If your eczema (atopic dermatitis) flare-ups are really bad, oral corticosteroids are one of the treatment options that can help soothe your irritated skin.
Also known as immunosuppressants, oral steroids work really well and can help bring your eczema symptoms under control fast. But these are strong prescription drugs, and long-term use may have downsides. Here’s everything you need to know about oral steroids before you give them a try.
What Are Oral Steroids?
Oral corticosteroids (commonly called steroids) are drugs in pill form designed to slow down your immune system and ease symptoms like swelling, itchiness, redness, and pain. They contain a synthetic substance similar to cortisol, a hormone your adrenal glands naturally produce.
If you have a condition that causes your immune system to act up, instead of protecting you, this may cause the defense system to attack your body. When you take an oral steroid pill, it lowers your white blood cell activity and lowers the immune system response. The drugs also control the chemicals that may cause inflammation and tissue damage in your body.
Some common oral steroid medicines include prednisone, cortisone, and methylprednisolone.
How Do Oral Steroids Treat Eczema?
When you have eczema, while researchers are not sure why, it causes your immune system to glitch and produce inflammation within your body. Because of this, your skin can have redness, itching, and irritation.
Oral steroids enter your body, attach themselves to special receptors in your cells, and work to quickly bring white blood cell movement under control. This then quickly stops your body from producing harmful chemicals that cause inflammation symptoms on your skin.
Oral steroids also help to stop the possible itch-scratch cycle and give your skin a chance to heal and stop possible skin infection.
What’s the Difference Between Oral and Topical Steroids for Eczema?
Corticosteroid medications come in different forms. They can be topical, oral, or sometimes injectable.
Oral steroids are strong, systemic drugs. This means that when you take a steroid pill by mouth, it affects your whole body. For eczema treatment, they’re used only for really bad flares. Your doctor will closely watch your reaction and will give you a plan to wean you off of them and avoid serious side effects.
Topical steroids, on the other hand, come in various strengths. They mostly come in a cream, ointment, or lotion, and medium- and high-potency steroids are more commonly used to control skin inflammation from eczema. You can apply them to specific areas that have a flare-up. For example, if your eczema shows up on your elbows, you should apply topical steroids only on the eczema-affected part of your elbow. And high-potency steroid creams should only be applied to your chest and arms, not your face or near your eyes.
You can use topical steroids for up to 2 weeks, twice daily, to bring your skin under control and then slowly come off of them. Topical steroids can have side effects too, such as thinning of skin, stretch marks, spider veins, and acne.
Who Can Take Oral Steroids for Eczema?
The use of oral steroids can be controversial. In fact, the American Academy of Dermatology Association states that “systemic steroids should be avoided when possible” for eczema treatment. That’s because these are strong drugs that can produce serious side effects if you use them long-term or in high doses. Doctors prescribe oral steroids sparingly and reserve them for people who have serious eczema flare-ups.
Most adults and children can safely take oral steroids, as long as it’s for a short time and you monitor for side effects. Usually, your doctor may prescribe around 20- to 30-milligram pills to take once per day for 7 days. Your provider may prescribe a higher dose if necessary but will provide a plan to taper off to a lower dose or switch to milder treatment options once your flare-up is under control.
If oral steroids are not taken properly, it’s possible to have a “rebound effect,” where your eczema symptoms pop right back up after you stop taking the drugs. To avoid this, it’s important to take all of the medications as prescribed and not skip any doses, even if you start to feel better. Talk to your doctor before you stop using them or quit other treatments you’re on to control your eczema.
Who Shouldn’t Take Oral Steroids?
Oral steroids are not suitable for everyone. While they can help reduce eczema, they could make certain conditions worse. Be cautious with high-dose oral steroid use if you have a history of:
- High blood pressure
- Osteoporosis
- Peptic ulcers
- Psychoses
- Diabetes
Oral steroids can also interact with other medications you may be on and cause side effects. Avoid oral steroids if you’re taking:
- Warfarin (blood thinner)
- Antifungal drugs (fluconazole, itraconazole, and ketoconazole)
- Nausea medications
- Aspirin
If you’re on these drugs, talk to your doctor or pharmacist. They may suggest other options to control your eczema.
Possible Side Effects of Oral Steroids
Long-term use of oral steroids can have side effects like:
- Skin thinning
- An increase in bacterial, fungal, and viral infections
- Stretch marks
- Acne
- Hair loss
- Weight gain
- Glaucoma or cataracts
- High blood pressure
- Gut issues
- Osteoporosis
- Stunted growth in children
- Irregular periods for women
Side effects vary from person to person. If you notice any negative reactions, tell your doctor right away. If it’s an emergency, call 911 or head to the nearest hospital for medical attention.