The Relationship Between Topical Steroid Use and Spreading Yeast Infections

I last wrote about Sam's fully body yeast infection, which I believe was just one unfortunate side effect of long term improper topical steroid use.  After seeing heartbreaking photos of another little boy on the solve eczema user's forum who looked a lot like Sam used to look, and was also on high potency steroids, I decided to do some research to see if I could find scientific support for my suspicions.

My findings strongly support my long-standing suspicions regarding topical steroids and their propensity to create an ideal environment for and proliferate spreading of infection, especially skin candida (yeast). Symptoms of candida infection include redness, raised or swollen patches, burning sensation, intense itchiness, and indistinct (or scalloped) rash edges. Such infections of the skin are  hellish to endure, but if treated properly and aggressively, recovery can be surprisingly swift and circumvent needless suffering.

Infected eczema on Sam's legs, May 2012

The problem with out of control infections like these, is that even if a child's eczema is 100% detergent related, once that eczema becomes infected you must treat and eliminate the infection first before you will see any results from detergent removal or soap washing.  We addressed both at the same time - the infection and the underlying detergent reactive eczema, which made the recovery process very comfortable and near painless. 

Some interesting tidbits:

The normal presentation of superficial infections can be altered when topical corticosteroids are inappropriately used to treat bacterial or fungal infections. Steroids interfere with the natural course of inflammation, potentially allowing infections to spread more rapidly.
source: http://www.aafp.org/afp/2009/0115/p135.html


Alteration of Infection
Because topical steroids change the way the immune system functions, they can inhibit the skin’s ability to fight off bacterial or fungal infections. A typical example of this is seen when someone applies a topical steroid to an itchy groin rash. If this is a fungal infection, the rash gets redder, itchier, and spreads more extensively than a typical fungal infection. The resulting rash is a bizarre pattern of widespread inflammation with pustules called tinea incognito.
source: http://dermatology.about.com/cs/medications/a/steroideffects.htm


Steroids are another type of medication that can cause women to develop a vaginal infection from yeast. The higher the dose and the longer you use them, the greater the risk, but even low-strength topical steroid creams may make yeast infections more likely.
source: http://www.everydayhealth.com/womens-health/yeast-infections/living/index.aspx


But, things may go quite wrong, when used on the wrong condition, wrong location, or wrong duration.
For instance, topical steroids may appear to help fungal infections, but they actually suppress the
body’s ability to fight the infection and make it worse. (Figure 1) Other diseases, including impetigo and rosacea, may appear temporarily to get better, as well, but these conditions are likely to become worse. Therefore, minor irritations can be well treated by topical steroids, but the wise patient understands what he or she is treating. The weakest of these agents, over-the-counter hydrocortisone in the United States is required to be labeled with a statement to the effect of: “stop use if condition worsens, symptoms persist more than 7 days or clear up and occur within a few days.” This required warning is well founded
source: http://www.iacdworld.org/skin/steroid.pdf



Use of potent topical steroids to inadvertedly treat fungal infections can result in a partial suppression of the signs and symptoms but do not treat the infection, which can then spread. This can also be seen in the presence of viral skin infections, where topical steroids should be avoided
source: http://www.topicalsteroids.co.uk/what_ar....ide_effects.htm



Steroids are best avoided in the presence of infection as these can exacerbate infections.
source: http://suite101.com/article/how-to-avoid....49#.UWSuMZPCaSo


Topical steroids may lead to superinfection, including staphylococcal folliculitis, dermatophytosis (10) and candidiasis, (3) particularly when they are applied to flexural sites or used with polyethylene occlusion. When a fungal infection is treated with topical steroids, widespread and unusual clinical patterns may develop.
source: http://www.drplace.com/Guidelines_for_us....ds.16.28969.htm


And check this out- situations where yeast infection are more likely to develop, see the bolded bullet point!:

The chance of a candidal skin infection developing is more likely in the following situations:
• Areas of skin that are moist or sweaty are ideal for candida to thrive. Therefore, the common sites affected are in the folds of skin in the groin, armpits, and under large breasts. (Another name for inflammation within a fold of skin or under a breast is 'intertrigo'. Candidal infection is a common cause of intertrigo.) Nappy rash is sometimes due to candida. Obese people may develop candidal infection between folds of skin. It can also affect skin between fingers and toes, and the corners of the mouth.
• If you have diabetes.
•If you take a long course of antibiotics or steroid medication.
• If you have a poor immune system. For example, if you have AIDS, or have chemotherapy, or have certain types of serious blood disorder.

Okay, so here's some information on treatment. Looking at this I am actually thinking that an anti-fungal cream might help clear the infection faster than ACV baths, which was the primary route I used to eliminate Sam's widespread infection.  But it couldn't hurt to do both at the same time! We never even tried anti-fungals because I didn't have a doctor at the time that I felt I could trust. Keep in mind many anti-fungals contain detergents.  The solve eczema mom, AJ, recommends Perrigo brand Nystatin in ointment as one of the safer anti-fungal creams for kids with underlying eczema.  If you are looking to treat infection while using the solve eczema website, you might want to ask your doctor about prescribing this particular anti-fungal. 

What is the treatment for candidal skin infection?
• An antifungal cream usually clears the infection within a week or so.
• Sometimes a mild steroid cream is added to reduce inflammation whilst the antifungal cream is working. (However, a steroid cream alone will make the condition worse as soon as the steroid is stopped.)
• Occasionally, if the rash is widespread, antifungal tablets are prescribed.
source: http://www.patient.co.uk/health/Candidal-Skin-Infection.htm


And, here I found some symptoms of candida skin growth which confirms to me that what I saw with Sam was most likely yeast infection. This list describes his rash perfectly... it explains the intense itching and potentially even the 'pimply' appearance we saw for a time on his torso and back:

Symptoms
• Itching (may be intense)
• Skin lesion or rash
o Growing red, inflammed area
o Infection of hair follicles (folliculitis) may look like pimples
o Located on the skin folds, genitals, trunk, buttocks, under the breasts, or on other skin areas
o Macule or papule
o May have satellite lesions (smaller lesions next to bigger ones)
o Skin redness or inflammationhttp://health.nytimes.com/health/guides/disease/cutaneous-candidiasis/


Most websites listed moist places on the body and skin folds as the most likely places for infection, and I think this is the medical mainstream understanding of how and where yeast occurs.  However the quote above that states that "widespread and unusual clinical patterns may develop" with the infection caused by steroids seems to describe what I saw with Sam and what others might be seeing as well.

Be cautioned that if you go to a doctor to have something like this diagnosed, my experience with two pediatricians, a pediatric dermatologist, allergist, and specialist I drove two hours to see, is that they knew nothing of widespread skin candida nor how to go about diagnosing it.  However the fact that this phenomenon is showing up on multiple medical websites across the world confirms the knowledge is out there- perhaps it is not publicized because of the concern over steroid fears.  Many parents on our forum have had similar experiences with doctors not having anything to say about widespread skin infections, though a  lucky few have found supportive doctors willing to work with them so its always best to try to get your doctor on board before treating.   It would be irresponsible of me to encourage anyone to go about self-diagnosing or treating without their doctor's guidance, however, as was our case, sometimes when doctors will not be of help you need to go with your intuition and look outside the box for a more effective cure.