PROLONGED USE OF TOPICAL STEROIDS AND THEIR SIDE EFFECTS
Abstract:
Topical steroids,commonly used for a wide range of skin disorders are associated with cutaneous and systemic side effects.
Objective:
To bring awareness among practitioners and patients about the adverse effects which occur merely due to the improper knowledge and over the counter use of topical steroids.
It is important for dermatologists to weigh the usefulness versus side effects of topical steroids and to make an informed decision regarding their use in each individual based on the factors such as age{old} site involved {intertriginous,crural} and type and duration of the disorder and type of steroids{high potent topical}
Hence topical steroids should be used with utmost caution.
Introduction:
In the middle of 20th century, topical hydrocortisone{double edged sword} was introduced
Mechanism of action:
In most of the skin disorders like allergic contact dermatitis psoriasis lichen planus etc phospholipase a2 gets activated by the respective stimuli which acts on cell membrane and release arachadonic acid from the phospholipids and leads to inflammation.the steroids will inhibit the phospholipase a2 and stop causing the inflammation.
Adverse effects of topical steroids:
Pre atrophy
Atrophy
Tachyphylaxis
Pathogenesis behind atrophy: steroids inhibit keratinocyte proliferation in epidermis , collagen 1 and 3 synthesis in dermis , fibroblasts and hyaluronan synthase 3 in extra cellular matrix leading to atrophy. Sudden withdrawal causes vasodilatation and burning sensation.
Trampoline effect : due to abrupt release of N2O stores.
Other side effects:
striae{rubra distensae}
steroid acne
purpura pseudo scars
aggravation of cutaneous infections
steroid induced telengectasia
steroid rosacea
post peel erythema
facial hypertrichosis
tinea incognito
hyperpigmented keratotic papules
Systemic side effects:
suppression of HPA axis
hyperglycemia
Conclusion:
what's new?
The key to safe use of topical steroid is short term use of appropriate potent steroid.
Prolonged use of steroids is not advisable.
Selective gulococorticoid receptor agonists are being developed which lessen these adverse side effects.
Reference: IADVL text book of dermatology, recent journals and articles,dermatology by mosby,clinical dermatology by nilendu sharma.