Most modern steroid enemas are foam based - as the likelihood of someone with colitis being able to retain a water based enema is quite low. These act topically applying the steroid directly to the colon - with only small amounts being absorbed into the bloodstream. This makes side effects less likely. The downside is that they can only reach the descending colon and rectum - so for those with extensive colitis oral steroids may be needed. A combination of Entocort and steroid enemas can provide topical treatment to the majority of the colon - again minimizing side effects. As the two main steroid enemas differ quite greatly I will cover them separately.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.
It is important to use the correct amount of topical steroid for your eczema, as instructed by your healthcare professional. Topical steroids should be applied with clean hands so that the skin just glistens. It can sometimes be difficult to judge how much steroid to use and there are guidelines on the amount required to cover body areas that are affected by eczema. These are based on the Finger Tip Unit (FTU), and explained in detail in our fact sheet which you can download as a pdf from the related documents to the right of this page.