Risks of Topical Corticosteriods

Most people immediately think of thinning of the skin (skin atrophy). This is a well-recognized possible side effect. It is true that potent and super potent topical corticosteroids can cause skin atrophy if applied too frequently and for a prolonged time without a break. Although early skin thinning can disappear if the topical corticosteroid is discontinued, prolonged use can cause permanent stretch marks (striae). Stretch marks usually occur on the upper inner thighs, under the arms, and in the elbow and knee creases. It should be noted that preteens and teenagers who have never used corticosteroids can also get stretch marks. Permanent skin atrophy from topical corticosteroids is now extremely uncommon when the treatment is used properly. In the past, recommendations did not specify the amount, frequency and duration to apply topical corticosteroids. We now know that these medications are safest when used intermittently, in an appropriate quantity, and for an appropriate length of time.

Many patients with under-treated eczema have the opposite of skin thinning, and actually develop thickening, and sometimes darkening of the skin (changes known as lichenification). This is the skin’s response to rubbing and scratching.

Frequent and prolonged application of a topical corticosteroid to the eyelids can cause glaucoma and even cataracts. Topical corticosteroids can occasionally cause tiny pink bumps and acne, especially when used on the face and around the mouth. On the body, greasy corticosteroid ointments can rarely cause redness around hair follicles, sometimes with a pus bump centered in the follicle (folliculitis). When corticosteroids are applied to large body surface areas, enough may be absorbed to inhibit the body’s own production of cortisol, a condition known as “adrenal suppression”. The risk of adrenal suppression is highest with high potency (Class 1-2) corticosteroids. Infants and young children have a higher ratio of body surface area compared to their weight, so they are more susceptible to corticosteroid absorption. If a child is given corticosteroids by mouth, in large doses or over a long term, prolonged adrenal suppression can be associated with growth suppression and weakened immune responses. Adrenal suppression does not have a significant effect on a child’s brain development.