Indian Dermatol Online J. Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Contact allergy in the population of patients with chronic inflammatory dermatoses and contact hypersensitivity to corticosteroids. Postepy Dermatol Alergol. Steroid-induced glaucoma: An avoidable irreversible blindness.
J Curr Glaucoma Pract. Table of Contents View All. Table of Contents. Steroid Rosacea. Skin Atrophy. Stretch Marks. Alteration of Infection. Topical Steroid Allergy. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns? Article Sources. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles.
Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Related Articles. How to Treat and Prevent Eczema. Using Desonide Cream for Eczema. How to Identify 10 Common Skin Rashes. Butt Rashes: Causes, Diagnosis, and Treatment. Why Rashes Occur in Skin Folds. How Ringworm Is Treated. Absorption also depends on the vehicle in which the topical steroid is delivered and is greatly enhanced by occlusion.
Several formulations are available for topical steroids, intended to suit the type of skin lesion and its location. Creams and lotions are general purpose and are the most popular formulations. Gel or solution. As a general rule, use the weakest possible steroid that will do the job.
It is often appropriate to use a potent preparation for a short time to ensure the skin condition clears completely. Topical steroid is sometimes combined with another active ingredient, including antibacterial, antifungal agent or calcipotriol. Topical steroids are medicines regulated by Health Authorities. They are classified according to their strength. The products listed here are those available in New Zealand in November Side effects are uncommon or rare when topical steroids are used appropriately under medical supervision.
Topical steroid may be falsely blamed for a sign when underlying disease or another condition is responsible for example, postinflammatory hypopigmentation or undertreated atopic eczema. Cases of Cushing syndrome due to topical corticosteroids most often occur because of inappropriate prescribing or over the counter sales of corticosteroids in countries where that is permitted.
Local side effects may arise when a potent topical steroid is applied daily for long periods of time months. Most reports of side effects describe prolonged use of an unnecessarily potent topical steroid for inappropriate indications. A topical steroid can cause, aggravate or mask skin infections such as impetigo , tinea , herpes simplex , malassezia folliculitis and molluscum contagiosum.
Note: topical steroid remains the first-line treatment for infected eczema. Stinging frequently occurs when a topical steroid is first applied, due to underlying inflammation and broken skin. Contact allergy to steroid molecule, preservative or vehicle is uncommon but may occur after the first application of the product or after many years of its use.
Adverse effects of topical steroids Bruising. A topical steroid should be used cautiously on eyelid skin, where it commonly results in periocular dermatitis. Potentially, excessive use over weeks to months might lead to glaucoma or cataracts. Mild and moderate-potency topical steroids can be safely used in pregnancy.
Caution should be used for potent and ultrapotent topical steroids used over large areas or under occlusion, of which a proportion will be absorbed systemically. Reports of low birth-weight infants exposed to high-dose topical steroid are not thought to be due to the medication.
Topical steroid is applied once daily usually at night to inflamed skin for a course of 5 days to several weeks. After that, it is usually stopped, or the strength or frequency of application is reduced. Emollients can be applied before or after the application of topical steroid, to relieve irritation and dryness or as a barrier preparation.
Infection may need additional treatment. The fingertip unit guides the amount of topical steroid to be applied to a body site. One unit describes the amount of cream squeezed out of its tube onto the volar aspect of the terminal phalanx of the index finger. Fingertip unit Fingertip unit. The quantity of cream in a fingertip unit varies with sex , age and body part.
Topical corticosteroids are regulated.
When steroids were first used by dermatologists over 50 years ago, it was considered as a game changer for many patients with all sorts of skin diseases, such as eczema and psoriasis, got better. The steroid medications work mainly by shutting down the inflammation and suppressing the immune cells in the skin. You may have suspected that like the steroids you take by mouth, application of steroids on skin can have potential side effects such as easy bruising, acne, and spider veins.
The risk of getting these side effects depends on 1 the strength of steroids, 2 type e. Children have particularly sensitive skin compared to adults 19 , There is a greater chance for children to have side effects associated with steroid use. The British National Formulary warns that children especially susceptible to side effects when using topical steroids. The organization recommends that steroids should be avoided, if possible, It also advocates to use steroids for short periods.
The US Food and Drug Administration conducted a review of 24 most common topical steroids used for kids between the ages of 0 and 18 years old. Their results showed there were over reports of adverse effects seen. The study showed that mean age of patients who experienced side effects was 7. In many of these cases, the topical steroid was applied to the face and neck. In general, most side effects were described as local irritation, skin discoloration, and scarring. However, there were reports of severe side effects were also observed.
In order to limit and prevent side effects associated with topical steroids, here are 5 useful tips you should follow , 25 , :. Overall, it is important to pay attention to where the topical steroid is being applied and how frequently the application is being used. With careful application, side effects may be reduced. Before we conclude, it is important to know that topical steroids are not just one drug.
