Topical corticosteroids, commonly known as steroid creams, are prescribed medications for managing inflammatory skin conditions like eczema and psoriasis. These formulations are effective because they deliver anti-inflammatory medication directly to the affected area. While generally safe for localized, short-term use, concerns sometimes arise regarding potential systemic side effects, which are typically associated with oral steroids. This article addresses whether using steroid cream can lead to weight gain.
Systemic Absorption and the Potential for Weight Gain
Steroid creams can potentially cause weight gain, but this outcome is rare for users who follow standard application instructions. The risk occurs only if the active corticosteroid is absorbed into the bloodstream in significant amounts, a process known as systemic absorption. Topical formulations are designed to keep the drug concentrated in the skin layers to treat localized inflammation effectively.
When systemic absorption occurs, it mimics the effects of oral steroids, which are known to cause weight changes. For most people using low-to-medium potency creams on small areas for short periods, the amount of drug entering the body is negligible. Therefore, the risk of systemic side effects like weight gain is minimal under normal therapeutic use.
Factors That Increase Systemic Absorption Risk
The likelihood of a topical steroid entering the bloodstream in a quantity sufficient to cause systemic side effects depends on several variables.
Factors Increasing Absorption
The strength, or potency, of the cream is a factor; high-strength formulations contain a greater concentration of the active ingredient, increasing the absorption potential. Applying the cream over a large percentage of the body’s surface area also greatly increases the total dose absorbed.
The duration of use is also a factor, as prolonged or continuous application over many weeks allows for chronic exposure. Application to areas where the skin is naturally thin, such as the face, eyelids, armpits, or groin, results in easier penetration.
Skin conditions like severe eczema or psoriasis compromise the integrity of the skin barrier and enhance drug absorption. The use of an occlusive dressing, such as a bandage or plastic wrap, over the application site traps moisture and significantly boosts the amount of steroid that passes through the skin.
The Physiological Mechanism of Weight Change
When a sufficient amount of the corticosteroid is absorbed into the bloodstream, it begins to act like the body’s natural stress hormone, cortisol. The presence of excess systemic corticosteroids can disrupt the body’s normal metabolic and fluid balance regulation.
One immediate mechanism contributing to an increase in body weight is fluid retention, which occurs because corticosteroids can increase the retention of sodium and water in the body’s tissues. This can lead to a quick, noticeable increase in weight and a sensation of puffiness or bloating.
Corticosteroids can also directly affect the neurological systems that control hunger, often leading to increased appetite. This stimulation of hunger can result in a higher caloric intake, which, over time, contributes to the accumulation of body fat.
In cases of significant and chronic systemic exposure, the absorbed steroid can also cause a distinctive redistribution of fat. This redistribution involves fat moving to central areas, such as the abdomen, the back of the neck, and the face, creating what are sometimes called Cushingoid features.