Corticosteroids for use on the skin

corticosteroids for use on the skin

What is a corticosteroid?

Corticosteroids are substances that act as an anti-inflammatory for the skin.  They also suppress the immune system so are helpful for allergic reactions.  Corticosteroids come in lotions, creams and ointments and vary greatly in strength.

Most people would be familiar with hydrocortisone as an over the counter low strength corticosteroid available from the Pharmacist.

 

What are corticosteroids used for?

Corticosteroid preparations are useful for flareups of eczema and psoriasis.

As a general rule corticosteroids should be applied in the lowest strength that is effective and for the shortest possible time.

This general rule has led to some people not using their prescribed corticosteroid enough and so they have not received the maximal benefit from it.  If in doubt speak with your Doctor or Pharmacist about the length of treatment that is right for you.

 

Corticosteroid use in children

Hydrocortisone is the agent of choice in children in most cases.  This is safe for children however care should be taken to only use the amount that has been prescribed and not use too much.  This is to minimise the amount that gets absorbed in to the blood stream and is usually only a concern if large areas of the body are being treated or if used for a long period.

It is unlikely that a child’s growth will be stunted from the use of corticosteroids on the skin if they are used appropriately.

 

Do corticosteroids thin the skin?

It is possible but unlikely that your skin will thin with the use of corticosteroids.  This effect has been seen in older patients, who have thinner skin to begin with, who have been using a strong corticosteroid for a long period of time.

 

Can corticosteroids change skin colour?

This is a question that has been asked from time to time.  It is usually the condition of eczema itself that causes changes in skin colour due to inflammation rather than the cream leading to skin colour change.

 

How can I make my corticosteroid work better?

Anyone who needs to use a corticosteroid should also be using a soap free wash a soap aggravates skin.

Moisturisers are also important and should be applied half an hour before a corticosteroid if possible.  When corticosteroids are not needed moisturisers should still be used to keep the skin in good condition.

 

Acne

acne

Acne

Everyone from teen age onwards knows about acne.  Even if you are one of the lucky ones who didn’t suffer much you will know someone who did.  Acne, also known as pimples, usually occur on the face but can occur on the chest and back as well.  They can appear as whiteheads, blackheads, pimples or cysts (don’t have a head).

Acne usually begins in the teenage years and lasts for the duration of these years however it can persist well into adulthood.

 

Causes of acne

Increased production of oil (sebum) by skin cells leading to blocked hair follicles is the main cause of acne.  Hormones that increase at puberty lead to a larger amount of oil.  When this oil causes a blockage in a pore it is common for bacteria that is present on our skin to then multiply in the pimple.  This leads to the pus-filled lump that we know as a pimple.

 

Prevention of acne

  • Wash the face twice a day with a non-soap cleanser and water. If you have been exercising or work in a humid environment or have just been sweating a lot you may have to wash following this also.
  • If non-soap cleansers don’t seem to be effective enough there are medicated cleansers that contain antibacterials, benzoyl peroxide or salicylic acid that are helpful.
  • It is very important not to over scrub the skin or make it too dry as this leads to irritation that may increase acne formation or dryness that leads the skin to produce more oil to compensate.
  • Picking, squeezing, touching the skin frequently with your hands and having hair hanging over your face are all things you should NOT Picking and squeezing increases the likelihood of scarring and touching with hands and hair increases the chance of pimple formation.
  • Use oil free make-up and moisturisers to avoid clogging of pores.
  • Always wash makeup off before going to bed to avoid clogging of pores overnight.

 

Treatment of acne

  • Treatment creams and gels containing benzoyl peroxide, sulphur and salicylic acid can be applied to acne to get rid of it.

Sometimes prescription treatment from your Doctor is required to treat acne.

  • Antibiotics taken orally or to be applied topically can help as they kill bacteria that is often involved in acne.
  • Azelaic acid lotion kills bacteria but also helps with inflammation.
  • Retinoids such as isotretinoin can be prescribed by a dermatologist for severe acne that is not responding to other treatment.
  • The contraceptive pill can be helpful in those females who have flare ups of acne associated with their menstrual cycle.

 

Though acne is common it should be treated seriously.  Those who suffer worst are usually teenagers who often feel self-conscious about their appearances anyway.

