Wednesday 17 April 2013

Potency of Topical Steroid Creams

Ok, I've decided to go all scientific on you all today (Sorry, I've been reading too much of Miss Kitty's Blog!) and talk about steroid cream potency.

I think this is an important subject to address and I base this on the fact that I was very ignorant about this subject up until recently. Yes, I knew that steroid creams came in various strengths and that different parts of the body absorb them in different ways.

The three main creams that I used over the years were Hydrocortisone, Eumovate and Betnovate. I knew hydrocortisone was mild enough to be sold over the counter and the only cream that doctors recommend to be used on the face, but how to the other two compare in strength? Well, I presumed that the Eumovate was a bit stronger than the hydrocortisone (and still used it on my face!) and that the Betnovate was stronger still, but had no clue how much stronger, maybe four times as strong? Boy, was I wrong.

According to Demnetnz.org, steroid creams come in a range of increasing potencies. The chart on their site is more useful than others I have seen because it actually compares the creams with hydrocortisone to show how strong they are.

Hydrocortisone is classed as a mild steroid and is on its own in Group 4. Bear in mind however, that people have become addicted to hydrocortisone cream over a prolonged time period, so it can be by no means considered "safe".

The next class is Group 3, the moderate steroids and includes my old friend Eumovate (Clobetasone butyrate) and another cream called Triamcinolone acetonide (Aristocort™ Cream/Ointment, Viaderm KC™ Cream/Ointment, Kenacomb™ Ointment).

Now for the shock: These creams are 2-25 times as potent as hydrocortisone! Ouch.

Group 2 contains the more potent steroids, including Betnovate, a cream that I dutifully slathered on my face, against doctors orders for over a year. These include Betamethasone valerate (Beta™ Cream/Ointment/Scalp Application, Betnovate™ Lotion/C Cream/C Ointment, Fucicort™),Betamethasone dipropionate (Diprosone™ Cream/Ointment, Daivobet® 50/500 Ointment/Gel),Diflucortolone valerate (Nerisone™ C/Cream/Fatty Ointment/Ointment), Hydrocortisone 17-butyrate (Locoid™ C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion) , Mometasone furoate (Elocon™ Cream/Lotion/Ointment)  and Methylprednisolone aceponate (Advantan™ Cream/Ointment)

These steroids are a staggering 100-150 as potent as hydrocortisone. This came as a major revelation for me because I did not realise just how strong they were. In other words, my twice daily slathering of Betnovate was like putting 200 applications of hydrocortisone on my skin. No wonder my skin is messed up.

Now for the big guns of Group 1. These include Clobetasol propionate (Dermol™ Cream/Ointment) and Betamethasone dipropionate (Diprosone™ OV Cream/Ointment).

You may want to sit down for this. These creams are up to 600 times more potent than hydrocortisone. and sadly, these very potent creams are commonly prescribed to treat eczema by dermatologists. Why? Because the weaker stuff is not working...

When these fail, dermatologists have no choice but to supplement with oral steroids like prednisone.

It also really matters where you apply the creams. The following chart is taken from the same site and shows absorption rates for various parts of the body:

  • Forearm absorbs 1%
  • Armpit absorbs 4%
  • Face absorbs 7%
  • Eyelids and genitals absorb 30%
  • Palm absorbs 0.1%
  • Sole absorbs 0.05%

  • So use a strong steroid on your eyelids and you are asking for trouble....

    The site also goes on to explain that 500g of hydrocortisone a week is enough to cause adrenal gland suppression, which may lead to a more serious condition called Cushings Syndrome.

    I hope that this research will help you to understand better how steroid creams vary in strength and potency. A worrying trend indeed. Ever wonder why eczema is a "Western Disease" and rarely occurs in Third world countries? Well, we "lucky" folks in the west have better access to medicines like these....


    23 comments:

    johnboy said...

    absolutely astounding . these potent and super potent cremes need banning imn my opinion . they are so dangerous its scary . i was given betnovate and i was told by a GP in my practice that i could use tiny amounts on my face but not around my eye area . the more i hear about this the more i am beggining to feel like a victim of profesional negligence . i think that the time is coming for me to seek answers about my treatment . another great post louise .

    Louise said...

    It really shocked me too. We use these creams without questioning them.

    Unknown said...

    Hi Louise
    The more I learn about our condition thanks to posts from yourself and others, it amazes me that the medical proffesion are actually allowed to carry on prescribing these creams so carelessly.
    I have been using these creams on my face for maybe 15 years on a regular basis, it scares the life out if me the damage that it has caused!
    An interesting yet worrying post, but people need to know the truth.
    Thank you for taking the time to research this.

    Keep healing
    Siegfried
    X

    Louise said...

    Thanks Siegfried.
    I too, used them on my face for 15 years. There is a lot of damage to be put right before I am fully healed but I'm getting the slowly. Every day without steroids is a day nearer healing.

    Anonymous said...

    Excellent work again Louise!

    I've had varying instructions from nurses and doctors alike regarding use on the face and around the eyes. I think we can all perhaps agree that regardless of the area applied the problem is also with the repetitive nature of the application.

    We'll get there eventually eh? Keep on truckin'!

    xxx

    Louise said...

    Spot on Kitty.
    I should have also mentioned the fact that because the cream affects blood vessels, it can also affect surrounding areas. Use it on the face and the eyes may be affected for example. This also explains why we can get eczema rash in strange places when we withdraw, because of the systemic nature of the drug.

