We recently combed through 2460 pages of a dermatology textbook, trying to answer one of the common questions asked by people who use steroids on their skin:
Is there a maximal quantity of steroids one can apply to the skin over a defined period?
Obviously, this is an important question. Topical steroid is a very common medication prescribed by doctors to treat a wide range of skin conditions such as eczema, psoriasis, and allergic contact dermatitis. When used appropriately, (i.e., using the right strength of topical steroids and use it for appropriate amount of time) the medication improve or cure the patients’ skin diseases.
However, many patients are prescribed a much stronger steroid than needed, and use the medication over a long period of time. The end results can lead to various side effects such as thinning of the skin. Worse yet, some patients report to develop topical steroid withdrawal syndrome or red skin syndrome.
Our research team reviewed a well respected Dermatology textbook1, and we specifically focused on the treatment sections for various dermatological conditions, in which steroids are commonly prescribed. We also reviewed an entire chapter on glucoccorsteroids, where the author discussed the mechanism of action, pharmacology, indication, dosage and contraindication of steroid use.
Our team uncovered only one interesting finding.
We found a reference on page 139, Chapter 9, titled “Psoriasis.” The author, Dr. Peter CM van de Kerkhof stated that maximum quantities for using topical steroids to treat psoriasis is 50g per week of superpotent corticosteroids and 100g perweek of potent corticosteroid.
The search was only partially satisfactory. From this reference, we understand the maximum recommended dosage to use topical steroids per week for different strengths of medications.
However, we had other questions:
1. Is this recommended dosage apply to children?
2. What are superpotent steroids and potent steroids? For that question, our team tracked down a very useful table ranking the potency of commonly prescribed topical corticosteroids.
Superpotent corticosteroids (class I steroids) are clobetasol ointment and cream 0.05%, betamethasone diproprionate gel and ointment 0.05%, diflorasone diacetate ointment 0.5% and halobetason proprionate ointment 0.05%.
3. Does this recommended dosage only apply to the treatment of psoriasis? What about other skin conditions, such as eczema?
4. This reference only told us about the maximum dosage per week. But, is there a maximum dosage over a period of 3 months, 6 months, or a year? Also, is there a total maximum dosage in one’s lifetime?
The bottom line, the research only found a small piece of information regarding the maximum dosage of topical steroids use. It is clear that more research is needed from our team. Please drop us a note in the comment section, if you know of other references or sources that have answered those other questions.