Side effects of cutaneous corticosteroids

The incidence of cutaneous adverse effects with local corticosteroid application peaked in the late 1970's. The reduction since has largely been due to improved understanding of how to use potent agents.

Local/cutaneous side effects are more common and include:

• epidermal and dermal atrophy causing thinning of the skin (reversible)
• striae – permanent
• purpura
• telangiectasia
• acneiform eruptions and rosacea
• hypertrichosis and hypopigmentation
• worsening of infections or secondary infections
• allergic contact dermatitis (1,2)
  • most commonly due to hydrocortisone
  • diagnosed when a condition such as eczema does not improve even after changing to a more potent agent - diagnostic patch testing is indicated

Systemic side effects although rare can be observed:

• iatrogenic Cushing's syndrome
• hypothalamic-pituitary-adrenal (HPA) axis suppression
• growth retardation in children (1)

Reference:

• (1) Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-40
• (2) National Institute for Health and Clinical Excellence (NICE) 2004. Frequency of application of topical corticosteroids for atopic eczema