Adverse effects of Topical Glucocorticosteroids
Topical corticosteroids were introduced into medicine about 50 years ago. They represent a significant milestone in dermatologic therapy. Despite encouragement to report observed adverse drug reactions, the clinical practice of reporting is poor and incomplete. Likewise, adverse effects and safety of topical corticosteroids are neglected in the medical literature.
The authors provide an updated review of their adverse-effect profile. Children are more prone to the development of systemic reactions to topically applied medication because of their higher ratio of total body surface area to body weight.
Cutaneous adverse effects occur regularly with prolonged treatment and are dependent on the chemical nature of the drug, the vehicle, and the location of its application.
The most frequent adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. Those that occur with lower frequency include hypertrichosis, pigmentation alterations, delayed wound healing, and exacerbation of skin infections. Of particular interest is the rate of contact sensitization against corticosteroids, which is considerably higher than generally believed. Systemic reactions such as hyperglycemia, glaucoma, and adrenal insufficiency have also been reported to follow topical application… Read more
GUIDELINES FOR THE SELECTION OF AN APPROPRIATE TOPICAL GLUCOCORTICOSTEROID
To meet the challenges of a plethora of different indications, topical corticosteroids of varying strength have been produced. Low- to medium potency agents generally are used to treat acute inflammatory skin lesions of the face and intertriginous areas, whereas highly potent agents are often required to treat chronic, hyperkeratotic, or lichenified lesions on the palms and soles.
HUMAN MODELS OF TESTING CORTICOSTEROID EFFICACY AND STRENGTH
Corticosteroid strength has been classified according to the vasoconstrictor assay, which is based on the extent to which the compound induces cutaneous vasoconstriction (‘‘blanching effect’’) in normal human subjects (Table I).18 The vasoconstriction test was established in 1962 to roughly estimate the efficacy of topical corticosteroids.19,20 . It represents an unspecific and simple in vivo test, although the phenomenon of vasoconstriction is not linked to the receptor-mediated activity of steroids.
However, the exact cause of this vasoconstriction remains unknown.
For many patients, the intermittent use of topical corticosteroids is highly effective, bears little risk, and is relatively inexpensive.35 However, when the inflammatory disease remains recalcitrant or affects particularly sensitive areas, the repeated use of potent such steroids is not desirable for extended periods.
In addition, patients may have genuine concerns about these agents that lead to non-compliance, even where treatment with them is appropriate. Thus a significant proportion of patients does not receive adequate treatment.