Inflammatory skin conditions
Topical steroids are effective in inflammatory dermatoses, such as eczema and psoriasis. They are of no value in urticaria or pruritus and will exacerbate rosacea and acne. Topical steroids are also used in other dermatoses eg keloid scars, alopecia areata and non-infected granulomas.
The risk of side effects runs parallel with the strength of the steroid, the duration of therapy and, to some extent, the degree of occlusion. The face, genitals and intertriginous areas will absorb more steroids than other areas. Cutaneous side effects may be apparent within two weeks' use. Use of the potent and very potent steroids should be carefully monitored and limited to a few weeks' duration, after which a milder steroid should be substituted if possible. Patients should be reviewed every three months. Only mildly and moderately potent steroids should be used in children to avoid potential growth retardation and long-lasting cosmetic disfiguration. If allergic contact dermatitis develops patients should be switched to another steroid in the same potency group.
Long term continuous or inappropriate use of topical steroids can result in the development of rebound flares after stopping treatment (topical steroid withdrawal syndrome). A severe form of rebound flare can develop which takes the form of a dermatitis with intense redness, stinging and burning that can spread beyond the initial treatment area. It is more likely to occur when delicate skin sites such as the face and flexures are treated. Should there be a reoccurrence of the condition within days to weeks after successful treatment a withdrawal reaction should be suspected. Reapplication should be with caution and specialist advice is recommended in these cases or other treatment options should be considered.
Secondary bacterial infection may occur, enhancing the inflammatory events and worsening eczema. Antibacterial agents can be combined with steroid preparations with good effect. However, the antibiotic can act as an allergen in some eczematous patients. With aminoglycosides there is a risk of ototoxicity and nephrotoxicity so they should not be applied to large areas, or to the external auditory canal in patients with a perforated ear drum.
For emollients used in the treatment of eczema and other dermatoses see the eczema, pruritus and dry skin conditions section.