Q:  Topical Steroids & Bipolar Disorder

Is it safe for a bipolar patient to use a topical steriod (prescription strength) for a short period of time?

I've been stable on my meds for several weeks now, and I don't want to screw it all up. I have a poison ivy rash that my doctor prescribed some cortisone cream for, but I'm hesitant to use it. My moods are very, very sensitive to steroids. I've used OTC hydrocortisone cream without problems, but I worry about the strong stuff.

Do I have reason to worry?

-k
 

Dear k -- 

Your question was a good opportunity for me to search for more information on this issue, thus the lengthy reply below, but the "bottom line" is pretty simple:  as you have surely considered yourself, if you can possibly avoid using the cream for a condition (poison ivy) that is going to go away on its own eventually anyway, then you can avoid whatever risk there might be in using it -- because, as you'll see below, there might be some risk, but how much risk is basically impossible to say.  And, if you have to use it, you obviously should use as little as possible and stop it as soon as possible, in discussion with your doctor. 

There are few data to go on here.   First, we could ask "how much gets absorbed?" when you use a steroid cream on your skin.  Here's what seems a reasonably solid answer to that one from the NZ Dermatologic Society:

Skin absorption of topical steroids

Steroids are absorbed at different rates from different parts of the body. A steroid that works on the face may not work on the palm. But a potent steroid may cause side effects on the face. For example:

• Forearm absorbs 1%
• Armpit absorbs 4%
• Face absorbs 7%
• Eyelids and genitals absorb 30%
• Palm absorbs 0.1%
• Sole absorbs 0.05%

Here's one other discussion, very technical, if you want to see some serious detail.  They note a few more factors that determine absorption: 

... absorption can vary with degree of hydration or occlusion, age of patient, whether the skin is intact or disrupted, skin temperature, and site of application.

and conclude:  Almost any administration of any of the glucocorticoids can be expected to be absorbed centrally to some degree.

So, if we presume you're going to absorb some, then we could ask "how much do you have to absorb to affect your mood stability?"  Well, for one thing, I see cases pretty frequently (like when I worked on an inpatient unit) where a patient got obviously symptomatic after taking an oral steroid or an injection, such as for an inflamed joint.  But I don't think I've ever seen a case where a patient came in symptomatic after topical steroid cream use.  On the other hand, describing prolonged use, one website does note mood changes as possible with a steroid cream (but in the context of months to years of use).  Thus, on the whole, I'd say it could be a risk, and more so the more cream you use and the longer you use it.  Your doctor probably already told you not to put any on your face (because of the higher absorption there).

Dr. Phelps

Published September, 2004