Question 1: Does it matter where I apply the topical steroid and how much is absorbed?
Answer 1: Oh yes! Beware of the most delicate areas around the eyelids, face, jawline, neck and thinnest skin on and around your private parts and genitals!
Question 2: Does it matter if my medication is an ointment, creme, foam, gel, shampoo, solution, lotion, compounding powder or spray for absorption?
Answer 2: Yes! They each have varying degrees of absorption and should be noted with your doctor as to when and where to apply. A diligent doctor may prescribe an ointment to skin areas that are thicker like palms of hands or psoriasis plaque areas from excessive itching and cumulative trauma to the skin with layers of dead skin piled up. Perhaps a more or less soluble ointment for other areas based on doctor’s assessment of how compromised the skin is in that specific location. A cream for the acute and subacute dermatoses that are rash prone and areas that can hold moisture. Be prepared to ask specific questions about each medication and where and when to apply.
Question 3: Are topical steroids tested on people with eczema or on people with normal skin?
Question 3: There are two types of tests. Absorption tests are conducted on healthy volunteers without atopic dermatitis.
For clinical purposes, topical steroids that go into the market are tested on diseased skin where the epidermal barrier is defective, and in those, the penetration of topical steroids is 2 to 10 times greater than that of healthy skin according to this study.
Question 4: Will only that area experience side effects or my whole body?
Answer 4: Possibly none, maybe one or all of the above. Some will only experience the most common skin atrophy and thinning locally in that localized area. Some will experience the full-body systemic effect of side effects. There’s just no way of knowing who, what, when will be the most affected and how.
In the example of the eye area, the steroids have been known to penetrate deep enough to affect interocular eye pressure and therefore, accelerate cataracts and glaucoma potential just by applying on the face and not necessarily around the eyes. So it can vary based on quantity, length of usage and the individual’s susceptibility to immune suppression therapies.
Another factor is if the person is already on another form of steroids such as inhalers for asthma and oral steroids such as prednisone for allergic reactions. Those patients are especially reactive to eye problems.
It’s sad, but here at ELAJ, we talk to young people in their 20’s that are already suffering from eye problems such as cataracts and yet, had no idea the steroids they used on their face were the cause. They simply were not informed properly by their doctor.