Topical corticosteroids

Topical corticosteroids are a group of eczema medications that work by reducing inflammation by suppressing immune system activity around the treated area. They are applied to the affected skin areas, usually once or twice daily.

How safe are these medications in the long term?

The answer depends on which corticosteroid is used and how you use it. The following things can increase your risk of side effects from topical corticosteroids, especially over the long term:

  • using a strong topical corticosteroid (such as betamethasone dipropionate, clobetasol, halobetasol, betamethasone valerate, halcinonide, fluocinolone, fluocinonide, diflucortolone, dexamethasone, amcinonide, or betamethasone valerate)
  • applying the medication to a large body area
  • covering the medication with an airtight dressing
  • using the medication for a long period of time (this period depends on the medication used, the size of the area being treated, and the use of airtight dressings)
  • using the medication on areas of the body that have thin layers of skin such as eyelids, face or groin

The long-term side effects of corticosteroids can be divided into local (affecting the skin) and systemic (affecting the whole body).

Local effects:
  • skin atrophy (thinning of skin), leading to pale, wrinkled skin with visible blood vessels
  • stretch marks
  • increased growth of body hair
  • loss of pigment (colour) in small areas of the skin
  • impaired wound healing
  • skin irritation
  • red spots on the skin
  • acne or rosacea (a condition causing facial flushing): may occur if topical corticosteroids are used on the face
  • telangiectasia (spider veins)
Systemic effects:
  • glaucoma or cataracts: more common if the medication is used near the eye
  • stunting of growth
  • weight gain
  • body changes: moon face (face becomes rounder and more moon-shaped) and buffalo hump (fat deposits on the back that look like a buffalo's hump)
  • weakened immune system

It's important to understand that not everyone will experience these side effects after using topical corticosteroids. Because your risk of these long-term side effects depends on which medication is used and how it is used, check with your doctor to make sure you or your child are using the medication appropriately. Your doctor may recommend that you use a weaker steroid, or that you use short treatment periods followed by "holidays" where no steroids are used, or that you try a different medication.

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