October 28, 2011
Dear Mayo Clinic:
Is it true that using steroid creams can thin the skin to the point that the skin is damaged? I have never heard of this and have used hydrocortisone and others for skin irritations on my five-year-old son for nearly two years. How much is too much?
If you have to use hydrocortisone on your son for longer than two weeks at a time without improvement, you should have him evaluated by a dermatologist.
Typically, steroid creams are used to reduce skin inflammation caused by conditions such as psoriasis and eczema. They are the cornerstone and first-line treatment of these and many other skin diseases. Steroid creams have been used for the past 50 years, but are not a cure because they have no effect on the underlying cause of inflammation. They can, however, be very effective in helping to control skin flare-ups and relieve symptoms, such as itching and irritation. Also, they help reduce the likelihood of infection that may occur as a result of scratching and trauma to the skin.
Commonly used topical steroids (corticosteroids) include hydrocortisone, triamcinolone, fluocinonide, and clobetasol. They work by preventing cells from producing inflammation-causing chemicals that are released in response to a variety of different triggers.
Topical steroids come in different strengths, ranging from mild to moderate, potent and very potent. Side effects are more common in high-potency prescription-strength steroid creams. Over-the-counter hydrocortisone is the lowest-potency steroid cream available, but could cause thinning of the skin if used daily for many consecutive weeks. This is especially true if steroid cream is used on thin, sensitive skin such as the eyelids, genital areas, or the folds of the skin. As a general rule, to minimize the risk of side effects, use the lowest strength preparation that is effective. Very potent steroids should only be used for short periods, whereas milder ones can be used longer.
In most cases, topical steroids are safe and well tolerated if used correctly. People who experience side effects usually are not using steroid creams properly. Applying the cream or ointment thinly and evenly to the affected areas on the skin is important. This minimizes the amount absorbed through the skin into the body. But, generally, topical steroids should not be applied more than twice a day, and once daily may be enough in certain situations.
Follow a dermatologist's instructions on proper use, especially since different types of topical steroids may be recommended in different areas of the body. For example, a lower-potency steroid may be recommended for sensitive skin such as the face, and a higher-potency steroid on the trunk.
In your son's case, a dermatologist may want to perform a skin biopsy or recommend different topical steroids or other anti-inflammatory topical medications.
— Matthew Hall, M.D., Dermatology, Mayo Clinic, Jacksonville, Fla.