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Cortisone cream…friend or foe?

Cortisone cream is a steroid, topically applied to relieve itching of dermatitis and eczema. It is available in retail forms such as Dermaid, Sigmacort, and Cortic, or by prescription.

These drugs are recommended and prescribed generally without hesitation or caution in children and adults. Yet topical steroids, such as cortisone, are associated with a raft of side effects affecting the skin or other body systems.

The main contradictory effect being that steroid creams slow down the healing of skin by directly reducing the rate of skin cell formation, collagen repair and by impairing the blood supply needed to support that repair. This is a rather problematic for people who already have damaged skin and therefore an increased requirement for healing.

Other common skin side effects are the loss of skin pigmentation, acne-like eruptions, fungal infections such as tinnea, dermatitis around the mouth, roseacea, spreading of the bacteria that causes acne, prolonged infections of cold sores and molluscum contagiosum.

A review published in the Indian Journal of Dermatology highlights the need for caution and limited use, particularly in children. [1]

The review states that children are particularly prone to develop systemic side effects when topical steroids (TS) are used because their softer skin has an enhanced capacity for absorption, compounded by the increased surface area to weight ratio.

The following is an excerpt from the review citing national medicine recommendations from the UK and USA, suggesting limiting the use of these substances in children:

“ British National Formulary states that skin of children is sensitive so they are likely to be susceptible to side effects of TS, hence they should be avoided in children or, if necessary, used with care and for short periods. Food and Drug Administrations centre for drug evaluations and research have reported TS side effects similar to those seen in adults. Some side effects not reported in adults but seen in children include local irritation, mood change, gynecomastia, genital hypertrichosis and staphylococcal infection.”

In case you’re wondering, gynecomastia is the growth of breast-like tissue in boys and hypertrichosis is unusual or excessive hair growth (it is a steroid afterall).

The message sent to parents and their children about the safety of long term cortisone use troubles me on two levels: clearly cortisone is not designed to manage eczema, it is intended for symptomatic relief. More importantly, the dominant and current medical management of eczema rarely explores the cause of the condition.

I have assisted many, many parents to solve the mystery of their children’s eczema, such that the eczema resolves, eliminating the need for spurious symptomatic treatments like cortisone, altogether.

[1] Coondoo A et al, Side-effects of topical steroids: A long overdue revisit. Indian Dermatol Online J 2014 Oct – Dec 5(4) 416-425

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