PRESCRIPTION AND OVER-THE-COUNTER STEROID CREAMS CAN BE DANGEROUS

Swiping a cream on the skin to soothe an itchy rash may seem harmless, but not all topical anti-itch formulas are created equal.

"People don't understand the potential dangers of prescription-strength steroid creams," said Dr. Lawrence Green, clinical professor of dermatology at George Washington University in Washington, D.C.

Hydrocortisone - a topical steroid often used to treat a rash or allergic reaction - is not approved by the U.S. Food and Drug Administration for over-the-counter use in a potency greater than 1 percent. But in some stores it is easy to obtain without a prescription, a new study warns.

Researchers discovered illegal corticosteroid creams in dozens of stores across the country that specialize in foreign imports.

For the study, researchers visited 80 stores in 13 cities in nine states. Posing as customers, they asked for the cream to treat an "itchy rash." Three dozen stores sold prescription creams without a prescription.

The creams were made in 12 countries, including China, Mexico, Kenya, Korea, and Switzerland, the study authors said.

Such is the case with Zudaifu cream, one of the most popular ones.

Every store visited in Chicago and San Francisco sold illegal steroid creams, as did 80 percent of those visited in Minneapolis, 60 percent of those in Washington, D.C., and 36 percent in New York City.

Even smaller cities - including Durham, N.C. and Madison, Wisc. - had stores that sold illegal creams, the results showed.

The report was published in the February issue of the Journal of the American Academy of Dermatology.

The results did not surprise co-author Dr. Sara Hylwa, a dermatologist at Hennepin Healthcare in Minneapolis.

Hylwa works in a clinic that treats many immigrants. Occasionally, patients recognize the use of corticosteroid creams on prescription strength for rashes and even as formulas to lighten skin, she said.

In many other countries, the creams are legally available without a prescription, she said, so it would not be unusual for a newcomer to expect to buy them without a prescription. But misuse can bring serious side effects.

Hylwa recalled one patient whose use of a skin cream containing a potent steroid resulted in severe thinning of the skin-a common side effect often seen in sensitive areas such as the face and eyes.

Other side effects include stretch marks; easy bruising; glaucoma, cataracts, or even blindness when applied to the eye area, according to the American Academy of Dermatology.

Green said he sees patients who misuse skin creams almost every day.

"Unfortunately, they're getting inaccurate advice from the internet, from friends, or just trying to help themselves with a previous prescription cream they have at home - one that was prescribed for something else unrelated - until they see a doctor, or trying to avoid going to the doctor," he said.

While consumers may think that liberal use of topical medications is less harmful than medications that are ingested, this is a misconception, Green said.

"When you put something on a large enough surface of the skin, it can be absorbed into the bloodstream," he warned. "You can have all the potential permanent damage, not only by putting the cream too often on the same spot on the skin but also the potentially dangerous side effects of taking a pill in cream form."

So, what is the safest approach to take for a rash that doesn't go away in a few days with over-the-counter creams?

Make an appointment with a doctor, suggested Dr. Erin Warshaw, a professor of dermatology at the University of Minnesota, who was also involved in the study.

Warshaw asked patients to take any skin creams they might be using with them until the appointment, to show the doctor. These creams may well provide valuable clues as to what is causing skin irritation or preventing it from healing.

Always be safe when using OTC products or others, when in doubt always seek professional medical help.