Understanding the Different Types of Steroids: A Guide for Eczema and Topical Steroid Withdrawal
As a Naturopath specialising in Eczema and Topical Steroid Withdrawal (TSW), I’m often asked about the different types of steroids as there is often lots of confusion about what is or isn’t a steroid.
Are we talking corticosteroids, plant steroids, anabolic steroids, sex steroids or even vitamin D?!
Let’s start with the medications.
Steroids, or corticosteroids, are synthetic drugs that mimic the effects of hormones naturally produced by the body. While they can be effective in managing certain skin conditions, their prolonged use or abrupt discontinuation can lead to adverse effects. In this article we will explore the different types of steroids and their implications in the context of eczema and TSW.
Topical Steroids
Topical steroids are commonly prescribed for eczema treatment and are available in different strengths. They work by reducing inflammation, alleviating itching, and helping to restore the skin barrier. These steroids are categorised into classes based on their potency, ranging from mild to super potent. Lower potency steroids are typically recommended for sensitive areas or thin skin, while stronger ones may be used for more severe symptoms. However, long-term use or excessive application of potent steroids can lead to skin thinning, discoloration, and other side effects.
Oral Steroids
Oral steroids, also known as systemic corticosteroids, are often prescribed for severe cases of eczema or to manage acute flare-ups. These might be synthetic glucocorticoids, like prednisone and dexamethasone. They are taken in tablet or liquid form and work by reducing inflammation throughout the body. While oral steroids can provide rapid relief, they are generally reserved for short-term use due to the potential for systemic side effects. Prolonged use of oral steroids can lead to weight gain, increased blood pressure, mood changes, and other health complications.
Inhaled Steroids
Inhaled steroids, commonly used for asthma management, may also be prescribed for individuals with eczema when the condition is associated with allergic triggers or respiratory symptoms. These steroids are delivered directly to the lungs via inhalers, reducing the risk of systemic side effects. However, prolonged or high-dose usage can still lead to localised side effects such as oral thrush or hoarseness.
Topical Calcineurin Inhibitors
Topical calcineurin inhibitors (TCIs) are a non-steroidal alternative for treating eczema. Unlike traditional steroids, TCIs work by targeting immune cells in the skin to reduce inflammation. They are commonly prescribed when other treatment options are not suitable or when steroids cannot be used on sensitive areas such as the face or genital region. Protopic (Tacrolimus ointment) or Elidel (pimecrolimus cream) are 2 examples in the UK.
Withdrawal from Topical Steroids
Topical steroid withdrawal (TSW) occurs when individuals abruptly stop using topical steroids after prolonged or excessive use. TSW can lead to a range of distressing symptoms, including severe skin inflammation, redness, and increased sensitivity. During the withdrawal process, the body gradually adjusts to the absence of steroids, and the skin begins to heal.
For those undergoing TSW and Topical Calcineurin Inhibitor withdrawal, a holistic approach that addresses the underlying causes and supports the body's healing process can be beneficial.
More types of Steroids
Anabolic Steroids
Anabolic steroids, also known as anabolic-androgenic steroids (AAS), are synthetic variations of the hormone testosterone. They are primarily used to promote muscle growth and enhance athletic performance. These steroids work by increasing protein synthesis in cells, leading to increased muscle mass and strength. However, their use comes with a range of potential side effects, including liver damage, hormonal imbalances, cardiovascular issues, and psychological effects. Anabolic steroids are classified as controlled substances in many countries due to their potential for abuse.
Mineralocorticoids
Mineralocorticoids are a type of steroid hormone that regulate electrolyte and water balance in the body. The primary mineralocorticoid is aldosterone, which acts on the kidneys, promoting sodium retention and potassium excretion. This helps regulate blood pressure and maintain proper fluid balance. Synthetic mineralocorticoids, such as fludrocortisone, are sometimes prescribed to individuals with adrenal insufficiency (Addison's disease) to compensate for the lack of natural hormone production.
Naturally produced steroid hormones
The natural steroid hormones produced by the body are generally synthesised from cholesterol in the gonads (your reproductive organs) and adrenal glands. These forms of hormones are lipids. They can pass through the cell membrane as they are fat-soluble, and then bind to steroid hormone receptors.
Sex steroids include both androgens (such as testosterone) and oestrogens (such as oestradiol). Androgens are primarily responsible for male sexual characteristics, while oestrogens are primarily responsible for female sexual characteristics. These hormones play vital roles in reproduction, sexual development, and overall health.
Medical use of sex steroids includes hormone replacement therapy (HRT) for menopausal symptoms, certain hormonal imbalances, and gender-affirming therapy for transgender individuals.
Vitamin D is a closely related hormone system.
Plant Steroids
Phytosterols are phytosteroids (phyto means plant), similar to cholesterol, that serve as a structural components of plant membranes. These are the plant based foods we eat.
Good food sources of plant sterols include fruits, vegetables, nuts, seeds, and whole grains and are beneficial to health.
For personalised advice for your own Eczema or TSW journey please book an appointment, I’d love to work with you.