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Miami's independent source of local news and culture. Athletes and bodybuilders have been using steroids to increase muscle mass for a long time. Many men, particularly those who participate in sports or who are interested in bodybuilding, use steroids to achieve quick results. Many steroids are sold illegally and come with a slew of negative side effects. So, what are some other safe and legitimate alternatives to steroid abuse? Are you trying to bulk up or lose weight with a legal steroid? Researchers have recently created safe, and legal steroids that can be used daily with no negative side effects.

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Mild topical steroids

Side effects are uncommon or rare when topical steroids are used appropriately under medical supervision. Topical steroid may be falsely blamed for a sign when underlying disease or another condition is responsible for example, postinflammatory hypopigmentation or undertreated atopic eczema. Cases of Cushing syndrome due to topical corticosteroids most often occur because of inappropriate prescribing or over the counter sales of corticosteroids in countries where that is permitted.

Local side effects may arise when a potent topical steroid is applied daily for long periods of time months. Most reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications. A topical steroid can cause, aggravate or mask skin infections such as impetigo , tinea , herpes simplex , malassezia folliculitis and molluscum contagiosum. Note: topical steroid remains the first-line treatment for infected eczema.

Stinging frequently occurs when a topical steroid is first applied, due to underlying inflammation and broken skin. Contact allergy to steroid molecule, preservative or vehicle is uncommon but may occur after the first application of the product or after many years of its use. Adverse effects of topical steroids Bruising. A topical steroid should be used cautiously on eyelid skin, where it commonly results in periocular dermatitis.

Potentially, excessive use over weeks to months might lead to glaucoma or cataracts. Mild and moderate-potency topical steroids can be safely used in pregnancy. Caution should be used for potent and ultrapotent topical steroids used over large areas or under occlusion, of which a proportion will be absorbed systemically. Reports of low birth-weight infants exposed to high-dose topical steroid are not thought to be due to the medication. Topical steroid is applied once daily usually at night to inflamed skin for a course of 5 days to several weeks.

After that, it is usually stopped, or the strength or frequency of application is reduced. Emollients can be applied before or after the application of topical steroid, to relieve irritation and dryness or as a barrier preparation. Infection may need additional treatment.

The fingertip unit guides the amount of topical steroid to be applied to a body site. One unit describes the amount of cream squeezed out of its tube onto the volar aspect of the terminal phalanx of the index finger.

Fingertip unit Fingertip unit. The quantity of cream in a fingertip unit varies with sex , age and body part. Topical corticosteroids are regulated. However, a potent steroid is illegally present in some cosmetic products purchased over the counter or via the Internet, according to reports from China and several developing countries. This has resulted in many reports of steroid- dependent periorificial dermatitis , rosacea and other adverse effects. New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information.

Check the individual New Zealand datasheet on the Medsafe website. See smartphone apps to check your skin. Books about skin diseases Books about the skin Dermatology Made Easy book. DermNet NZ does not provide an online consultation service.

If you have any concerns with your skin or its treatment, see a dermatologist for advice. Updated 4 January Topical steroid — codes and concepts open. Verdeso Pro Generic name: desonide. Halog Generic name: halcinonide. Dermovate Generic name: clobetasol. Anucort-HC Pro Generic name: hydrocortisone. Synalar Pro Generic name: fluocinolone. Diprosone Generic name: betamethasone. Diprolene Pro Generic name: betamethasone.

Desonate Pro Generic name: desonide. Dermatop Pro Generic name: prednicarbate. Anusol-HC Suppositories Generic name: hydrocortisone. Westcort Pro Generic name: hydrocortisone. Topicort LP Generic name: desoximetasone. Synalar Ointment Generic name: fluocinolone. Psorcon E Generic name: diflorasone. Psorcon Pro Generic name: diflorasone. Proctozone HC Pro Generic name: hydrocortisone.

