CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Dermatitis - contact - Management
What are the adverse effects of topical corticosteroids and how can they be managed?
- When used correctly, topical corticosteroids rarely cause serious adverse effects. The likelihood of adverse effects is directly related to the potency and amount of topical corticosteroids used — a thin layer should be applied once or twice a day, adjusting the potency to control symptoms.
- Systemic adverse effects are rare but include adrenal suppression that can result in symptoms of Cushing's syndrome and in children, growth retardation. Table 1 shows the safe weekly prescribing limit for topical corticosteroids to avoid systemic adverse effects. This is based on expert opinion, not data derived from controlled trials, and local adverse effects may occur at lower doses.
- Local adverse effects are more common.
- Transient burning or stinging is most common and may necessitate changing the product.
- Of more concern is skin atrophy, which is particularly common in the skin of the antecubital or popliteal fossae.
- Hypertrichosis, telangiectasia (especially on cheeks), acne, and steroid-induced contact dermatitis may also occur.
Table 1. Weekly dose of topical corticosteroids unlikely to cause systemic adverse effects in adults.
Treatment period | Moderate (grams) | Potent (grams) | Very potent (grams) |
|---|
< 2 months | 100 | 50 | 30 |
2–6 months | 50 | 30 | 15 |
6–12 months | 25 | 15 | 7.5 |
|
- Evidence on the safety of topical corticosteroids over the longer term is lacking, as most controlled studies have been performed over short time periods (typically 6 weeks or less). Therefore, CKS has largely based its recommendations on extrapolation of short trials, limited observational studies, clinical experience, and expert consensus, all of which are reflected in narrative reviews [Charman and Williams, 2003; DTB, 2003].
© NHS Institute for Innovation and Improvement