Abstract Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. Keywords: Cutaneous , adverse , steroids. What was known?
Some of these side effects may seriously damage the skin. Hence, topical corticosteroids should be used with utmost caution. Introduction Topical steroids were introduced in , when Sulzberger and Witten first used topical hydrocortisone. Table 1 Adverse effects of topical steroids on skin. Open in a separate window. Figure 1. Atrophy: Wrinkling and thinning of skin 4 weeks after irregular use of Mometasone. Physiology of skin atrophy due to topical steroids Topical steroids cause the synthesis of lipocortin, which inhibits the enzyme phospholipase A2.
Pathogenesis of skin atrophy due to topical steroids Inhibitory effect on keratinocyte proliferation in the epidermis Inhibition of collagen 1 and 3 synthesis in the dermis Inhibition of fibroblasts and hyaluronan synthase 3 enzyme resulting in the reduction of hyaluronic acid in the extracellular matrix leading to dermal atrophy. Steroid-Induced Telangiectasia Steroid-induced telangiectasia occurs due to stimulation of release of nitric oxide from dermal vessel endothelial cells leading to abnormal dilatation of capillaries.
Steroid Acne The pathogenesis of topical steroid-induced acne has been proposed to be due to the degradation of the follicular epithelium, resulting in the extrusion of the follicular content. Steroid Rosacea Topical steroids increase the proliferation of Propionibacterium acnes , and Demodex folliculorum , leading to an acne rosacea-like condition within 6 months. Figure 2. Topical steroid - dependent face. Used as fairness cream for 2 months.
Perioral Dermatitis Facial perioral dermatitis, more commonly seen in females, presents with follicular papules and pustules on an erythematous background, with sparing of the skin near the vermillion border of the lips.
Purpura, Stellate Pseudoscars, Ulcerations Steroid-induced protein degradation leads to dermal atrophy and loss of intercellular substance, which further cause blood vessels to lose their surrounding dermal matrix, resulting in the fragility of dermal vessels, purpuric hypopigmented, and depressed scars. Aggravation of Cutaneous Infections Tinea versicolor, onychomycosis, dermatophytosis and Tinea incognito [ Figure 3 ] are the common cutaneous infections aggravated by topical steroids.
Figure 3. Delayed Wound Healing Delayed wound healing may occur due to various reasons. Contact Sensitization to Topical Steroids Contact sensitization may occur due to prolonged use of steroids and application of certain drugs e. Eyelid Dermatitis Patients with atopic and seborrheic dermatitis on chronic topical steroids, develop a flare around the eyes within days after stoppage of steroids. Tachyphylaxis Topical corticosteroids may induce tachyphylaxis with chronic use. Trichostasis Spinulosa A study has shown the association of trichostasis spinulosa with topical steroids.
Striae Rubrae Distensae Striae due to steroids must be differentiated from those due to weight gain and pregnancy. Figure 4.
Striae due to topical steroid applied for 3 weeks for atopic dermatitis. Post Peel Laser Erythema Syndrome Persistent redness of the face, after peel or laser has been noted in patients using topical steroids before the procedure. Status Cosmeticus Women with status cosmeticus cannot tolerate makeup and complain of a continuous burning sensation after any application.
Chronic Actinic Dermatitis-Like Eruption Patients present with facial erythema and lichenification on the face, forearms and upper neck. Corticosteroid Withdrawal Patterns The pattern of corticosteroid withdrawal is as follows: A week after corticosteroids are stopped, a mild erythema occurs at the site of the original dermatitis. Conclusion The key to safe use of topical steroid is short term use of appropriate potency steroid.
Prolonged use of steroids is not advisable. References 1. Steroid acne most often occurs on the chest but may also develop on the face, neck, back and arms. The steroids may aggravate a prior tendency to acne. It may affect any site prone to acne eg face.
The lesions tend to be more uniform in appearance than is usual with acne. Steroid-induced acne vulgaris Steroid acne.
In many patients, steroid acne is the same condition as Malassezia folliculitis. It is due to a proliferation of malassezia yeasts also known as pityrosporum. It presents with itchy superficial papules and pustules on the chest and back. Very potent topical corticosteroids are not usually prescribed for pregnant or breastfeeding women, or for very young children. Sometimes you may be prescribed them under the supervision of a skincare specialist dermatologist. Unless instructed otherwise by your doctor, follow the directions on the patient information leaflet that comes with the medicine.
This will give details of how much to apply and how often. Most people only need to use the medicine once or twice a day for 1 to 2 weeks. Occasionally a doctor may suggest using it less frequently over a longer period of time. The medicine should only be applied to affected areas of skin.
Gently smooth a thin layer onto your skin in the direction the hair grows. If you're using both topical corticosteroids and emollients , you should apply the emollient first. Then wait about 30 minutes before applying the topical corticosteroid. Sometimes, the amount of medicine you're advised to use will be given in fingertip units FTUs. A FTU about mg is the amount needed to squeeze a line from the tip of an adult finger to the first crease of the finger.
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.
Risks of Topical Corticosteriods. Get the latest news. Get the latest eczema news delivered to your inbox. Advances in research and treatments Lifestyle tips and hacks Stories from the community.
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