Eczema, also known as atopic dermatitis, is a chronic skin condition that affects millions of people worldwide. Characterized by inflammation, redness, dryness, and itching, eczema can significantly impact a person's quality of life. One of the most commonly prescribed treatments for eczema is cortisteroids, often referred to as simply "steroids".
These medications provide rapid relief from symptoms, BUT they are not without drawbacks, especially when used over the long term. This article explore how steroids work in treating eczema, their benefits, and why they are not suitable as an long-term treatment option.
How Do Steroids work for Eczema?
Cortisteroids are synthetic drugs designed to mimic the effects of cortisol, a hormone naturally produced by the adrenal glands. Cortisol plays a crucial role in regulating inflammation, immune responses, and metabolism. When applied to the skin, topical steroids help to:
Reduce Inflammation
Inflammation is the body's response to an irritant or injury. In eczema, the immune system overreacts, leading to swelling, redness, and itching. Steroids suppress this immune response by inhibiting the production of inflammatory cytokines, reducing the skin's inflammatory reaction.
Suppress the Immune System
Eczema is partially driven by an overactive immune system that mistakenly attacks the skin. Cortisteroids dampen this immune activity, thereby preventing excessive inflammation and further damage to the skin barrier.
Relieve Itching and Discomfort
By reducing inflammation and immune system activity, steroids help alleviate the itching associated with eczema. This relief can improve sleep and quality of life for those suffering from severe flare-ups.
Constrict Blood Vessels
Steroid cause vasoconstriction (narrowing of blood vessels), which reduces swelling and redness. This effect contributes to the visible improvement of eczema symptoms within hours or days of application.
Types of Steroids Used for Eczema
Cortisteroids come in different potencies, ranging from mild to very potent. the choice of steroid depends on the severity of eczema, the location of the rash, and the age of the patient.
- Mild Steroids (E.g. Hydrocortisone 1%) - suitable for sensitive areas like the face and for mild eczema.
- Moderate Steroids (E.g. Betamethasone Valerate 0.05%) - Used for moderate flare-ups.
- Potent Steroids (E.g. Mometasone Furoate 0.1%) - Reserved for more severe cases and thickened skin.
- Very Potent Steroids (E.g. Clobetasol Propionate 0.05%) - Used for short durations in severe cases here other treatments have failed.
Short-Term Benefits of Steroid Use
When used correctly under medical supervision, corticosteroids can provide rapid relied and improve eczema symptoms significantly. Some key benefits include:
- Quick reduction in itching and redness
- Short-term control of flare-ups
- Improved sleep and daily functioning
- Prevention of skin infections by reducing scratching
However, while steroids can effectively manage acute flare-ups, they do no address the underlying causes of eczema, such as a defective skin barrier or immune system dysregulation.
Why Steroids are Not a Good Long-Term Treatment
Despite their effectiveness in short-term use, corticosteroids come with significant risks when used over an extended period. These risks can lead to more severe skin issues and systemic complications.
1. Skin Thinning (Atrophy)
Prolonged steroid use can cause thinning of the skin, making it more fragile and prone to bruising, tearing, and infections. Thinning skin loses its protective barrier function, exacerbating eczema over time.
2. Rebound Flare-Ups (Topical Steroid Withdrawal - TSW)
One of the biggest concerns with long-term steroid use is the risk of Topical Steroid Withdrawal (TSW), also known as Red Skin Syndrome. This condition occurs when the skin becomes dependent on steroids, leading to severe, widespread inflammation when the medication is discontinued. Symptoms if TS include:
- Burning, stinging, and redness
- Severe itching and swelling
- Skin peeling and oozing
3. Tachyphylaxis (Steroid Resistance)
Over time, the skin may develop resistance to steroids, requiring stronger doses or more frequent applications to achieve the same effect. This cycle can lead to increased dependence on steroids without long-term resolution of eczema.
4. Risk of Systemic Absorption
When used excessively or on large areas of the body, topical steroids can be absorbed into the bloodstream, potentially causing systemic side effects such as:
- Hormonal Imbalances (e.g. adrenal suppression, Cushing's Syndrome)
- Increased blood sugar levels
- Weakened Immune Function
5. Changes in Skin Pigmentation
Long-term use of steroid can lead to hypopigmentation (lightened patched of skin) or hyperpigmentation (darkened patches), which can be distressing, especially in individuals with darker skin tones.
6. Increased Risk of Infections
Since steroids suppress the immune system, prolonged use can increase the risk of bacterial, fungal, or viral skin infections. This includes conditions like impetigo, ringworm, and herpes simplex virus reactivation.
Conclusion
While steroids can be highly effective in controlling eczema symptoms in the short term, they are not a sustainable long-term treatment due to significant risks such as skin thinning steroid withdrawal, and systemic effects. Instead, a comprehensive approach that include barrier repair, non-steroidal anti-inflammatory treatments, and lifestyle modifications offer a safer and more effective way to manage eczema eczema in the long run.