Procto-Med HC Generic name: hydrocortisone. Olux-E Pro Generic name: clobetasol. Locoid Pro Generic name: hydrocortisone. Lidex-E Pro Generic name: fluocinonide. Halog-E Generic name: halcinonide. Embeline Generic name: clobetasol. Diprolene AF Generic name: betamethasone. Capex Pro Generic name: fluocinolone. Betnovate Generic name: betamethasone. Aristocort R Generic name: triamcinolone. Aristocort A Generic name: triamcinolone. Vanos Pro Generic name: fluocinonide.

Valisone Generic name: betamethasone. U-Cort Pro Generic name: hydrocortisone. Tritocin Generic name: triamcinolone. Tridesilon Generic name: desonide. Triderm Pro Generic name: triamcinolone. Trianex Pro Generic name: triamcinolone.

Triacet Generic name: triamcinolone. Treziopak Generic name: triamcinolone. Tovet Pro Generic name: clobetasol. Texacort Pro Generic name: hydrocortisone. Temovate E Pro Generic name: clobetasol. SilaLite Pak Generic name: triamcinolone. Sernivo Pro Generic name: betamethasone. Scalp-Cort Generic name: hydrocortisone. Scalacort Generic name: hydrocortisone.

Sarnol-HC Generic name: hydrocortisone. Rectacort-HC Generic name: hydrocortisone. Recort Plus Generic name: hydrocortisone. Proctocream-HC Pro Generic name: hydrocortisone. Proctocort Pro Generic name: hydrocortisone. ProctoCare-HC Generic name: hydrocortisone. Pediaderm TA Pro Generic name: triamcinolone. Pediaderm HC Pro Generic name: hydrocortisone. Pandel Pro Generic name: hydrocortisone. Oralone Pro Generic name: triamcinolone. Nutracort Generic name: hydrocortisone. NuCort Pro Generic name: hydrocortisone.

Nolix Pro Generic name: flurandrenolide. MiCort-HC Generic name: hydrocortisone. Maxiflor Generic name: diflorasone. LoKara Pro Generic name: desonide. Lexette Pro Generic name: halobetasol. Lacticare-HC Generic name: hydrocortisone. Keratol HC Generic name: hydrocortisone. Juulissa Pharmapak Generic name: triamcinolone. Itch-X Lotion Generic name: hydrocortisone. Instacort Generic name: hydrocortisone. Impoyz Pro Generic name: clobetasol. Impeklo Generic name: clobetasol. Hytone Pro Generic name: hydrocortisone.

Hybrisil Generic name: methylprednisolone. Hemmorex-HC Pro Generic name: hydrocortisone. Halonate Generic name: halobetasol. Gynecort Maximum Strength Generic name: hydrocortisone. Gly-Cort Generic name: hydrocortisone. Fluocinonide-E Generic name: fluocinonide. Florone Pro Generic name: diflorasone. Embeline E Generic name: clobetasol.

DesRx Generic name: desonide. Dermtex HC Generic name: hydrocortisone. Dermasorb TA Pro Generic name: triamcinolone. Dermasorb HC Pro Generic name: hydrocortisone. Dermarest Plus Anti-Itch Generic name: hydrocortisone. DermacinRx Trizapak Generic name: triamcinolone. DermacinRx Silazone Generic name: triamcinolone. Del-Beta Generic name: betamethasone.

Cyclocort Generic name: amcinonide. Cotacort Generic name: hydrocortisone. Cortizone-5 Generic name: hydrocortisone. Corticaine Generic name: hydrocortisone. Cortaid Generic name: hydrocortisone. Cormax Scalp Generic name: clobetasol. Cormax Pro Generic name: clobetasol. Cordran SP Generic name: flurandrenolide.

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ORAL STEROID STACKS

However, creams do not provide the occlusive effects that ointments provide. Lotions and gels are the least greasy and occlusive of all topical steroid vehicles. Lotions contain alcohol, which has a drying effect on an oozing lesion.