    It is also worth mentioning that one of the itsan members messaged me to tell me that she became addicted to hydrocortisone after only short term use. It is worth bearing this in mind too.

    bob said...

    I applied betamethisone to my genital area and groin for over a year. The pain and itch I have endured since February has been awful. When I saw my doctor and brought in Dr. Rappaport's study, my doctor was shocked. Luckily I wasn't a long term user and I am on my way to healing. I believe your blog may have saved my life. Thank you.

    Louise said...

    Thanks for sharing this bob. I'm glad your doctor listened to you and was able to help.

    I love hearing that my blog is helping people. You made my day! Hope you heal quickly from this awful condition X

    Unknown said...

    This is really interesting as I am having loads of problems mananging my eczema. I have started using the Dermol 500 lotion, which comes in a massive container, Im shocked to see its really high as I use it all over :( does this mean I am absorbing loads of it?
    What are you guys using instead? I tried dream cream by lush,thats ok, I would love to try simple sugars but I am in the UK and it costs a fortune to get it shipped... Cheers

    Louise said...

    I think dermol 500 is different to dermol cream. As far as I know, dermol 500 lotion does not contain steroids. I hope this puts your mind at ease.

    Unknown said...

    Thanks for the update, I did check the contents after and could not see Clobetasol propionate, which is a relief

    RedHead said...

    Good god! I've been slathering Betnovate on my face for as long as I can remember. I wish I hadn't been so vein, now my poor skin on my cheeks is very thin and I've definitely got RSS. I'm about to embark on my own withdrawal journey! Thanks for being such an inspiration x

    Unknown said...

    ive been using clobetasol on my face for a year now and everytime i try to withdraw it, my face gets very itchy. Rashes all over :( will it be gone soon?im having break outs too. its sucks :(

    Louise said...

    Chacha, that sounds worrying. If you come off steroid creams you may be looking at a 3 year withdrawal process. There is no quick fix.

    If you want help or advice, please go on the itsan forum at itsan.org

    Elaine said...

    Poor you, Louise. You will get better. But think of all that betnovate! You might be 2 years you know, before you get there. There is clearly stress involved in the desperate desire to be well again, especially after almost 18 months. But us longer term users have a longer term recovery. Sad, but true.
    take care, and hang on!
    elaine

    Unknown said...

    Thank you so much for this post. I recently stopped using topical steroids on my face and the side-effects were truly awful. My skin is healthy again now and I have written a blog to help others who may be going through the same thing.
    Thanks again, with my love and encouragement, Holly x http://lotusgirlskin.blogspot.co.uk/

    Conky said...

    omg....I just made the connection a week ago that the hair loss on my head (I have lost about half the hair on top of my head and it is freaking me the F out as I am only 43 ffs!) I am experiencing coincides with me using Viaderm KC cream on my face for about 6 yrs...over using it unknowing of the side effects...I tossed it a week ago and my face is in full blown hive mode...I do not know if that is b/c if the cream no longer being used or b/c I was just in Vegas and got randomly jabbed in the hand by a airborn cacti spine (wtf are the chances of that?)...I tend to get facial hives so I really just do not know for sure what is causing this face leprosy. Ugh.

    Unknown said...

    Hi Louise,
    I am considering TSW and have been reading through your blog! But this post has really scared me :( I have been using locoid cream 0.1% for about 20 years (I am 22) and until now I thought it was mild hydrocortisone! But I've just realised that's it more potent, what is the difference between hydrocortisone and hydrocortisone butyrate? And just how much more potent is locoid than group 1?
    Sorry for all the questions but I would really appreciate some advice :(
    Thankyou! Best of luck with your healing xx

    Louise said...

    Hi adeebah,

    I googled Locoid cream and although it is in a higher potency class than hydrocortisone, it is not a potent steroid. It is classed as "lower mid potency" which is one stage above mild potency. It seems to be a mid range steroid that doctors use on children, so it is not as bad as the super potent creams.

    If you are thinking of coming off, I would recommend joining the forum at itsan.org are there are many knowledgeable people there who can help you.

    Unknown said...

    Thankyou! I shall do, all the best x

    Diana said...

    Hi,
    I have been using hydrocortisone 1% ccream on my face for 3 months straight and I have stopped using it causing my face to get worse red itchy and spread.

    Do you happen to know the approx time it would take for my face to heal since it is sensitive and damaged? :(
    What do you think about moisturizing during the stage of tsw? Cause some people say don't but my face is so dry :'( ahh
    Anything else you recommend to help speed up recovery?

    Louise said...

    Hi Diana,
    Sorry to hear that the steroid creams have caused you problems. Even with the milder creams, addiction can occur when used daily for many weeks.

    Luckily, your usage has been short, so hopefully symptoms should resolve themselves fairly quickly, as long as there are no other underlying problems or allergies.

    To moisturise or not is down to personal choice. Some people like the comfort of a moisturiser, whereas others prefer to let the skin heal itself without interference. If you do choose to moisturise, try to use something as natural as possible, without additives and nasties.

    You may find, as I have, that as your skin heals, you don't need to use as much moisturiser and can eventually manage without it.

    Please consider joining us on the forum at itsan.org. You would be made most welcome and numbers are growing every day. We now have almost 1500 members. It is free to join.

    Nancy said...

    I would like to add a case about steroid adsorbing.

    I suppose:

    1. Baby's skin is highly absorbing, much more than adult.
    2. Some kind of laundry detergent can greatly enlarge absorbing too.

    My baby only use steroid no more than 4 weeks. She had suffer TSW more than 15 months and still in TSW !