 

Sunburn

sunburn

Summer is coming.  Avoid sunburn.

If you have fair skin like mine you know that sunburn can occur in less than 15 minutes or in the time it takes to hang out the washing!  We looked at how to protect our skin from the sun earlier in the week.  Now let’s look at what sunburn is and what to do if sunburn occurs.

What is sunburn?                                                                                          

Sunburn is a radiation burn to our skin.  Sunburn can occur on cloudy days and even if we are not directly exposed to the sun such as when we are near reflective surfaces such as snow, concrete or sand.  UVA and UVB radiation both reach the earth though our skin responds differently to each.  Our skin does not have to burn to have sun damage.  Tanning is also a sign that UV damage has occurred.  Having a tan does not prevent against getting sunburned either!

UVA radiation penetrates deeper in to our skin layers and causes damage to new skin cells that are forming.  This can lead to dry, rough and wrinkled skin and also sunburn and skin cancer.

UVB radiation affects the surface layer of our skin and causes skin cancers as well as sunburn.  It also causes tanning, burning and aging.

Sunburn usually appear within minutes to hours of the burn occurring.  The skin can continue to change colour for up to three days.  As well as redness and heat, itching, swelling and sometimes blistering can occur.

Other ways to avoid sunburn

The old slip, slop, slap has gotten more fancy adding a seek and slide.  To refresh your memories that’s slip on a shirt, slop on sunscreen, slap on a hat, seek shade and slide on some sunglasses.

Staying out of the sun during the hottest part of the day is the best idea.  These times vary depending on where you are in the world.

Sunburn treatment

It is important to drink water as sun exposure can make you dehydrated.

Cool compresses and cool showers/baths can help (do not use soap as this may irritate).

Spray on pure aloe vera is great for soothing sunburned skin (especially if you keep it in the fridge to make it cold) and it helps with healing.

If there are blisters avoid popping them.  Hydrocolloid dressings available from the Pharmacy are great for healing burns.

Keep sunburned skin out of the sun until it has healed and then for a time after.

Nothing will stop skin from peeling if it is going to peel.  Apply moisturiser to the skin if this happens to help with itching.  Don’t rip peeling skin off but let it come off on its own.

If severe sunburn has occurred or if a baby or child is involved seek medical advice.

 

Exposure to UV radiation causes permanent skin damage and may cause skin cancer which can be deadly.

Choosing your sunscreen

safe sunscreen

All sunscreens are not equal

Everyone knows that they should wear sunscreen not only to avoid the pain and unsightliness of burning but also to avoid potentially deadly skin cancers.  Choosing a sunscreen is just as important as remembering to wear it.

There are two types of active ingredients (the ingredients that protect our skin from the sun) in sunscreens.

  • Reflectors (physically block sun absorption)
  • Absorbers (chemically absorb the sun’s rays)

There are also other inactive ingredients in sunscreens that make up the product to make it smell nice, preserve it and make it feel nice on the skin.

Physical blockers in sunscreens

The most common physical blockers are zinc oxide and titanium dioxide.  These ingredients work by placing a physical layer of mineral on our skin that blocks and reflects UVA and UVB away from our skin.

Chemical absorbers in sunscreens

Some of the most common chemical absorbers are oxybenzone, octyl methoxycinnamate, 4-methylbenzylidene camphor and octocrylene.  These work by absorbing UVA, UVB or both.

Choosing a sunscreen

Chemical sunscreens are favoured by those who want to apply sunscreen quickly and easily and not have it visible.  These sunscreens even come in sprays now as well as creams and lotions.  The downside to these sunscreens is that they can irritate the skin and have been linked to hormone disruption and free radical formation.  Using a sunscreen in a spray form has the potential for chemicals to be inhaled and thus cause damage to the lungs.

Physical sunscreens aren’t as popular due to the whitening effect they have on skin.  This is because they provide a physical barrier to the sun.  As such they are not usually able to be absorbed in to skin cells so don’t have the adverse effects of the chemical sunscreens.

Technology has been able to improve physical sunscreens so that they don’t make skin as white by making the particles of sunscreen smaller. There is concern however that particles that are too small (nanoparticles) can cause problems themselves through being absorbed into skin cells and the blood stream.

