
advice to underuse their topical steroids.
And I don't want our advicetoday to fall into that trap.
They are superb treatments, butthey've got to be used responsibly.
(10:11):
Absolutely.
And if anyone listening is thinking,I'm not quite sure if I'm using
my topical steroid correctlyor how I should be using it.
What I would say, the real messagefrom the wayside pulpit here today is
just go and ask your pharmacist, askyour doctor, ask your practice nurse.
There is no such thing asa stupid question, ever.
So, do please get your mindclear as to how you should be
(10:34):
using your topical steroid.
And one other thing when you were justtalking there, George, that sort of
sprang into my head, patients willnot only talk about thinning of skin.
Increasingly over the last decade, Ifound the awareness of allergy being
much greater than it ever used to be.
And I've also heard healthcareprofessionals say to patients, "you
(10:56):
can't be allergic to topical steroids."
That couldn't be more wrong, could it?
It couldn't be more wrong, no.
Allergy to the topical steroidmolecule is well-documented, it was
first described in the last century.
And I think it's much more commonthan we as a profession recognise.
In fact, studies from Europe and theUSA have shown the incidence from
(11:20):
patch test clinic patients rangesfrom just 0.5% to over 10%, 10.7%.
So there's certainly a measurablenumber of patients who are allergic.
So it does exist.
Creams have a high-water contentand so need preservatives, which
is one of the reasons why I prefergenerally to prescribe ointments.
(11:41):
They have no water and sodon't need preservatives.
And allergies to the preservativesthat are used and other ingredients
in creams are even more commonthan allergy to topical steroids.
So you can imagine a realnightmare scenario there.
You've got an allergic conditioncaused by your topical steroid, which
a topical steroid should make better,but it's just adding fuel to that fire.
(12:03):
And so, you've got a real problemtrying to sort that all out.
It is an issue and we shouldn't dismissit and we need to take that seriously.
But we also mustn't forget thattopical steroids themselves
can affect our immune system.
They're powerfulimmune-suppressing agents.
Our immune system is really amarker of how well we can remain.
(12:24):
And I think that can also be aplus and a minus in their use.
Yes, topical steroids are prettypowerful broad immune-suppressing
agents, and that's how they work.
When the immune system is misbehaving,as it does in eczema, you can calm that
down and the eczema gets better usually.
(12:44):
But when you're depending on thatimmune system to keep an infection
at bay, as for example a fungalinfection, putting a steroid on that
just drives the fungus down deeper.
It drives it down into thedeeper layers of the skin.
And because it's now no longer onthe surface, it doesn't look scaly.
It's more difficult to diagnose andit's a lot more difficult to treat.
Putting a steroid on when there's someinfections can be an absolute disaster.
(13:09):
And then finally, there are a number ofskin conditions that I have never seen in
somebody who doesn't use topical steroids.
A classic example is perioraldermatitis, a not uncommon
condition usually in young women.
When they get spots or an eczematousrash around the mouth, strangely,
steroids initially seem to make that abit better, but then make it much worse.
(13:32):
So they use a stronger steroid,which makes it a bit better.
But then it gets even worse andyou're into this vicious cycle and
the only way of managing that inthe long run is to keep steroids
completely away from the face.
It also makes rosacea worse.
So there are some skin conditions, whichwe don't understand entirely why, but they
(13:52):
are caused and driven by topical steroids.
That's a nice place tocome full circle to.
And also just to remind everyonelistening to what we said right
at the top of this podcast.
That it's quite unusual, the vast majorityof people using topical steroids, um,
(14:14):
have no problems with them whatsoever.
They do what they say on the tin,they are safe, they are effective,
and much of what we've talked abouttoday doesn't actually happen.
But it is worthwhile, now in thisday and age, to just mention the
possibilities that people mayhave, especially if they're using
topical steroids in the longer-term.
(14:35):
And I do hope that you foundwhat George and I have said
today interesting and helpful.
And as always, if you do have anyquestions about your use of topical
steroids, do discuss them with yourdoctor or healthcare professional.
So I endorse everything thatRoger's just said there.
I couldn't practice dermatologywithout using topical steroids.
(14:57):
They are really wonder drugs,but they have these problems.
And there's a further problem theycause, which we're going to talk about in
another podcast, called Topical SteroidWithdrawal Syndrome, which is ghastly.
So we're going to devotea whole podcast to that.
So we do hope you'll join us next time.
We'd also like to thank our sponsor,AproDerm®, for their help in putting
these Skin Deep podcasts together.
(15:19):
We couldn't have done it without them.
And finally, if you do enjoy thesepodcasts, and I know many of you are
and that's fantastic to hear, do rateand review us because it really does
help us in putting them together.
And send us some feedback wereally do love to hear from you.
Until the next time we speakit's goodbye from George.
Goodbye.
(15:40):
And it's goodbye from me.
Goodbye
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