AboutDr Alan Galbraith Expertise I can answer most questions on most drugs. Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease.
Organizations Institute of Biology, London.
Publications Author of "Fundamentals of Pharmacology" 5th Edition published in November 2007 by Pearson Education, Australia.
Question Hello Dr. Galbraith, I was diagnosed with eczema at age 18 and have been fighting it off and on for 20+ years. My first dermatologist could not find the source of the eczema and prescribed triamcinalone ointment for me, which I used daily for several years (at least three to four). Eventually, with another doctor's help, we discovered that the eczema was caused by food allergies. Unfortunately, the food allergies change occasionally so the eczema comes back when I eat a previously unknown trigger-food. All of this is to say that I've kept a tube of steroid cream around all these years just for such occasions (even after the first several years of daily use) and have noticed that when I do need to use the cream, that I become either agitated or extremely tired by the end of the day. I have had my prescription changed to mometasone thinking that I only have this effect with triamcinalone, but to no avail. I get the same symptoms with the new cream. I am writing to you because, when I mention these symptoms to my doctors, they dismiss the complaint saying that I should not be absorbing the steroids and therefore should not be feeling any systemic symptoms. I know what I know however - I do get symptoms upon using these creams. In your response to another question you mention that "one must be very careful with [steroid creams] especially the more potent creams which can in the long term cause severe thinning of the skin and if absorbed over a prolonged period can cause many systemic effects." Can you explain these systemic effects and give me some direction as to how to speak to my doctor about whether I should be tested for these effects, or give me a systemic threshhold as to when I should insist that my doctor test me? Any advice would be appreciated as I am tired of being dismissed by the medical establishment. Thank you.
Answer Dear Bao
I cannot understand why your doctors are dismissing your complaints as they seem genuine to me. Although modern corticosteroids (eg mometasone) are less liable to cause systemic effects due to skin absorption this is always a possibility. Steroids are produced naturally by the body and are necessary for certain normal processes but in excess (like for most things) can cause problems and mimic a disease (but usually only mildly) called Cushing's Syndrome. If you do look up this condition which is awful do not think that you will get all of the symptoms, only a few and mildly. I do not want you becoming more distressed unnecessarily. Emotional changes do occur in excess activity of corticosteroids and all I can suggest is that you persuade your doctor to get a blood test for the mometasone after using it for several days. It goes without saying that avoidance of potential food allergies is paramount and a nutritionist may be able to help by identifying possible cross allergies.
