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The side effects of steroids in skin care.

Psoriasis._Foto property of Psorialess

The biggest problem with using topical steroids? When you quit, the condition gets worse.

Adverse effects of topical corticosteroids:
Like all kinds of medications, topical steroids have the potential to produce adverse reactions. Some steroid-induced side effects are listed below:
1)  Cutaneous changes

  •     Skin blanching from acute vasoconstriction.
  •     Hypo-pigmentation.
  •     Rebound worsening of the pre-existing skin condition.
  •     Miliaria.
  •     Rosacea, perioral dermatitis, acne.
  •     Skin atrophy with telangiectasia, stellate pseudoscars, purpura, and striae.
  •     Delayed wound healing.
  •     Hyper-trichosis of face.
  •     Allergic contact dermatitis ** (Hydrocortisone).

2)  Cutaneous infection and infestation

  •     Folliculitis
  •     Tinea incognito
  •     Impetigo incognito
  •     Scabies incognito


3)  Eyes

  •     Glaucoma
  •     Cataracts


4)  Systemic

  •     Adrenal suppression
  •     Osteoporosis
  •     Stunted growth in children
  •     Cushioned appearance


Using Topical steroids with eczema:
When an eczematous inflammatory skin condition fails to respond to topical steroid therapy, the following factors need to be considered:

  •     Co-existing infection (bacterial, fungal, viral, scabies etc.)
  •     Wrong diagnosis (e.g. drug eruption, Pagets disease, mycosis fungoides mistaken as eczema)
  •     Insufficient potency of steroid for the site or skin condition.
  •     Inappropriate vehicle or base (e.g. cream is not as effective as ointment for dry lichenifed skin, salicylic acid acts as keratolytic and aids penetration of hyperkeratotic palms and soles)
  •     Poor compliance or incorrect method of application and skin care
  •     Irritant contact dermatitis: aggravated by water, detergents, lotions, antiseptics, certain herbal remedies.

Allergic contact dermatitis: allergens such as metal, rubber, glue, and medicaments

The biggest problem with using topical steroids? When you quit, the condition gets worse.

Allergic contact dermatitis and topical steroid preparations.
This is increasingly recognized in recent years and accounts for one of the many causes of unsatisfactory response to topical steroid therapy. Allergy to corticosteroids accounts for 4% of allergic contact dermatitis.
Potential sensitizers in topical steroid preparations include:

  •     Preservatives or stabilizer in the vehicle (e.g. parabens, lanolin, ethylene- diamine)
  •     Antimicrobials (e.g. neomycin, clioquinol)
  •     Steroid molecule itself (e.g. hydrocortisone, clobetasol)

Face, hand, perineal area, and lower leg are sites where medicaments are frequently applied and associated with allergic contact dermatitis to topical preparations. More common steroid sensitizers may be related to their frequency of use and include hydrocortisone, Locoid, Dermovate, etc. A thorough medicament history is important for diagnosis and should be confirmed with patch testing. Standard series allergens as well as corticosteroids series should be used for testing.

Corticosteroid series include:

  •     Amcinonide 0.1%
  •     Betamasone 17 valerate 0.12%
  •     Clobetasol 17 propionate 0.25%
  •     Hydrocortisone 1%
  •     hydrocortisone 17-butyrate 0.1%
  •     Triamcinolone Acetonide 0.1%
  •     Budesonide 0.1%
  •     Prednisolone 0.1%

Corticosteroids Rebound Effect: Late readings at 72 hour or later for clinical relevance.

Chronic Use of Steroids
Chronic use of steroids almost always leads to tachyphylaxis (lack of response). Changing from one steroid to another may delay tachyphylaxis, but the only way to prevent it is to stop using topical corticosteroids, at least temporarily. Alternatively, regiments which have been called “pulse therapy” or “weekend therapy” are quite effective and minimize the likelihood of a person developing skin side effects (see below) and tachyphylaxis. In these regiments, strong topical corticosteroids are applied on weekends only, and emollients or non steroidal antipsoriatic agents are applied.

The continued use of steroid based or corticosteroid-based medications will lead to decalcification of the bones. Since psoriasis is in the majority of cases also associated with arthritis (most psoriasis sufferers also have a form of arthritis) decalcification of the bones will lead to extension of the arthritis or an increase in the pains associated with arthritis.

Topical Steroids and Photo-therapy
Use of topical steroids can shorten the duration of remission in patients who are undergoing photo therapy with ultraviolet B or PUVA. It is sometimes necessary to treat stubborn plaques with topical steroids in those undergoing photo therapy. However topical corticosteroids should not be used routinely on all psoriatic plaques. Other agents namely can increase the redness and inflammation brought on by ultraviolet B or PUVA photo therapy. Topical tars also have photosensitizing potential.

Steroids are not a monotherapy
It is still important to moisturize regularly even though topical steroids come in crème formulations. In most cases, steroids are not a monotherapy; that is they must be used with other medications.

Systemic Steroids
Sometimes psoriasis lesions are injected with steroid medication. The injections can be effective in clearing isolated psoriasis lesions, but are not practical when there are many lesions. There are few side effects from intralesional injections if they are used only occasionally and for a small number of lesions. Oral doses or muscular injections of steroid medications are not a standard treatment choice for psoriasis. Occasionally, the withdrawal of steroids may be associated with a worsening or flare of psoriasis and long-term use can create serious side effects.

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