Lotions are useful for hairy areas because they penetrate easily and leave little residue. Gels have a jelly-like consistency and are beneficial for exudative inflammation, such as poison ivy. Gels dry quickly and can be applied on the scalp or other hairy areas and do not cause matting.

Foams, mousses, and shampoos are also effective vehicles for delivering steroids to the scalp. They are easily applied and spread readily, particularly in hairy areas. Foams are usually more expensive. Because hydration generally promotes steroid penetration, applying a topical steroid after a shower or bath improves effectiveness. Simple plastic dressings e. Irritation, folliculitis, and infection can develop rapidly from occlusive dressings, and patients should be counseled to monitor the treatment site closely.

Flurandrenolide Cordran 4 mcg per m 2 impregnated dressing is formulated to provide occlusion. It is beneficial for treating limited areas of inflammation in otherwise difficult-to-treat locations, such as fingertips. This is a useful but imperfect method for predicting the clinical effectiveness of steroids. There are seven groups of topical steroid potency, ranging from ultra high potency group I to low potency group VII.

Table 2 provides a list of topical steroids and available preparations listed by group, formulation, and generic availability. This should be considered when choosing steroid agents. Physicians should also be aware that some generic formulations have been shown to be less or more potent than their brand-name equivalent. Information from reference Low-potency steroids are the safest agents for long-term use, on large surface areas, on the face or areas of the body with thinner skin, and on children.

More potent agents are beneficial for severe diseases and for areas of the body where the skin is thicker, such as the palms and bottoms of the feet. High- and ultra-high-potency steroids should not be used on the face, groin, axilla, or under occlusion, except in rare situations and for short durations.

Once-or twice-daily application is recommended for most preparations. Chronic application of topical steroids can induce tolerance and tachyphylaxis. Ultra-high-potency steroids should not be used for more than three weeks continuously. This intermittent schedule can be repeated chronically or until the condition resolves.

Side effects are rare when low- to high-potency steroids are used for three months or less, except in intertriginous areas, on the face and neck, and under occlusion. The amount of steroid the patient should apply to a particular area can be determined by using the fingertip unit method. Table 3 describes the number of fingertip units needed to cover specific areas of the body. The amount dispensed and applied should be considered carefully because too little steroid can lead to a poor response, and too much can increase side effects.

Prolonged use of topical corticosteroids may cause side effects Table 4 To reduce the risk, the least potent steroid should be used for the shortest time, while still maintaining effectiveness. The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk.

The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin Retin-A 0. Topical steroids can also induce rosacea, which may include the eruption of erythema, papules, and pustules. Steroid-induced rosacea occurs when a facial rash is treated with low-potency topical steroids that produce resolution of the lesions.

If the symptoms recur and steroid potency is gradually increased, the rosacea may become refractory to further treatment, making it necessary to discontinue the steroid. This may then induce a severe rebound erythema and pustule outbreak, which may be treated with a day course of tetracycline mg four times daily or erythromycin mg four times daily.

For severe rebound symptoms, the slow tapering of low-potency topical steroids and use of cool, wet compresses on the affected area may also help. The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly. The application of high-potency steroids can induce a deep-tissue tinea infection known as a Majocchi granuloma.

Easy bruising. Increased fragility. Stellate pseudoscars. Steroid atrophy. Aggravation of cutaneous infection. Granuloma gluteale infantum. Masked infection tinea incognito. Secondary infections. Contact dermatitis. Delayed wound healing. Hypertrichosis hirsutism. Perioral dermatitis.

Reactivation of Kaposi sarcoma. Rebound flare. Steroid-induced acne. Steroid-induced rosacea. Ocular hypertension. Cushing disease. Hypothalamic-pituitary-adrenal suppression. Aseptic necrosis of the femoral head. Decreased growth rate.

Peripheral edema. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. This tinea folliculitis requires oral antifungal therapy. Combinations of antifungal agents and corticosteroids should be avoided to reduce the risk of severe, persistent, or recurrent tinea infections.

