The idea of using steroids is often loaded with strong negative feelings by the public, but most of us in the field of medicine have an appreciation for the balance that exists between the risks and benefits of various types of steroids. There has often been extensive media coverage of athletes using banned steroids to gain a competitive advantage; however, there are other types of prescription steroids that provide relief for serious illnesses and some patients even rely on them as a necessary part of life. In my dermatology practice, I frequently prescribe glucocorticoids, the type of steroid that has an unparalleled ability to provide relief to patients experiencing considerable inflammation of the skin. Patients with seborrheic dermatitis and eczema can benefit from topical steroids in this category. This blog is intended to help demystify steroids by briefly sharing some of their benefits and risks, particularly with the topicals used to assist with skin-related medical conditions.
First, let’s sort out the definitions by highlighting the three main types of steroids:
- Anabolic androgenic
- Mineralocorticoids
- Glucocorticoids
Anabolic androgenic steroids are most commonly known for their effects on the androgen receptors in our bodies, which affect our muscles, hair follicles, voice depth, and sexual function. When steroid abuse in sports is discussed, anabolic androgenic steroids are almost always the concern. Although our bodies naturally produce testosterone, a type of anabolic steroid, some chemical synthetic derivatives activate the testosterone receptors in our body, providing a “boost” to certain functions carried out by the testosterone in our bodies.
Mineralocorticoids are produced naturally by our adrenal gland and are responsible for the salt and water balance in our body. Increased salt in our diet causes water retention in our blood vessels, which helps dilute the elevated sodium in the bloodstream. As a result, with more fluid in our vessels, we feel more swollen in the short term. So, if after consuming that bag of salty chips at night (we’re all guilty!) your eyes appear puffy and swollen first thing in the morning, that is the mineralocorticoids doing their job! It is beneficial to monitor our food consumption habits because if high sodium levels are repeated over time it may increase our risk of hypertension.
Glucocorticoids are also naturally secreted by the adrenal gland, which is activated in a cascading fashion by our hypothalamus and anterior pituitary gland in the brain (how about that combination of biology terms?!). When used for therapeutic purposes, glucocorticoids are helpful in reducing inflammation and suppressing the immune system when it is overactive. We use this class of steroids commonly to treat rashes on the skin, like eczema, autoimmune diseases, like lupus, and to reduce swelling of our pulmonary airways in asthma. Cortisol, which occurs naturally in the body, is the most common type of glucocorticoid but there are many derivative glucocorticoids that are synthetically derived.
Many dermatologists, myself included, rely on synthetically-derived glucocorticoids in topical forms such as a cream or a gel to treat inflammatory conditions of the skin. I also treat seborrheic dermatitis on the scalp with topical steroids in the form of a lotion, foam, or oil to reduce the redness and scaling that is so troublesome. Topical steroids like hydrocortisone and stronger agents like triamcinolone, fluocinolone, fluocinonide or clobetasol are recommended at times as well with positive results.
Despite the fairly predictable and beneficial outcomes of topical steroid use, there are always important risks to consider. Two important considerations are 1) the class or concentration of the steroid and 2) the area of skin where the topical is applied. A Class VII steroid is the least potent, and a Class I is the strongest. We also may regard the concentration of the particular compound by the designated percentage, often ranging from 0.01-1%. For quick reference, this number is often printed right on the bottle, tube, or container in the ingredients list of the topical steroid.
Once an appropriate concentration is identified, application directions are crucial to follow. For example, a super-potent topical steroid prescribed for eczema on the palms or soles should not be used on the face or the scalp to treat seborrheic dermatitis. Instead, a less potent topical steroid like hydrocortisone valerate may be used for a few days to reduce the inflammation and prevent hyperpigmentation before switching to a steroid-free product. Topical steroids may actually thin out the skin, make it lighter in color, and even cause stretch marks. Another concern is that topical steroids may cause acne on the face, chest or back. I educate patients that the steroids should be considered temporary treatments, rather than curative medications used indefinitely. As such, it is important to have an effective agent to use after the flare subsides that helps maintain the clearance without the use of the steroids.
So, where do LivSo products fit in with steroid regimens? LivSo products do not have any steroids in our formulas and are not intended to replace medications prescribed by your dermatologist or any other medical professional. LivSo products are intended to complement those recommended or prescribed regimens as specialized ingredients work to promote scalp health and help bridge the gap between efficacy and common cosmetic preferences, including well-moisturized, manageable hair.
The appropriate use of steroids in medicine may be life-changing for many people suffering with a variety of medical conditions. It is clear that these medications must be used carefully in order to prevent unwanted side effects but hopefully, a little bit of education allows you to be less intimidated or overly concerned by a recommendation from your primary care provider or board-certified dermatologist to start a regimen that includes a steroid. The relationship with your medical provider is built on trust and you should certainly be comfortable asking any questions you may have about how to use any of your meds - safely.
Live free & clear,
Shari