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Is it safe to have the vaccine while using topical steroids?

Question: Is it safe to have the Covid vaccine while using topical steroids?

Answer: I’m not a medical doctor and this is a question best answered by a medical doctor.  Please consult your doctor!  With that nudge, I’ll share what I know based on what I’ve read.  First off, a lot depends on how long you’ve been taking the corticosteroid and what the dosage is.  If it’s a low/moderate dose taken for less than 2 weeks, I don’t think there’s anything to be concerned about.  If, however, it’s a moderate/high dose* that you’ve taken for 14 days or more, there are a few concerns: 

  • Corticosteroids have the potential to be immunosuppressive and are presumed to cause some degree of altered immunocompetence.  Having a compromised immune system means that the effect of vaccination may not be as robust.  In this case, it’s best to talk with your doctor about whether to continue taking the steroids and have the jab OR discontinue use of the steroid for a bit of time then take the vaccine for improved immune response.  There are pros/cons of each approach.
  • The second issue concerns safety. For inactivated vaccines there’s no safety risk associated with taking corticosteroids when vaccinated. However, for live attenuated vaccines (like MMR, Yellow Fever), many clinicians consider relatively high doses* of steroids taken for ≥14 consecutive days to be sufficiently immunosuppressive to warrant concern about the safety of vaccination.  For live attenuated vaccine administration, the Advisory Committee on Immunization Practices (ACIP) recommends,  “Vaccination providers should defer live-virus vaccination for at least 1 month after discontinuation of high-dose systemically absorbed corticosteroid therapy administered for ≥14 days.”  Here it’s important to note that all COVID vaccines currently authorized for use or under consideration (e.g. Pfizer, Moderna, Johnson & Johnson) are inactivated (for a reminder on vaccine types, see Q&A of 1/21).  This means that the safety concerns described herein do not currently pertain to COVID vaccinations.  
  • Finally, CDC’s clinical guidance for mRNA vaccines against COVID states, “Immunocompromised individuals can receive COVID-19 vaccination if they have no contraindications to vaccination [e.g. severe allergic reaction]. However, they should be counseled about the unknown vaccine safety profile and effectiveness in immunocompromised populations, and the potential for reduced immune responses…”

*Per ACIP and PAHO, “many clinicians consider a dose equivalent to either 2 mg/kg of body weight or a total of 20 mg per day of prednisone for 2 or more weeks as sufficiently immunosuppressive to raise concern about the safety of vaccination with live virus vaccines.”