Topical Steroid Side Effects

Topical steroids are extremely effective at treating a wide range of inflammatory diseases, but these medications are not without risks.

Some potential topical steroid side effects include burning, stinging, stretch marks, skin thinning, and infections. Long-term use can lead to skin and eye damage.

This article explores these and other side effects of topical steroids, some of which are mild and transient and others of which are severe and irreversible.

Erythema

Erythema describes skin redness that commonly accompanies a rash or an inflammatory skin condition. With topical steroids, erythema is common on the face but can also affect the genitals and other delicate areas of skin. Burning or stinging sensations may also occur.

Erythema may occur when first starting treatment and gradually resolve as your skin adapts to the treatment. But, it can also develop if with high-potency steroids or when the drug is overused. This may require a dose adjustment or the discontinuation of treatment.

Blackheads and Whiteheads

Oral steroids are known to cause acne-like breakouts called acneiform eruptions on the trunk and limbs of some people. While this is uncommon with topical steroids, the drugs can sometimes cause comedones—better known as blackheads or whiteheads—on the face with prolonged use.

The risk is greatest in people with existing comedones or acne. This can lead to an outbreak of acne in some people, including a more severe form of acne known as nodular acne.

Contact Dermatitis

Allergic contact dermatitis is a generally non-severe reaction experienced by some topical steroid users. They may either be allergic to a non-active ingredient (like lanolin or a chemical preservative) or the actual steroid molecule.

People who use multiple drugs to treat a chronic skin condition are at a higher risk of allergic contact dermatitis.

Tachyphylaxis

Tachyphylaxis is a rapid decrease in the response to a topical steroid due to repeated use. Overuse of steroids can cause the skin to develop a tolerance to the drug, rendering them useless.

When this happens, people will often increase the dosage or apply the steroid more frequently. This not only increases a person's tolerance to the drug but the risk of more serious side effects as well.

Tachyphylaxis can usually be reversed by stopping treatment for at least seven days and then restarting.

Rosacea

Prolonged use of a topical steroid on the face can cause rosacea. This is an inflammatory condition that causes reddened skin and a rash, usually on the nose and cheeks.

Not only can topical steroids cause rosacea, but the abrupt discontinuation of the drug after prolonged use can lead to rosacea symptoms, including intense facial redness and fluid-filled bumps.

Skin Atrophy

Skin atrophy is one of the most common side effects of topical steroid overuse. It describes the thinning of the upper layer of skin (called the epidermis) and structural changes in the middle layer of skin (called the dermis). When this happens, the skin can become lax, wrinkled, and shiny.

Skin atrophy can make the outer layer of skin noticeably thinner and the underlying veins more visible. This may be accompanied by telangiectasia (spider veins), purpura (purplish blood spots), and hypopigmentation (the loss of skin color).

Skin atrophy is usually reversible once the topical steroid is stopped, but it may take months for the skin to thicken to normal.

Stretch Marks

Repeated use of topical steroids in areas where skin touches skin, such as the groin and armpits, can result in stretch marks (striae).

Stretch marks from topical steroid use are permanent and irreversible. They can be very itchy and may require a lower-strength steroid to treat the underlying itch.

Skin Infections

Because topical steroids alter the way the immune system works, they can lower the skin’s ability to fight off bacterial and fungal infections.

A typical example of this is when someone applies a topical steroid to an itchy groin rash. This can cause the overgrowth of fungus naturally residing on the skin, leading to a fungal skin infection like jock itch (tinea cruris).

A fungal skin infection caused by topical steroids is known as tinea incognito.

Topical steroids can also cause the worsening of existing skin conditions, which is why you should never apply the drug to infected skin.

Glaucoma

Glaucoma is a rare side effect of topical steroids during which the pressure inside the eye can build, causing progressive damage to the optic nerve. Glaucoma generally occurs with the long-term overuse of oral steroids, but it can also occur when high-potency topical steroid eyedrops are overused.

Despite the fact that glaucoma is uncommon in topical steroid users, it has been known to cause permanent loss of vision and blindness in isolated cases.