STEROID is the shortened word for corticosteroid or glucocorticoid, a drug used in topical formulations for inflammatory conditions of the skin, the largest human organ.

Some skin manifestations, such as redness or irritation, swelling and itching, are responsive to topical steroid due to its anti-inflammatory, immunosuppressive, vasoconstrictive and anti-proliferative effects.

Formulations of topical steroidal preparations are creams, ointments, solutions, lotion, gel, foam aerosol, powder and patch. However, the pharmaceutical and cosmetic industry has introduced other terms for various forms of preparations such as paint, balm, mist and milk.

The most appropriate choice of preparation is selected based on the site of treatment and the nature of the dermatosis. So for example, for a dry or scaly condition, ointment and oils are best suited whilst for an oozy and wet skin condition creams, lotions and drying paste are recommended.

There are seven classes of potent drugs. The strength of the following compounds are categorised as mild, moderate, potent and very potent:
* Mild – hydrocortisone and hydrocortisone acetate
* Moderate – clobetasone butyrate, triamcinolone acetonide
* Potent – betamethasone valerate, betamethasone diproprionate (cream, gel, ointment), diflucortolone valerate, mometasone furoate and methyl prednisolone aceponate.
* Very Potent – clobetasol proprionate and betamethasone dipropionate in optimised formulation

As seen above, the chemical structure attached to the base molecule, whether valerate, butyrate or dipropionate, determines the potency. Presentations also come in various strengths ranging from 0.025 to 2.5 per cent. Additionally, the vehicle used in the formulated product can optimise the effectiveness of the preparation and hence determine the strength. So read the fine print of labels carefully before choosing an inconspicuous spot for trial test.

The fingertip rule applies for application of steroidal cream and varies with sex, age and body part. One finger-tip is equivalent to 0.5g in an adult male and 0.4g in an adult female.

So, for example, one fingertip can evenly cover one hand and three fingertips one arm, whilst one foot should require two fingertips and one leg six fingertips. It will take a 20 to 30 gram size cream or ointment to cover an entire body. Infants from six months to one year usually require quarter of an adult dosage and children from four years of age just one third of an adult requirement.

“Red skin syndrome” is the condition associated with topical steroid addiction and withdrawal which features burning, stinging or bright red skin after overuse and subsequent withdrawal within one to two weeks.

The abuse of steroidal preparations includes:
* prolonged use of an appropriate steroidal preparation
* misuse of steroidal preparation
* application of inappropriate potency

Some of the side effects seen from the abuse of steroidal preparations are skin thinning, stretch marks, very delicate skin (easy to bruise and tear), enlarged blood vessels and a localised patch of thickened or lengthened hair.

It is not recommended that you apply hydrocortisone-like creams on the face since such preparations may cause skin thinning. Since facial skin is already thin it may exacerbate some skin conditions, unless it is recommended by the dermatologist. Likewise you should not use steroidal creams on broken or infected skin, around the bottom, genitals or the eye.

Another side effect is glaucoma and cataract if applied on the skin of eyelid over a prolonged period of weeks or months.

Cushing syndrome, characterised by moon face and buffalo hump, is a rare side effect if used appropriately. However abuse of topical steroid for example using 50 gram clobetasol propionate or 500 gram hydrocortisone per week can result in Cushing syndrome.

Only mild or moderate steroidal formulations may be used safely in pregnancy. There are inconclusive reports of babies born with low birth weight when exposed to high doses of topical steroids from mothers.

Children under age 10 should not use certain cream unless directed by the doctor. If it is used then the particular attention must be given to the directions which includes dosage application, frequency and duration of treatment. If placed on such medications on a long term basis then the child’s growth (height and weight) should be monitored and immediately reported if there is a concern.

Unrestricted access to these types of preparations in countries like ours coupled with self-diagnosis and or recommendation from an unqualified person may worsen the plight for a cure since this may result in a cascading trial and error process hereafter.

For further discussion, contact the pharmacist of Medicine Express Pharmacy located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg. Tel #225-5142.