Physical sunscreens provide broad spectrum protection from UVA and UVB radiation.  Some chemical sunscreens protect against both of these and some protect against one or the other and so must be combined to give broad spectrum protection.

The best and safest sunscreen to use is one that comes in a lotion or cream form and contains zinc oxide in non-nano particle size.

My recommendations are MiEssence Reflect Outdoor Balm as it is not too white and not greasy.  Other brands I like are Billie Goat Soap and Little Urchins zinc sunscreens for the same reasons.

Try Miessence Reflect Outdoor Balm which is also Organic.

What is SPF (Sun Protection Factor)?

SPF tells us how well a sunscreen protects our skin.

In Australia the maximum that can be advertised is 50+.  In other countries SPF’s higher than 50 are advertised but this does not mean they are more effective.  Understanding different SPF’s is tricky.  There is not a large difference between them.

SPF 15 blocks approximately 94% of UVB rays.

SPF 30 blocks approximately 97% of UVB rays.

SPF 50 blocks approximately 98% of UVB rays.

How much sunscreen to apply and how often

Sunscreen should be applied 20-30 minutes before going out in the sun to give it time to work.

It is very important to apply enough sunscreen.  SPF is based on having a certain amount of sunscreen on our skin and applying too little means it won’t protect as well or for as long.  The following is what is suggested

  • Each limb and our front and our back require a teaspoonful each.
  • Our face, neck and ears require half a teaspoon each.

Don’t forget ears, lips and backs of hands when applying sunscreen!

Sunscreens need to be reapplied every 2-4 hours as stated on the product.  Heavy sweating, swimming or rubbing of the skin with a towel may mean earlier reapplication is necessary.

Sunscreen for babies

Protecting the precious skin of babies is especially important.

Babies under 6 months should not have their skin in direct sunlight and should be clothed and in shade to avoid the sun.  Reflective surfaces such as sand and snow can cause babies to burn as the sun is reflected back on to them.

Chemical absorber sunscreens should not be used on babies under 6 months and in some cases 12 months as high doses of the chemicals can be absorbed.

Physical blocker sunscreens can be used in babies over 6 months as these are not absorbed in to their skin.

 

Eczema

eczema

Eczema prevention and treatment

 

Most of us have probably seen what eczema looks like.  Eczema is more common in young children and people who also suffer with asthma and allergies.   Children who suffer with eczema may outgrow it.  Another name for eczema is atopic dermatitis.  Dermatitis means inflammation of the skin and atopy means having a predisposition to allergic things.

Eczema symptoms

Eczema symptoms include; redness, itching and dryness.  These symptoms usually occur in patches in the creases of the elbows, behind the knees, around the ankles, neck and wrists and may occur on the face and head.

Eczema sufferers often have dry and sensitive skin generally.  When eczema gets worse this is called a “flare up”.

Causes of eczema flare ups

  • Skin dryness
  • Skin irritants such as soap, bubblebath, chemicals, woollen clothes, perfume
  • Over heating
  • Stress
  • Contact with some fabrics
  • Contact with sand, grass, chlorine in pools
  • Contact with dust mites, animals

Preventing eczema flare ups

The most important thing anyone can do to keep their skin healthy and prevent flare ups is to keep the skin well moisturised.  This is important for everyone, not just eczema sufferers.  Using a soap free wash or aqueous cream to clean our skin without removing the skins natural oils is the first important step.  The second step is to moisturise after bathing as our skin absorbs so much more when our pores are open.  It is important to use a moisturiser without additives.

Treating eczema flare ups

Your Doctor or Pharmacist can provide creams for flare ups.  It’s a good idea to treat flare ups quickly so that they resolve quicker.  Corticosteroid creams are the most common type of cream and when used appropriately are unlikely to have side effects.  It is important to keep using a moisturiser even if an extra cream has been prescribed for treatment.

If the skin is really dry using a skin oil available from the pharmacy really helps and can be added to bath water or sprayed on the skin after showering.

If the skin is especially itchy use an oatmeal based wash or put half a cup of oats in a stocking, tie it up and place in the bath.

See the MiEssence Body Care range for products suitable for eczema prone skin.