9 Ways to Manage Your Topical Steroid Side Effects

Corticosteroid creams, ointments, and other products that you apply to your skin have been used to treat atopic dermatitis/eczema for more than 70 years. They can help control a flare by quickly reducing the inflammation in your skin. But like any medicine, topical steroids can cause side effects. To prevent them, apply your treatment just as it’s prescribed, try to protect your skin from more irritation, and know when to call your doctor.

Topical steroids reduce skin cell growth, which can make your skin look shiny and “see-through” and your veins easier to notice. To prevent skin thinning, doctors usually prescribe the lowest effective dose for the shortest time needed. Ask them to show you the correct amount to use, then spread the cream in thin, even layers only to the affected area. Not better after two weeks? Let your doctor know so they can decide the next steps.

Bruises form when blood leaks out of the small blood vessels just under your skin. If your skin starts to thin while using topical steroids, you may see more black and blue spots. Make sure your doctor knows all the prescription and over-the-counter medicines and supplements you take. Many can affect blood clotting and make bruises more likely. In the meantime, apply ice and elevate any bruised areas to help them heal faster.

Sometimes topical steroids can cause an acne-like rash. Unlike regular pimples, these bumps are often the same shape and size. They usually show up within two weeks of use. Tell your doctor if you break out. If you need to stop that specific steroid, they can explain how to safely do so. Your skin may slowly clear up on its own. To help your skin, use gentle alcohol-free skin products, try not to squeeze or pick, and avoid the sun.

Topical steroids tear apart the fibers that make up skin tissue. As they heal, you may see indented streaks called stretch marks. They can be pink, red, brown, or purple. To try to prevent them, massage in a cream with hyaluronic acid every day. If you do get stretch marks, ask your doctor about a prescription drug, like tretinoin, or a procedure, like laser therapy, to fade them. Act quickly. New stretch marks are easiest to treat.

Using topical steroids on your face can cause a rash around your mouth that’s known as perioral dermatitis. It can include fluid-filled bumps that itch and burn. Let your doctor know if you get this rash. You may need a prescription medicine to treat it. To help your skin heal, use only gentle, fragrance-free soaps and moisturizers, and take a break from wearing makeup.

After using topical steroids for a while, your skin may lighten (hypopigmentation). Steroids impact your body’s ability to make melanin, which adds pigment to skin. Once you stop the cream, your skin will likely return to normal. Dark spots (hyperpigmentation) happen when thinned skin’s exposed to sunlight. If you get them, your doctor can prescribe a cream or suggest a procedure, like a chemical peel, to fade them. Always wear a broad-spectrum sunscreen to help them fade.

Topical steroids aren’t a cure for eczema. They can only get a flare under control. Because of that, your symptoms may come back once you stop using them. If that happens, your doctor could prescribe a nonsteroid treatment you can use for a longer time or an immunosuppressant that you take by mouth or a shot. They may also want you to use topical steroids two days a week for several months to help break the flare cycle.

Sometimes, steroid creams get absorbed through your skin and go into your blood. That prevents your adrenal glands from making their own steroids, causing a condition called hypoadrenalism. The symptoms include low blood pressure and fatigue. If you have hypoadrenalism, you’ll need to be treated with hormone medicines. To lower your risk, keep your skin clean and moisturized. If it’s dry, you might apply more steroid cream by mistake.  

When you stop topical steroids, you risk a reaction called topical steroid withdrawal (TSW). It’s more likely if you use a high-potency product for over a year. Warning signs include a sunburn-like rash, stinging, and changes to skin not treated with steroids. Over time, you can have hair loss, fatigue, depression, and insomnia. TSW is rare and hard to treat, so if you think you have symptoms, see a dermatologist.