Topical Steroid For Treatment of Eczema - Why We Stopped Using Them On Our Child

Topical steroids (corticosteroids) are prescribed by the NHS for infants and adults with eczema. Steroids are a group of hormones naturally produced by the body. Topical Steroids are synthetic medications that are applied directly to the skin (atopic). They can reduce inflammation, reduce skin skin and itchiness; all symptoms of eczema and other dry skin conditions. (1)

Whilst lots of people find relief, this often is temporary as the skin can become used to them and over time require more to achieve the same effects on reducing symptoms. They have been used for around 70 years and in more recent years, about 10 years, people using them are discovering they have Topical Steroid Addiction (TSA) and when stopping use, whether tapered or immediate, are experiencing Topical Steroid Withdrawal, as well as realising they do not address the root causes of eczema and instead act as a plaster/band-aid for temporary relief leading to a viscous cycle of long-term use. (2)

Topical Steroid Withdrawal can at first mimic severe eczema symptoms and is often diagnosed as this by medical professionals and more potent steroids are prescribed, and in some cases oral steroids. People within the eczema community are trying to raise awareness, including us, to stop the use of any steroid, on any part of the body, for children including the concerning use for nappy rash, as well as being available without prescription.

People often report that whilst Topical Steroids can be effective, this is short lived and as soon as they are stopped, the eczema resurfaces. This was the case for us, and many other families I have since connected with. After following medical guidance for around 10 months, it become increasingly clear that Topical Steroids were not effective for my son's eczema. After endless research into natural remedies and alternatives to paraffin based emollients and topical steroids, we transitioned off of both and have thankfully never looked back. (2)

Eczema is not a dry skin condition, contrary to it being described as that everywhere. It actually is a faulty skin barrier, which results in microscopic gaps. It can often be described as the mortar in brick work. The mortar is missing thus leaving gaps in the top layer (epidermis) of skin where anything can get into these gaps, causing skin irritation resulting in the skin symptoms we visually see such as redness, dryness, itching, flaky, cracked and raised skin.

This could be partly due to a low skin protein called Filaggrin. This protein brings together the skin structure of the outermost skin cells, forming tight bundles, strengthening the cells creating a strong barrier. (3) All babies are born without the Filaggrin protein which is why it is important to not expose our children with chemicals, strong washing detergents and perfumed soaps as well as baths which surprisingly can be harsh on a babies newborn skin. Our skin should keep the womb fluids on it, for as long as possible, allowing it to gently transition from to the world's air. (4).

Some people with eczema may have a dry skin condition which means they have a deficiency in this filaggrin protein. Not having sufficient filaggrin can result in the skin's natural moisture seeping out through these gaps and allowing substances in. (5)

If you do not have this gene, but still have eczema, the skin inflammation can still result in a reduction of this filaggrin protein, worsening the already troublesome symptoms. (4)

L-histidine, an amino-acid, can enhance the barrier function and is found in some foods. In a study (6) L-histidine 4g daily supplements were found to reduce eczema symptoms by around 32% in the group receiving this supplement vs zero change in the placebo group. The groups were switched, and when the placebo group were given the supplement, the eczema symptoms were reduced. Further studies are always needed, particularly when groups are small and when new research and information is emerging.

Foods that contain L-histidine are: meat, dairy products, legumes (chickpeas, peas, soya, peanuts), nuts, seeds, egg and wholegrain. (7)

Topical Steroids are not suitable for long-term use. The NHS recommends two week periods or longer periods less frequently (1) but eczema may require daily management, potentially for life for some people.

Management of environmental factors is essential no matter what topical cream is used. Think of food allergies - if an individual removes these foods out of the diet, there is no trigger from exposures to the allergen but as soon as the person is exposed, an allergic reaction would occur. If someone with eczema is continuously exposed to a substance causing skin irritation, the skin will continue to be inflamed and active.

I started to address these triggers by completing a diary. At first, I was writing in short form and after a while it become really confusing and impossible to reflect back on, which is fundamental. I then created a diary which daily tasks and weekly tasks as well as review sections. This allowed me to see how my son's skin was interacting with our daily life and I quickly discovered exactly what was worsening his skin. 

I was able to then address each trigger, one at a time, and trial ways to reduce exposure. Bathing was a culprit for his weeping skin and as soon as we removed the weeping stopped. Once we were able to get the skin down substantially, we were able to gradually built tolerance back up and he was able to have baths again without any issues. 

Our journey illustrates that a more holistic approach, instead of focusing on topical creams, is a possible way to improve eczema symptoms. 

As well as Topical Steroid Addiction (TSA), steroids come with other risks and side effects. According to the current NHS information, the most common side effect of topical corticosteroids is a burning or stinging sensation when the medicine is applied. 

Less common side effects can include:

• worsening or spreading of a skin infection you already have
• inflamed hair follicles 
• thinning of the skin
• stretch marks
• contact dermatitis which is a skin irritation caused by a mild allergic reaction to the steroid itself
• acne
• rosacea
• changes in skin colour
• excessive hair growth on the area of skin being treated

It doesn't detail on the main website about growth issues but this is also a side effect. The elderly and very young are more vulnerable to side effects. (9)

For my tiny baby, I felt overwhelmed and anxious that he would be at increased risk of these symptoms and I wanted to find a better option for him. Children have thinner skin and the long term use of these could have had some serious implications for his health, so I felt I had to as his parent try the alternative ways to give him hope in later life. It is important to note that lots of studies suggest that misuse of topical steroids is what causes the addiction however, us and many other people have been prescribed and instructed to use outside of the guidance by the NHS itself. 

References and research:

Note: Please consult with a medical professional if you are concerned about your child’s health in any way. This article is just sharing my experiences and is not intended to treat or diagnose your child. Always consult with your doctor before starting any treatments.

(1) https://www.nhs.uk/conditions/topical-steroids/

(2) https://www.itsan.org/what-is-tsw-syndrome/#:~:text=Topical%20Steroid%20Withdrawal%20Syndrome%20is,to%20treat%20the%20skin%20condition.

(3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872242/

(4) https://biomee.com/dry-skin/#:~:text=Causes%20of%20filaggrin%20deficiency&text=Genetic%20filaggrin%20deficiency%E2%80%94a%20chronic,into%20water%2Dbinding%20amino%20acids

(5) https://www.nursem.co.uk/pages/filaggrin-and-eczema?utm_term=&utm_campaign=221021_PMAX_Shopping_AllProducts_GS&utm_source=google_ads_pmax_shopping&utm_medium=cpc&gclid=Cj0KCQjwm66pBhDQARIsALIR2zASv2qP9KLFn0yeHXKPf2smcVwQTfGb5rYBuwwMK7OswlWVic-3upsaAk29EALw_wcB

(6) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5634381/

(7) https://www.healthcenterhudsonyards.com/fight-chronic-inflammation-with-food/

(8) https://www.ouh.nhs.uk/patient-guide/leaflets/files/14460Peczema.pdf

(9) https://www.nhs.uk/conditions/topical-steroids/