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Daily Cuts - What To Know About Using Steroid Creams
Steroid creams are often prescribed for fast, effective relief of various skin conditions and ailments, but too much can go too far. Dr Kok Wai Leong, Senior Consultant and Dermatologist, HMI Medical Centre tells Andrea Heng and Hairianto Diman what we need to know about steroid creams so that we can use them safely.
HSA Warns Against Using Skin Cream With Potent Steroid After Woman Suffers Severe Skin Reactions
SINGAPORE – Members of the public are advised not to purchase or use a skin cream that caused a woman in her 50s to suffer severe skin reactions after using it, the Health Sciences Authority (HSA) said on Aug 26.
Called Touch Skin by DermaCare Skin Relief Treatment Cream, the product is touted to soothe eczema, chickenpox and insect bites.
The woman had been using the cream for about eight years for her sensitive facial skin, and would experience a sudden worsening of symptoms – also known as flare-ups – whenever she stopped applying it.
She had purchased the cream from a shop in Orchard Road and continued buying it from the seller via messaging platform WhatsApp after the physical shop closed in 2020.
In May 2024, the woman saw an advisory issued by HSA warning against a similar product found to contain a steroid and sold on the touchskin.Com.Sg website. She immediately stopped using her regular cream.
Two days later, she developed red, sensitive and itchy skin on her face and consulted a doctor. The doctor found her skin to be severely inflamed, sensitive to sunlight, and thinned out with telangiectasia, also known as spider veins, and reported the adverse event to HSA.
A test conducted by HSA revealed that the cream contained betamethasone valerate, a potent steroid usually prescribed for inflammatory conditions that should be used under medical supervision.
Ongoing investigations have also revealed that Touch Skin by DermaCare Skin Relief Treatment Cream and the product flagged by HSA in May were sold by the same seller.
Creams containing potent steroids for the treatment of skin conditions should be used only under medical supervision, said HSA.
Long-term unsupervised use of such creams can cause hypersensitivity reactions, thinning of the skin and topical steroid withdrawal syndrome, which presents symptoms such as burning, itching and redness when their use is suddenly stopped.
The steroids may also be absorbed into the body and cause serious adverse effects when applied to large areas of the skin or used over a prolonged period. Adverse effects include high blood pressure, cataracts, muscular and bone disorders, an increased risk of infections and Cushing's syndrome, which causes a "moon face" appearance and upper body obesity with thin limbs.
HSA said that members of the public should be wary of purchasing skin creams from dubious, unfamiliar or online sources, as consumers cannot be certain where and how these products were made, or if they have been adulterated with harmful ingredients.
"Adulterated products are often manufactured under poor conditions with no quality control, and different batches of the same product may contain variable amounts of ingredients and/or different types of adulterants," it said, adding that consumers should buy only from reputable pharmacies or retailers' websites, or those with an established retail presence in Singapore.
From 2022 to July 2024, HSA has detected an increased number of creams marketed for skin conditions such as rash, eczema and psoriasis that contained steroids and other potent medicinal ingredients.
Examples of these creams include Touch Skin by DermaCare Skin Relief Treatment Cream, Special Skin Treatment cream, Star Cream, JolicareTM (Original, Baby and Collagen), Tao Ju Hui Yi Mei Li Shang Kou Hu Li Ruan Gao and Euzema Confidence Revival Cream.
The majority of the creams were used on young children. As young children are more susceptible to the effects of adulterants such as steroids, they suffered serious adverse effects from the use of these creams. The creams were sold on websites, e-commerce platforms, social media platforms and, in one case, by a peddler at a makeshift stall.
Those using such creams are advised to see a doctor as soon as possible, said HSA.
Suddenly stopping the use of creams containing steroids without medical supervision may also worsen underlying skin conditions or cause topical steroid withdrawal symptoms.
A healthcare professional should be consulted to help manage chronic skin conditions instead of using unfamiliar skin products, added the authority.
HSA instructed all sellers and suppliers of these products to stop selling them immediately, and said it would not hesitate to take stern enforcement action against anyone who sells and supplies products found to be adulterated with steroids.
Those found guilty can be jailed for up to three years, fined up to $100,000, or both.