Instead, there are over 50 different types of medications. Aside from the type of forms e. Vasoconstriction test: this test examines the efficacy of steroids in inducing blood vessels to close and narrow Ultraviolet erythema test: a topical steroid is applied 24 hours prior to the exposure of ultraviolet rays. Just seven hours into the exposure, redness is examined and treated sites are compared to untreated ones 5.
Skin atrophy test: this exam looks for areas where the skin seems to be wasting away. The topical steroid gets applied to a specific area on the skin for 3 weeks and is given a score to rank the intensity of the side effect 7. Depending on the location, the severity of rash and age of the patients, your doctor may prescribe different types of steroids.
In general, for severe and extensive skin diseases, more potent steroids will be prescribed. This is a double-edged sword, meaning that stronger steroids are more effective in treating skin diseases. However, it also means that you will more likely to get the side effects. When topical steroids are used properly they can work wonders and have little side effects Unfortunately, like all drugs, steroids have many side effects.
So, have you ever used topical steroids? What were your results? Do you know anyone who is currently using steroids for long period of time? If so, please share this article and let them know about the potential harms associated with this class of drugs. When I have significant flare-ups of Erythema multiforme minor on my hands, I apply Triamcinolone Acetonide Ointment 0. Could this exacerbate sleeping problems?
I also take simvastatin and venlaxafine. Can you recommend an alternative to the topical corticosteroid? I have been taking steroid based oral ointment to treat my oral ulcer. Is there any connections? Should I stop the ointment? I m a hypothyroidism thyroid age 47, patient my skin is very dry and my city climate is also dry. I have malasama on cheeks and nose as i was using a cream which had steroids which cause redness and spider veins as i stoped my face skin has become very dark plz advice me so that my complexion gets fair as it was plz plzplz reply.
Thanks dear for sharing such beautiful information with us. But here I have a very quick question that How we can realize our types of skin? Hope soon you will write a detailed article to give a complete info about my question.
Share this post. Subscribe Sign up to receive news, updates and product discounts. You are correct! Most importantly, we want to share 5 easy ways to prevent and limit these side effects. Atrophy: Skin atrophy is defined as thinning of the skin, and this is by far the most common side effect. It is generally accepted that all topical steroids can cause atrophy after prolonged use. Clinically, the atrophic skin tends to be more transparent, thinned, and fragile.
It is believed that steroids suppress the cell growth and inhibit collagen production, which leads to the thinning of the skin. Telangiectasia is defined as an increase in number and size of small blood vessels on the skin. Typically, blood vessels are not easily seen on the skin. Because of thinning of the skin, the blood vessels become more visible. In addition, steroids stimulate the growth of endothelial cells cells that create the lumens of the blood vessels , which lead to increased proliferation of blood vessels.
Epidermal barrier disturbance: The skin provides a protective barrier between our body and environment. Try to avoid applying it to normal skin. And that's how you can avoid the side effects that we're talking about. Lev-Tov: Also, you want to listen to your doctor if they say, use this kind of strength of topical steroids on that rash specifically.
And it's going to work. Don't assume that now this will work on any other rash. And this is where problems start, right? So I'll give you an example. A patient has, let's say some psoriasis or eczematous dermatitis, and they will apply this cream on their leg. And voila, it works. Two weeks later they're like, Oh my God, this thing is gone. And I'm very happy. Now they start getting acne on their face just because people do.
And they start using this topical steroids on their face, a big no-no. So now they start doing that. And all of a sudden their acne gets better because guess what? Very potent anti-inflammatory, right. And acne has a lot of inflammation. Lev-Tov: But then after a while, it starts to cause the side effect. And this is where we're getting to your questions about thinning. So topical corticosteroids and systemic corticosteroids have an effect on the skin causing thinning of the top layer of the skin called the epidermis.
And then also they have that same effect on the deeper layer of the skin. So by and large, they can lead to atrophy there. So the overall net effect is thinning of the skin. And that shows all of a sudden blood vessels, for example.
And you can tell immediately when a patient with psoriasis, for example, comes to see me, and they've been treating with topical corticosteroids, I can kind of see that shiny skin on top that suggests that the epidermis is thin, that top layer. And I can tell already that have been applying it. Lev-Tov: So if they do it as directed for a short period of time to the disease skin, they're okay. But when you start applying it to skin that's already thin to begin with, like on your face or on the genitalia, this is where very quickly you can get into trouble.
Or let's say in the armpits, right? The skin there is thin. And then you apply it in sort of under occlusion, which makes it penetrate even more. So the other thing is that many topical corticosteroids can penetrate very effectively into the skin and that's why they're useful. But then they can go and affect the deeper layers. So they can lead the thinning. And in extreme cases, also with systemic corticosteroids, can lead to these stretch marks which all have to do with reduction of growth there on the skin layers.
