Many dermatologic conditions, such as eczema, psoriasis and vitiligo, are treated with topical corticosteroids. Topical corticosteroids can cause many local side effects to the skin where the medication is being applied; however, since the corticosteroid medications are absorbed into the skin, long-term use and high doses can cause some systemic complications as well.
Skin Atrophy
According to Jonathan D. Ference in a 2009 article in the "American Family Physician" journal, all topical steroids can cause skin atrophy, which is thinning of the skin. There are certain characteristics that increase the risk of developing skin atrophy--higher potency or strength steroid cream, thinner skin previously or older patients can increase the risk. For many patients, the skin atrophy improves after discontinuing the corticosteroid cream.
Stretch Marks
Another side effect of topical corticosteroid medications are the formation of stretch marks, or striae. As noted by Richard A. Helms and colleagues in the 2006 "Textbook of Therapeutics: Drug and Disease Management, a breakdown of the connective tissues of the skin causes the stretch marks. After discontinuing the medication, the striae do not go away but they may fade over time.
Telangiectasia
Telangiectasias, or dilated blood vessels, are another side effect of topical steroids. These enlarged blood vessels become visible underneath the thinned skin. Richard A. Helms and colleagues in the 2006 "Textbook of Therapeutics: Drug and Disease Management" note that the development of telangiectasias, striae and skin atrophy may be due to long treatment periods or extra applications.
Acne or Rosacea
The use of topical corticosteroids can cause an outbreak of acne or rosacea with redness, bumps and pus-filled pimples as noted by Jonathan D. Ference in a 2009 article in the "American Family Physician" journal. When a facial rash is treated with corticosteroids and the rash rebounds requiring an increase in steroid strength. The rash may become resistant to treatment and require a discontinuation of the steroid. This is also an example of the side effect of steroid rebound.
Secondary Infections
The risk of secondary infections is associated with the duration of therapy and the dose of the treatment according to the Pharmacy Practice News website. The steroids interfere with the natural course of inflammation and infection and allow any infection present to spread more rapidly. These infections may be caused by either bacteria or fungi.
Other Complications
With long-term usage of topical steroid medications, there is a risk of systemic complications, such as problems with the body's own steroid product or problems with glucose management as noted by Richard A. Helms and colleagues in the 2006 "Textbook of Therapeutics: Drug and Disease Management." This is more common in patients who are using the medication on large areas of skin or who have larger skin area to body weight ratio like children. Some patients can develop ophthalmic problems, such as cataracts or glaucoma or cardiovascular problems like high blood pressure as noted by Jonathan D. Ference in a 2009 article in the "American Family Physician" journal.
References
- Skin Therapy Letter: Topical Corticosteroid Dosing, Mechanisms of Action and Prescribing
- Mayo Clinic: Prednisone and Other Corticosteroids
- "America Family Physician Journal"; Choosing Topical Corticosteroids; Ference JD et al; 2009.
- Textbook of Therapeutics: Drug and Disease Management ; Helms RA and Quan DJ; 2006
