Corticosteroids are the most potent and effective local anti-inflammatory medications available and have a striking ability to inhibit cell division. They are the therapy of choice in most inflammatory condition  like eczema, dermatitis and psoriasis. You should remember that topical steroids are used for supression or relieve signs and symptoms of most skin conditions, and they are not curative therapy for skin conditions.

There are many topical steroids available, and they differ in potency and formulation. The risk of side effects from topical corticosteroids is directly  related to its potency , duration of therapy, frequency of application and anatomical area. Low potent corticosteroids have less side effects than Ultra potent  topical corticosteroids. To minimise the side effects of  Ultra potent topical corticosteroids limiting its use to maximum of 50 gm per week and maximum of 2 weeks is recommended. After 2 weeks or after an acute condition is on controlled,dosing can be reduced and with a tapering maintenance therapy and major side effects can be reduced.

Multiple potential adverse effect  are associated with use of topical corticosteroids.The most common are discussed below.

Skin atrophy and maceration: Skin atrophy and maceration are frequent findings if potent corticosteroids are used for longer time, especially when used with occlusive technique. This is reversible after discontinuation of therapy within 2-6 months.
Striae: They are Most common around the groin, axillae, and inner thigh.They are usually not reversible, but it may fade over period of time.
Telangiectasia: They are small visible distended blood vessels seen in skin surface . They are commonly seen on the face, neck, chest and sometimes on upper thigh and below knee. They are often reversible, but sometimes can be permanent. For permanent telangiectasia , Sclerotherapy  is the first line of therapy.
Abnormal hair growth: Sometime longterm use of topical corticosteriods might result in fine hair growth around the areas but it is reversible.
Hypopigmentation: Sometime hypopigmentation can occur with the use of potent therapy, most common in dark skinned people. This hypopigmentation is a reversible one.
Supression of Infections: Corticosteroids have ability to supress the infection. So, sometime symptoms and signs of bacterial,fungal or any viral infection may be masked which might further results in worsening of the conditions without being recognized.
Rebound dermatitis: When sudden discontinuation of corticosteriods, rebound dermatitis might occur. So the therapy must be taper for few weeks before discontinuation.
Systemic side effects: High potent topical corticosteroids used for a longer duration of time may induce mild hypercortisolism, hyperglycemia, Hypothalamic-pituitary axis suppression, and rarely cusing’s syndrome and growth retardation in children. Children and elderly are at higher risk of side effects.

Tachyphylaxis: Tachyphylaxis or Tolerance might occur after a few weeks of therapy. If an inflammatory skin condition gets worsens after initial good response, tolerance to the anti-inflammatory effects of topical corticosteroids should always be suspected. This can be prevented by limiting the frequency of application per day. This is a reversible condition and can be managed by stopping therapy for a few days ( 4 days ), and then resuming with the same treatment or any other  alternate agent.

Other common side effects might be: Purpura ( Bruising with with minimal trauma), and Acneform/Rosacea like eruptions ( common on face).

Topical corticosteroids treatment  are being used for more than 50 years in skin therapy and they bear minimal risk if used properly with a proper prescription of a dermatologist and a regular supervision. They are safe if used with appropriate potency and strength for appropriate skin condition.

If you have any questions regarding  topical corticosteroids you can ask us at DermaTalk Skin Care Forums

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