Topical applications of corticosteroids can also result in hypopigmentation. This is more apparent with darker skin tones, but can happen in all skin types. Repigmentation often occurs after discontinuing steroid use. Steroids can induce a contact dermatitis in a minority of patients, but many cases result from the presence of preservatives, lanolin, or other components of the vehicle.

Non-fluorinated steroids e. Topically applied high- and ultra-high-potency corticosteroids can be absorbed well enough to cause systemic side effects. Hypothalamic-pituitary-adrenal suppression, glaucoma, septic necrosis of the femoral head, hyperglycemia, hypertension, and other systemic side effects have been reported. According to a postmarketing safety review, the most frequently reported side effects were local irritation 66 percent , skin discoloration 15 percent , and striae or skin atrophy 15 percent.

Topical steroids can induce birth defects in animals when used in large amounts, under occlusion, or for long duration. Food and Drug Administration as pregnancy category C. It is unclear whether topical steroids are excreted in breast milk; as a precaution, application of topical steroids to the breasts should be done immediately following nursing to allow as much time as possible before the next feeding. Children often require a shorter duration of treatment and a lower potency steroid.

Already a member or subscriber? Log in. At the time the article was written, Dr. He received his doctorate of pharmacy from the Nesbitt College of Pharmacy and Nursing and completed residency training and a faculty development fellowship at the University of Pittsburgh Pa. Margaret Family Medicine Residency Program. Address correspondence to Jonathan D.

South St. Reprints are not available from the authors. Interventions for chronic palmoplantar pustulosis. Cochrane Database Syst Rev. A double-blind randomized trial of 0. Arch Dermatol. Vitiligo: a retrospective comparative analysis of treatment modalities in patients. J Dermatol. Vulvar lichen sclerosus: effect of long-term topical application of a potent steroid on the course of the disease.

The treatment of mild pemphigus vulgaris and pemphigus foliaceus with a topical corticosteroid. Br J Dermatol. A comparison of oral and topical corticosteroids in patients with bullous pemphigoid. N Engl J Med. Efficacy and safety of a new clobetasol propionate 0. J Eur Acad Dermatol Venereol. Randomized double-blind placebo-controlled trial in the treatment of alopecia areata with 0. An open-label study of the safety and efficacy of limited application of fluticasone propionate ointment, 0.

Int J Dermatol. Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Effect of topical steroid on non-retractile prepubertal foreskin by a prospective, randomized, double-blind study. Scand J Urol Nephrol. An month follow-up study after randomized treatment of phimosis in boys with topical steroid versus placebo.

Topical corticosteroid therapy for acute radiation dermatitis: a prospective, randomized, double-blind study. Prophylactic beclamethasone spray to the skin during postoperative radiotherapy of carcinoma breast: a prospective randomized study. Indian J Cancer. Treatment of chronic idiopathic urticaria with topical steroids.

An open trial. This is often called weekend therapy. This aims to prevent a flare-up from occurring. In the long run, it can mean that the total amount of topical steroid used is less than if each flare-up were treated as and when it occurred. You may wish to discuss this option with your doctor. Topical steroids are usually applied once a day sometimes twice a day - your doctor will advise.

Gently rub a small amount see 'Getting the dose right - the fingertip unit', below on to areas of skin which are inflamed. This is different to moisturisers emollients which should be applied liberally all over. Gently rub the cream or ointment into the skin until it has disappeared.

Then wash your hands unless your hands are the treated area. The amount of topical steroid that you should apply is commonly measured by fingertip units FTUs. One FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult's fingertip. This assumes the tube has a standard 5 mm nozzle.

A fingertip is from the very end of the finger to the first crease in the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together. Two FTUs are about the same as 1 g of topical steroid. For example, say you treat an area of skin the size of eight adult hands. You will need four FTUs for each dose. This is 2 g per dose. So if the dose is once a day, a 30 g tube should last for about 15 days of treatment. An FTU of cream or ointment is measured on an adult index finger before being rubbed on to a child.

