Topical corticosteroids: proper understanding and good prescription

Abstract

Adverse effects of topical corticosteroids consist of topical adverse reactions that arise in the skin of applied area and systemic adverse reactions caused by percutaneous penetration of corticosteroids. Systemic adverse effects (iatrogenic Cushing syndrome) are observed only after a long-term use of extraordinary large amount of potent corticosteroids. The occurrence of topical adverse reactions, including folliculitis, acne, dermatophytosis, skin atrophy, purpura, telangiectasia, hypertrichosis, depigmentation and rosacea-like dermatitis, depends on the period and the sites of application, as well as the potency of corticosteroids. Dermatologists must have thorough knowledge of these topical adverse reactions and are obligated to prevent and treat them. There was a controversy whether eye cataract, red face and hyperpigmentation of the neck seen in atopic dermatitis are adverse effects of topical corticosteroids, but today many dermatologists think that they are not related to the use of corticosteroids. The potency and the dose of corticosteroids have to be adequately selected according to the severity and the area of skin lesions. In order to obtain good compliance, simple prescription is desirable, and the application dose per day should be clearly indicated. Tachyphylaxis, the presence of which can not be denied, is not probably connected to serious clinical problems. (Online only)