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Corticosteroids - topical (skin), nose, and eyes - Management
What are the adverse effects of topical corticosteroids?
- When used correctly, topical corticosteroids rarely cause serious adverse effects.
- The likelihood of adverse effects is directly related to:
- Duration of treatment — long-term treatment is likely to result in systemic absorption.
- Area of the skin being treated — treating large areas of skin increases the risk of absorption.
- Condition of the skin — absorption is greatest in thin, inflamed skin.
- Potency of the topical corticosteroid — the greater the potency, the greater the risk of absorption.
- Occlusion — use of topical corticosteroids under occlusion increases the risk of systemic absorption.
- Age — children and elderly people are more susceptible to the adverse effects of topical corticosteroids because they have a thinner epidermis. Elderly people also have reduced dermal collagen (due to age and sun damage).
- Local adverse effects are more common. They mostly occur on the face, in skin folds, and in areas that are treated over the long term. Local adverse effects include:
- Transient burning or stinging — this is common, especially in the first 2 days of application on untreated, inflamed skin. It does not usually warrant a change of treatment, as it improves as the skin responds to treatment.
- Worsening and spreading of untreated infection.
- Thinning of the skin — the skin improves over a period after stopping treatment.
- Permanent stretch marks.
- Allergic contact dermatitis — due to the corticosteroid or the excipients.
- Acne (or worsening of existing acne) or rosacea.
- Mild depigmentation — usually reversible.
- Excessive hair growth at the site of application (hypertrichosis).
- Systemic adverse effects are rare, but may include:
- Adrenal suppression.
- Cushing's syndrome.
- Growth retardation in children.
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