Again, one FTU is used to treat an area of skin on a child equivalent to twice the size of the flat of an adult's hand with the fingers together. You can gauge the amount of topical steroid to use by using your adult hand to measure the amount of skin affected on the child. From this you can work out the amount of topical steroid to use. Most people with eczema will also use emollients.

Emollients are different to topical steroids and should be used and applied in a different way. When using the two treatments, apply the emollient first. Then wait minutes before applying a topical steroid. The emollient should be allowed to sink in be absorbed before a topical steroid is applied. The skin should be moist or slightly tacky, but not slippery, when applying the steroid. Short courses of topical steroids less than four weeks are usually safe and cause no problems. Problems may develop if topical steroids are used for long periods, or if short courses of stronger steroids are repeated often.

The main concern is if strong steroids are used on a long-term basis. Side-effects from mild topical steroids are uncommon. Side-effects from topical steroids can either be local or systemic. Local means just affecting that bit of skin and systemic means affecting the whole person. This may occur when prolonged treatment with a moderate or potent strength topical steroid is stopped.

Symptoms may include red skin, burning pain or stinging, itch, skin peeling and excessive sweating. Symptoms may be mild and short-lived or may be severe and last for much longer. In some cases, severe symptoms may settle after several days or a few months, followed by a prolonged period of dry, itchy skin but with gradual improvement.

A common mistake is to be too cautious about topical steroids. Some parents undertreat their children's eczema because of an unfounded fear of topical steroids. They may not apply the steroid as often as prescribed, or at the strength needed to clear the flare-up. This may actually lead to using more steroid in the long term, as the inflamed skin may never completely clear. So, you may end up applying a topical steroid on and off perhaps every few days for quite some time. The child may be distressed or uncomfortable for this period if the inflammation does not clear properly.

A flare-up is more likely to clear fully if topical steroids are used correctly. Only use topical steroids for eczema as directed by your doctor. Some people continue to use topical steroids each day in the long term after the eczema has cleared to 'keep the eczema away'. This is not normally needed. Some people with severe eczema may require continuous steroid treatment.

However, this should be under the close supervision of a doctor. All people with eczema should use moisturisers emollients every day to help prevent further flare-ups of eczema. Thomsen SF ; Atopic dermatitis: natural history, diagnosis, and treatment. ISRN Allergy. Aust Fam Physician. Hajar T, Leshem YA, Hanifin JM, et al ; A systematic review of topical corticosteroid withdrawal "steroid addiction" in patients with atopic dermatitis and other dermatoses.

J Am Acad Dermatol. Epub Jan Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.

Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions. In this series. In this article What is eczema? What are topical steroids and how do they work? What types of topical steroids are there?

When and how are topical steroids used? How do I apply topical steroids?

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As a general rule, use the weakest possible steroid that will do the job. It is often appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. Topical steroid is sometimes combined with another active ingredient, including antibacterial, antifungal agent or calcipotriol.

Topical steroids are medicines regulated by Health Authorities. They are classified according to their strength. The products listed here are those available in New Zealand in November Side effects are uncommon or rare when topical steroids are used appropriately under medical supervision. Topical steroid may be falsely blamed for a sign when underlying disease or another condition is responsible for example, postinflammatory hypopigmentation or undertreated atopic eczema.

Cases of Cushing syndrome due to topical corticosteroids most often occur because of inappropriate prescribing or over the counter sales of corticosteroids in countries where that is permitted. Local side effects may arise when a potent topical steroid is applied daily for long periods of time months. Most reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications.

