‘Steroids thin the skin’

Skin atrophy (thin, shiny, skin that bruises easily) is the biggest reported concern from Qr8 patients around topical steroid use. This typically happens with prolonged use of super/highly potent steroids, not at low concentrations of low potency steroids used for a limited time under medical supervision [6].⁠

The addition of tretinoin in a fading treatment has also been shown to negate the atrophic effects of topical steroids by thickening the dermis [7-9]⁠.⁠

‘Steroids have scary side effects’

Studies report that people worry about an enormous variety of negative side effects from topical steroids. These include: weight gain, asthma, skin thinning, growth stunting, skin aging, stretch marks, skin irritation, acne, broken capillaries, systemic effects, eye complications such as cataracts, resistance, impairment of the immune system, and even the general concern about unknown long-term side effects. But the same studies show that these side effects happen rarely, and are reported to doctors even less. They usually occur with long term, unsupervised use of topical steroids, or regular use of systemic steroids [1].

Our skin barrier does a stellar job at keeping topical ingredients (even drugs!) from entering the bloodstream. Only a tiny amount of topically applied hydrocortisone is actually absorbed past the skin barrier, which is all you need for it to have a positive effect. To get technical, less than 2% of topically applied hydrocortisone is absorbed into the systemic circulation after single stay on application of more than 1 day [10].

‘The instructions about how to use my steroid aren’t clear’

Applying your cream ‘sparingly’ doesn’t mean much. Likewise, use a ‘pea-size amount’ or ‘1 or 2 pumps, enough to cover your face’ is open to interpretation. Patients are generally afraid that they are using too much, so err on the side of not using their treatment properly (or at all!) [11-13]. It’s why our Qr8 instructions are so detailed, and our treatments are dispensed in medical-grade packaging with a calibrated doing mechanism. And if you need more help, our nurse is available to chat with on our text support line any time during QLD business hours!

‘If you use a topical steroid, you’ll end up with perioral dermatitis (PD)’

We see and hear this a lot on social media (in fact some companies use this to sell you their skincare products!), so here’s the facts from our own point prevalence studies*: For every 1000 patients we treat, there are less than 5 at any one time with perioral dermatitis. This is half the reported 1% prevalence of PD in the general community. So our intensive support for your skin barrier during treatment, and careful prescribing and monitoring practices, mean that you’re less likely to get PD at Qr8, even when using a topical steroid in your formulation.

*A point prevalence study is a fancy epidemiology term for a snapshot study, conducted at various points in time. We check our PD rates each season/quarter, and include patients on all types of topical treatments, but exclude those who have a primary diagnosis of PD (i.e. have come to Qr8 seeking help for their PD, not another skin condition).

3. Where does all this misinformation come from?

We all love and trust our nearest and dearest, but unfortunately studies show that it’s negative comments from friends, family and non-medical personnel that are the most common sources of misinformation about topical steroids leading to steroid phobia [14, 15]. Other studies point to the internet, social and other media as the source [11, 16, 17]. Our experience at Qr8 is that Facebook chat groups are a leading source of misinformation about these ingredients for our patients.

And finally…

Remember that as a Qr8 patient you will chat every 3 months with one of our doctors in a video consultation, where you will have the opportunity to raise any concerns (like your fears around steroids, or any other ingredient you are prescribed for that matter!) and get evidence-based answers from a medical professional who knows these ingredients thoroughly, has worked with them for long periods of time, and understands your personal medical and skin history. Likewise, our dermatology nurse is available to chat with by booking a video consultation with her (included as part of your treatment), or via text chat any time during QLD business hours.

Studies show that this kind of personalised advice, and an ability to raise your personal concerns and have them addressed individually, is more successful at overcoming misinformation than educational videos, standardized written information or a link to an online forum [16, 18]. Yet another reason why Qr8 is personalised just for you!