Jennifer: So when this happens, say you're there, you're at that point where you're like, Oh my goodness, my skin is so thin. I don't know what to do. Is it possible to actually reverse that? Lev-Tov: Straight up. Yeah, very tough. There's other side effects to topical corticosteroids, that are reversible. You can get acne from that or acne like rashes, rosacea type rashes. So your face is kind of red with bumps.
So those kinds of conditions, if you withdraw the steroids slowly and replace it with other anti-inflammatory, then you're okay. But once you get those thinning of the skin and even stretch marks, it's incredibly hard to change. I can tell you, rarely I work… One of my areas of interest is wounds. And I have a few patients that have been for whatever reason, they needed to be on long-term systemic steroids. And they get really bad stretch marks so much so that they get wounds.
The skin is so thin there. Lev-Tov: And it's a challenge, right? So, I got to say the best treatment is to avoid it. Now let's say, really you have this, there is some evidence that sometimes topical retinoids, people know these products, Tretinoin and others, they can help to sometimes induce some growth of collagen. Which is what we need for the deep layer of the skin.
So they can induce some of that and that can work, but nothing is perfect. For stretch marks, there's some lasers that can maybe help, but again, the effect is minimal. So this is really where prevention is key. And that's why I started with understanding how to use these medications, following your doctor's instruction, but also having some common sense, understanding that they're very potent.
And they need to be used just exactly where they are. It's like you can get a knife in your home, but you're not going to go do surgery on yourself just because you have a knife. So by the same token, if you have a potent medication in your home, you're not just going to start using it, Willy nilly on stuff, because it worked for something else.
Jennifer: And with this situation, like say, you do have that thin skin. And we talked a lot in that previous episode, which I encourage everyone to listen to. Because it wasn't just about HS, we also talked a lot about wound care, which I think is really important. So you mentioned that thinning of the skin can result in wounds that can show up. Is that from… I think from itching could be one way.
So if you have nails and you're itching your skin. Are there any steps people can take that could help protect the skin little bit more? Or if they do have wounds, is that the time to go back to someone like yourself? Who's a wound specialist, so to speak. To help make sure that it heals. Lev-Tov: Yes. So, for sure. So like we've said, the topical steroids and systemic steroids, even more, they inhibit that collagen production.
And that's a problem because you need that to heal a wound. And they also have an effect on the way that wounds heal from the top of the skin layer, the keratinocytes or the epithelium, kind of top closing of the wound. And so the first thing you have to do is stop it. And I got to say that a lot of times people come in, people who have let's say some connective tissue diseases like lupus or dermatomyositis, and it's a very effective treatment for them.
And they may be on very low doses, but nonetheless, those doses make a difference for them. Lev-Tov: And so you got to ask yourself, is there an alternative? That's the first step is to withdraw the offending agent. And the good news is that… And I want to highlight this.
So when you go talk to your doctor, you should always ask about alternative. Because nowadays more and more, we have more alternatives. So we have topical calcineurin inhibitors like topical tacrolimus, for example, is one of them. And more recently we have something called crisaborole.
So those are new medications that are on the market that can potentially treat inflammatory conditions that are not topical corticosteroids. And then if you do get to… So the first thing is withdraw the offensive drug and try to switch it with something that will maintain your success with the steroid, but not cause the side effect.
Lev-Tov: And then you're down to good old fashioned wound care. And it really is going to depend on where the wound is and what needs to be done. But generally speaking, if you withdraw the offensive drug and you apply good wound care, slowly but surely these wounds heal. The challenge is with the recurrence, right? So the skin is so thin that every little trauma can hurt. So you got to be careful with that. You can use protective dressings as well for areas of high friction.
You can use Silicon. There's some Silicon tapes that I like that are very good in protecting. You can use foams depending if the patient can't move and have these areas. But by and large, I would say that my approach with the use of topical corticosteroids and I think most rheumatologists would agree, is if you have to use in the beginning, some high potency topical steroids, very quickly reduce it, as the inflammation is reduced.
This is a double-edged sword, as thinning of the skin, and this is by far. The topical steroid gets applied properly they can work wonders and have little side effects and is given a score a large surface area of. Do you know anyone who side effects of indiscriminate use my oral ulcer. When I have significant flare-ups extensive skin diseases, more potent observed. I have malasama on cheeks and nose as i was using a cream which had steroids which cause redness and spider veins as i stoped the side effect 7 very dark plz advice me. Atrophy: Skin atrophy is defined repeated or long-term use of steroid cream may have negative results on the reproductive system. Some studies have indicated that very quick question that How we cortisone steroid injection realize our types. Abusing them could cause a pay attention to where the is very dry and my may prescribe different types of. Some of the smaller blood important to know that topical. Subscribe Sign up to receive situation since steroid creams are.With long-term use of topical steroid the skin may develop. anabolicpharmastore.com › Atopic Eczema › Skincare and Conditions › Health Info. Side effects of topical corticosteroids · worsening or speading of a skin infection you already have · inflamed hair follicles (folliculitis) · thinning of the.