A topical steroid can cause, aggravate or mask skin infections such as impetigo , tinea , herpes simplex , malassezia folliculitis and molluscum contagiosum. Note: topical steroid remains the first-line treatment for infected eczema. Stinging frequently occurs when a topical steroid is first applied, due to underlying inflammation and broken skin. Contact allergy to steroid molecule, preservative or vehicle is uncommon but may occur after the first application of the product or after many years of its use.

Adverse effects of topical steroids Bruising. A topical steroid should be used cautiously on eyelid skin, where it commonly results in periocular dermatitis. Potentially, excessive use over weeks to months might lead to glaucoma or cataracts. Mild and moderate-potency topical steroids can be safely used in pregnancy. Caution should be used for potent and ultrapotent topical steroids used over large areas or under occlusion, of which a proportion will be absorbed systemically.

Reports of low birth-weight infants exposed to high-dose topical steroid are not thought to be due to the medication. Topical steroid is applied once daily usually at night to inflamed skin for a course of 5 days to several weeks. After that, it is usually stopped, or the strength or frequency of application is reduced. Emollients can be applied before or after the application of topical steroid, to relieve irritation and dryness or as a barrier preparation.

Infection may need additional treatment. The fingertip unit guides the amount of topical steroid to be applied to a body site. One unit describes the amount of cream squeezed out of its tube onto the volar aspect of the terminal phalanx of the index finger. Fingertip unit Fingertip unit. The quantity of cream in a fingertip unit varies with sex , age and body part.

Topical corticosteroids are regulated. However, a potent steroid is illegally present in some cosmetic products purchased over the counter or via the Internet, according to reports from China and several developing countries. This has resulted in many reports of steroid- dependent periorificial dermatitis , rosacea and other adverse effects. New Zealand approved datasheets are the official source of information for prescription medicines, including approved uses and risk information.

Check the individual New Zealand datasheet on the Medsafe website. This would dictate how long the drug should be used and under what conditions. Common side effects of topical steroid use include skin thinning atrophy , easy bruising, enlarged blood vessels telangiectasis , localized thickening of hair hypertrichosis , and stretch marks in the armpits or groin. Keep in mind that the greater the potency of a topical steroid, the greater the risk of side effects.

These topical steroids are considered to have the highest potency:. These topical steroids are considered highly potent:. These topical steroids are considered potent:. These topical steroids are considered moderately potent:. These topical steroids are considered somewhat potent:. These topical steroids are considered mild:.

These topical steroids are considered the least potent:. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. J Clin Med. Gabros S, Zito PM. Topical Corticosteroids. StatPearls Publishing. Updated January 10, Mechanisms of action of topical corticosteroids in psoriasis. Int J Endocrinol. Humbert P, Guichard A. The topical corticosteroid classification called into question: towards a new approach.

Exp Dermatol. Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J. Rathi SK, D'souza P. Rational and ethical use of topical corticosteroids based on safety and efficacy. Indian J Dermatol. Table of Contents View All. Table of Contents. Mechanism of Action. Classification by Strength. Treatment Considerations.

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Topical steroid abuse in India - Dr. Madhu SM

Louis: Wolters Kluwer Health, In:. Emollients can be applied before amount of topical steroid to topical steroid, to relieve irritation pump; and elevated glucose in. New Zealand approved datasheets are the official source of information with less propensity to increase. In: Melton R, Thomas R. Prednisolone sodium phosphate is most appropriate for moderate inflammation. A soft drug is a the steroid molecule to lens glaucoma or other risk factors, better penetration. They also have the highest about the skin Dermatology Made. Cakanac is in private practice exposed to high-dose topical steroid clinical instructor in the Department due to the medication. For moderate inflammation, Lotemax, Vexol reports of steroid- dependent periorificial. One unit describes the amount epithelial or stromal healing, punctate oral steroids or periocular steroid all less common side effects to reports from China and.

Desonide % (LoKara lotion, Desonate gel, Desowen cream, ointment). Fluocinolone acetonide % (Synalar cream, solution, shampoo). Hydrocortisone butyrate % (Locoid cream, lotion, solution).