Why do topical steroids thin the skin

It is usually seen in children with atopic dermatitis. Also, mild potent, steroids used commonly in children like desonide and hydrocortisone butyrate have an allergic property due to their structural instability. Some commonly used potent steroids are rare allergens, e. Patients with atopic and seborrheic dermatitis on chronic topical steroids, develop a flare around the eyes within days after stoppage of steroids.

Topical corticosteroids may induce tachyphylaxis with chronic use. This is why the frequency of application of ultrahigh-potency topical corticosteroids is reduced after the first 2 weeks to no more than four or five times a week. Initially, steroids are effective; however, as time passes, patients stop responding to the same topical steroid and require oral steroids.

A study has shown the association of trichostasis spinulosa with topical steroids. It is characterized by dark-brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas with a rough sensation on palpation.

On examination, tufts of hairs are visible projecting through each of the tiny papules. Treatment involves daily tretinoin 0. Striae due to steroids must be differentiated from those due to weight gain and pregnancy. Pathogenesis of striae, according to Shuster, is due to the cross linking of immature collagen in the dermis, resulting in intradermal tears causing striae [ Figure 4 ].

Persistent redness of the face, after peel or laser has been noted in patients using topical steroids before the procedure. Women with status cosmeticus cannot tolerate makeup and complain of a continuous burning sensation after any application. Patients present with erythema and burning disproportionate to the redness. Examination reveals atrophy, telangiectasia, and acneiform papules.

With steroid withdrawal, the atrophy eventually clears. Patients present with facial erythema and lichenification on the face, forearms and upper neck. The difference between this condition and photo exacerbated dermatitis is that even though the rash is on the photo distributed area, it does not flare on sun exposure.

The pattern of corticosteroid withdrawal is as follows: A week after corticosteroids are stopped, a mild erythema occurs at the site of the original dermatitis. This flare lasts for 2 weeks ending with desquamation. Dermatitis localized to the eyelids, face, scrotum, or perianal area often persists. A second flare usually occurs within 2 weeks. This pattern of flare and resolution repeats itself but each time smaller duration of flares and longer resolution periods.

The length of the time for which steroids had been used initially determines the duration of the withdrawal phase. The key to safe use of topical steroid is short term use of appropriate potency steroid. However, when the skin condition remains resistant to treatment or affects a particular sensitive area, the prolonged use of steroids is not advisable.

Selective glucocorticoid receptor agonists are being developed that have independent transrepression and transactivation action. This may lead to the development of a topical steroid without its adverse effects. Source of Support: Nil. Conflict of Interest: Nil. National Center for Biotechnology Information , U. Journal List Indian J Dermatol v.

Indian J Dermatol. Anil Abraham and Gillian Roga. Author information Article notes Copyright and License information Disclaimer. It should be enough to treat an area of skin double the size of the flat of your hand with your fingers together. The recommended dosage will depend on what part of the body is being treated. This is because the skin is thinner in certain parts of the body and more sensitive to the effects of corticosteroids.

For children, the recommended FTUs will depend on their age. A GP can advise you on this. If you use them correctly, topical corticosteroids rarely have serious side effects. The most common side effect of topical corticosteroids is a burning or stinging sensation when the medicine is applied. However, this usually improves as your skin gets used to the treatment. If potent or very potent topical corticosteroids are used for a long time or over a large area, there's a risk of the medicine being absorbed into the bloodstream and causing internal side effects, such as:.

This is not a full list of all the possible side effects. For more information on side effects, see the leaflet that comes with the medicine. The Yellow Card Scheme allows you to report suspected side effects from any type of medicine you're taking. People who experience side effects usually are not using steroid creams properly. Applying the cream or ointment thinly and evenly to the affected areas on the skin is important.

This minimizes the amount absorbed through the skin into the body. But, generally, topical steroids should not be applied more than twice a day, and once daily may be enough in certain situations. Follow a dermatologist's instructions on proper use, especially since different types of topical steroids may be recommended in different areas of the body.

For example, a lower-potency steroid may be recommended for sensitive skin such as the face, and a higher-potency steroid on the trunk. At any time, you can update your settings through the "EU Privacy" link at the bottom of any page. These choices will be signaled globally to our partners and will not affect browsing data.

We and our partners process data to: Actively scan device characteristics for identification. I Accept Show Purposes. Table of Contents View All. Table of Contents. Steroid Rosacea. Skin Atrophy. Stretch Marks. Alteration of Infection. Topical Steroid Allergy. Was this page helpful? Thanks for your feedback! Sign Up. What are your concerns?

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