366: What Are Topical Steroids (aka. Glucocorticoids) + How They Actually Work In Your Body w/ Dr. Luis Franco

The Healthy Skin Show

What are topical steroids? Often prescribed for chronic skin conditions, I’ll bet you’ve probably used them at some point during your treatment.
Sure, they work quickly, but are they without side effects? To answer that question, we need to talk about glucocorticoids, which are hormones naturally produced by the adrenal glands as part of the stress response.
Topical steroids fall under the glucocorticoids category, and due to those who’ve experienced something called topical steroid withdrawal, some people are described by physicians as “steroid phobic.”
While there are serious downsides, glucocorticoids can have some incredible anti-inflammatory effects on various health conditions. That’s why it’s crucial for us to have a nuanced conversation about this!
Dr. Luis Franco joins me to discuss everything you’ve wanted to know about topical steroids, types of glucocorticoids, and concerns about side effects from using topical steroids.
Dr. Luis Franco is a Tenure-Track Investigator at the National Institute of Musculoskeletal and Skin Diseases (NIAMS). He was born in Colombia and grew up between Colombia, Brazil, Mexico, and the United States. He attended medical school in Colombia before returning to the United States, initially as a postdoctoral fellow at Duke University. Dr. Franco attended Baylor College of Medicine for specialty training in internal medicine and medical genetics. In 2014, he moved to the National Institute of Health (NIH).
In This Episode:

• What are topical steroids versus glucocorticoids?
• Are topical steroids + glucocorticoids bad?
• Cortisone vs cortisol (and glucocorticoids examples by name)
• Side effects of glucocorticoids
• What is topical steroid withdrawal?
• How glucocorticoids modulate your immune system

Quotes
“Glucocorticoids exist naturally. They are hormones that are produced by our bodies. And they're produced by this very particular gland that's above our kidneys, that's called the adrenal gland or the suprarenal gland. And so our adrenal glands produce these chemicals called glucocorticoids. And those chemicals have many, many roles in biology and the one that is sort of best understood is that they are part of the stress response.”
“I think the side effects that are important to know for topical glucocorticoids are one, something called skin atrophy, which is kind of a thinning of the skin that people notice when they've been applying glucocorticoids for a long time. Some people also notice little, kind of red, blood vessels that come up. These are called telangiectasias. These are like reddish blood vessels that become very visible on the skin of people who have used topical glucocorticoids.”
Links
Find Dr. Franco online
Healthy Skin Show ep. 344: NEW RESEARCH On Topical Steroid Withdrawal Symptoms + TSW Red Skin Trigger
Topical Steroids Potency Chart
Immune regulation by glucocorticoids can be linked to cell type–dependent transcriptional responses
Glucocorticoid-induced eosinopenia results from CXCR4-dependent bone marrow migration

Chapitres

1. Introduction (00:00:00)

2. What are topical steroids versus glucocorticoids? (00:01:44)

3. Are topical steroids + glucocorticoids bad? (00:07:33)

4. Cortisone vs cortisol (and glucocorticoids examples by name) (00:12:11)

5. Side effects of glucocorticoids (including topical steroid skin side effects) (00:18:26)

6. What is topical steroid withdrawal? (00:28:20)

7. How glucocorticoids modulate your immune system (00:33:18)

8. Final thoughts (00:46:55)