the Effects of Topical Steroids on Skin and Joint Pain

Steroids

Hello Dr.
Huang: About three to four months ago, I experienced pain in the inner joint of my right wrist.
Actions like writing with a pen or using scissors exacerbated the pain.
Initially, I applied anti-inflammatory ointment continuously, but later sought treatment at a traditional Chinese medicine rehabilitation hospital for a month, with no relief of symptoms.
I then turned to an orthopedic specialist, who diagnosed me with what is commonly known as "mommy's thumb" and administered an injection at the affected area.
Shortly after, I indeed felt better, but the skin near the injection site on my right wrist has turned a pale white and feels slightly indented.
I suspect this might be due to excessive application of the anti-inflammatory medication.
Could you please advise on the potential consequences of overusing topical anti-inflammatory medications? Will the pale skin eventually return to its normal color over time? Thank you for your time and clarification!

Xiao Ding Dang, 30~39 year old female. Ask Date: 2006/08/16

Dr. Huang Ruiyun reply Dermatology

Topical anti-inflammatory ointments that contain only non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief will not cause skin atrophy or hypopigmentation; such side effects are associated with corticosteroids.
The white discoloration may gradually fade over several months to a year.

Reply Date: 2006/08/16

More Info

Topical steroids, such as Mometasone Furoate, are commonly prescribed for various skin conditions due to their anti-inflammatory properties. They can effectively reduce redness, swelling, and itching associated with skin disorders. However, their use, especially in conjunction with moisturizers, can lead to some confusion regarding their effectiveness and potential side effects.

In your case, the persistence of symptoms despite using topical steroids and a moisturizer could be due to several factors. First, the cold and dry climate in Europe can exacerbate skin conditions, leading to increased dryness and irritation. This is particularly true for conditions like eczema or dermatitis, where the skin barrier is compromised. Applying a moisturizer immediately after bathing is generally recommended, as it helps to lock in moisture. However, if the moisturizer is not suitable for your skin type or if it contains irritating ingredients, it could potentially worsen your symptoms.

Regarding the interaction between the topical steroid and the moisturizer, there is no direct evidence to suggest that they negatively interact. However, the order of application can matter. Typically, it is advised to apply topical steroids first and then follow with a moisturizer. This allows the steroid to penetrate the skin effectively before being sealed in by the moisturizer. If you are applying the moisturizer first, it may create a barrier that prevents the steroid from being absorbed properly.

As for your question about whether to stop using the moisturizer or continue with both, it would be prudent to consult with a healthcare professional. They can assess your skin condition and recommend the best course of action. In general, it is not advisable to stop using a moisturizer, especially in a dry climate, as it plays a crucial role in maintaining skin hydration and barrier function.

Regarding the skin discoloration and indentation you mentioned after receiving a steroid injection for your wrist pain, this is a known side effect of corticosteroid injections. The "whitening" of the skin can occur due to skin atrophy, which is a thinning of the skin that can result from prolonged or excessive use of topical steroids or injections. This effect may improve over time, but the duration can vary depending on individual skin types and the extent of the steroid use. It is essential to monitor the area and consult with your healthcare provider if you notice any concerning changes.

In summary, while topical steroids can be effective in managing skin conditions, their application must be carefully considered, especially in conjunction with moisturizers. The cold and dry environment can complicate skin health, and it is crucial to maintain a proper skincare routine that includes both effective medication and adequate hydration. If symptoms persist, seeking professional advice is always the best course of action.

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