Topical Use of Steroids in the Aged*

Steroid preparations for topical use include a variety of forms, among them hydrophobic ointments, emulsions, liquids, and gels. These drugs are chosen according to the status and site of the lesion and the patient’s age. There are five grades of steroid preparations for topical use in terms of the potency of their clinical effect. The skin of elderly persons tends to be dry and therefore does not absorb steroids well. However, if steroids of high potency are used for a long period, elderly patients are apt to suffer side effects of steroid application, including enhanced atrophy, purpura, xeroderma, capillary telangiectasia, delayed wound healing, and susceptibility to infection, because their skin is atrophied. In the elderly, the skin becomes dry as it looses its ability to retain water. To treat pruritus and asteatotic eczema under these conditions, steroid preparations of mild to moderate potency and having a hydrophobic base should be used. If nummular eczema or autosensitization dermatitis has occurred as a result of scratching, steroids of higher potency should be selected. Emulsions are not suitable for moist lesions like erosions and ulcers, because of the issues of reabsorption and stimulation. Although seborrheic eczema and psoriasis are common in the elderly, the former requires short-term steroids of moderate or lower potency, whereas the latter requires the cautious use of stronger steroids.