Members of the public who have any information on the sale and supply of these illegal products may contact HSA's enforcement branch on 6866-3485 during office hours from Mondays to Fridays, or via e-mail at hsa_is@hsa.Gov.Sg
Topical Steroid Withdrawal (TSW) And Eczema: What You Need To Know
Topical steroid withdrawal (TSW) is not well understood. Researchers don't know what percentage of people develop it or why some people react to topical steroids in this way.
Topical steroid creams are one of the most common methods to manage eczema. While they don't usually cause harm, in rare cases, topical steroids may lead to a painful condition called topical steroid withdrawal (TSW).
This condition can develop in the weeks after stopping the use of a topical steroid. It can cause a severe rash, swelling, and other symptoms.
TSW is not fully understood or sufficiently studied, but usually occurs in the context of prolonged topical steroid use and can manifest in different ways on the skin. For most people with inflammatory skin disease, the benefits of topical steroid use as prescribed by a dermatologist far outweigh the risks.
Topical steroid creams are often used to treat eczema and other skin conditions, as they decrease inflammation, which is the cause of common symptoms like itching and scaling.
TSW is a rare reaction to stopping the use of topical steroid creams. It can result in a rash that is more severe and painful than the eczema it was originally used to treat. This rash can appear as patches or bumps on the skin.
The majority of reported TSW cases are in people with eczema; however, using topical steroid creams for another skin condition over a long period might also contribute to TSW.
There is some evidence that people who previously used topical steroids to treat eczema are more likely to develop a red, swelling TSW rash that is painful and burning.
There are two proposed subtypes of TWS, erythematoedematous and papulopustular. Erythematoedematous TSW manifests as a red swelling rash, while papulopustular TSW shows up as acne-like pustules on the skin.
TSW can lead to multiple symptoms. Not everyone who experiences TSW will have the same symptoms. Since the condition is so rare, there is no set diagnostic criteria.
Usually, the telltale symptom is inflamed skin that causes a painful or burning sensation and appears after stopping topical steroid use. This rash commonly appears on your arms or legs and is known as a "red sleeve," but it can occur anywhere on your body.
Other symptoms of TSW include:
TSW can be painful and distressing. Unfortunately, this condition is very rare and can be hard to spot. People with eczema might have trouble distinguishing TSW from an eczema flare.
There currently are no tests to diagnose TSW. Instead, a dermatologist will use your symptoms and medical history to diagnose the condition.
You might be diagnosed with TSW if you:
TSW is very rare and there is no standard or agreed-upon treatment. If you're diagnosed with TSW, your dermatologist will help you develop a plan to treat it. Potential treatment options include:
If there is significant widespread rash, a doctor may occasionally use oral steroids in the short term while a longer term medication, like dupilumab, starts to kick in. However, oral steroids carry a high risk of rebound rash on discontinuation, so it is not recommended as a long-term solution.
Researchers don't know why some people develop TSW. The condition is rare and more studies need to be done to help dermatologists fully understand it. The main risk factor for TSW is using mid- or high-potency topical steroids for a year or more.
Unfortunately, topical steroids are present in cosmetic OTC products in some Asian and African countries where people unknowingly apply topical steroids to their face for a prolonged amount of time. These patients tend to develop steroid-acne but also are at risk for TSW.
The condition appears to be more common in adult women who have applied topical steroids to their face or genital area.
TSW might cause symptoms that last weeks, months, or years. People with the condition will recover at different rates and respond to treatments differently. Since the condition is so rare, there is not an average time estimate for recovery or a known outlook.
Most people who use topical steroids are able to stop them without any side effects. If you use topical steroids prudently and follow the advice of your dermatologist, TSW is unlikely to occur. Most dermatologists will recommend the use of topical steroids for under 2 weeks.
In rare cases, people can develop a condition called topical steroid withdrawal, or TSW. This condition tends to develop due to the self-led application of topical steroids for a prolonged amount of time.
Be sure to read labels carefully to ensure you are not unknowingly applying a topical steroid to your skin.
Since eczema is frequently treated with topical steroids, it's important for people with eczema to know about this rare condition. TSW causes a burning and painful rash. Some people experience additional symptoms, such as hair loss or depression.
Talk with your dermatologist if you're concerned about TSW. They can help you adjust to an alternative topical medication or suggest other treatments.
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