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drug adverse effects of topical glucocorticoids

Adverse effects: 1) common* - skin atrophy, thinning & wrinkling of skin - striae, visible veins (groin is common area) - acne, rosacea - perioral dermatitis - easy bruising, purpura 2) less common - hypertrichosis - pigmentation alterations - delayed wound healing - exacerbation of skin infections 3) other - contact sensitization 4) systemic reactions within chronic use of potent agents [2,6] - hyperglycemia - systemic absorption may increase risk of type 2 diabetes [11] - glaucoma - cataracts [7,8] - adrenal insufficiency - high doses of potent glucocorticoid during pregnancy may result in low birth weight infant [4] - potent topical glucocorticoids associated with increased risk for osteoporosis & major fracture (< 122/10,000 patient years) [12] * adverse effects more common when applied to areas of occlusion by clothing or skin folds [2] Management: - do not use potent of fluorinated glucocorticoids on face - try to limit use to one week; if longer therapy is needed try pulse therapy, 1 week of therapy, 1-3 weeks off

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DRUGS: topical glucocorticoid FORM: drug adverse effects topical glucocorticoid

References

  1. Prescriber's Letter 16(12): 2009 Comparison of Topical Corticosteroids Detail-Document#: 251227 (subscription needed) http://www.prescribersletter.com
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18. American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
  3. Prescriber's Letter 18(10): 2011 Hyperglycemia Associated with Non-oral and Locally Injected Corticosteroids Detail-Document#: 271022 (subscription needed) http://www.prescribersletter.com
  4. Chi CC et al Pregnancy Outcomes After Maternal Exposure to Topical Corticosteroids. A UK Population-Based Cohort Study. JAMA Dermatol. Published online September 04, 2013 PMID: 24005903 http://archderm.jamanetwork.com/article.aspx?articleid=1735120
  5. Del Rosso J, Friedlander SF. Corticosteroids: options in the era of steroid-sparing therapy. J Am Acad Dermatol. 2005 Jul;53(1 Suppl 1):S50-8. PMID: 15968264
  6. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006 Jan;54(1):1-15 PMID: 16384751
  7. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  8. Haeck IM, Rouwen TJ, Timmer-de Mik L Topical corticosteroids in atopic dermatitis and the risk of glaucoma and cataracts. J Am Acad Dermatol. 2011 Feb;64(2):275-81
  9. Beer K, Downie J. Sequelae from inadvertent long-term use of potent topical steroids. J Drugs Dermatol. 2007 May;6(5):550-1 PMID: 17679193
  10. Barnes L, Kaya G, Rollason V. Topical corticosteroid-induced skin atrophy: a comprehensive review. Drug Saf. 2015 May;38(5):493-509. Review. PMID: 25862024
  11. Andersen YMF, Egeberg A, Ban L et al. Association between topical corticosteroid use and type 2 diabetes in two European population-based adult cohorts. Diabetes Care 2019 Jun; 42:1095 PMID: 30936111 http://care.diabetesjournals.org/content/42/6/1095
  12. Egeberg A, Schwarz P, Harslof T et al Association of Potent and Very Potent Topical Corticosteroids and the Risk of Osteoporosis and Major Osteoporotic Fractures. JAMA Dermatol. Published online January 20, 2021. PMID: 33471030 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775153 - Jackson RD Topical Corticosteroids and Glucocorticoid-Induced Osteoporosis - Cumulative Dose and Duration Matter. JAMA Dermatol. Published online January 20, 2021 PMID: 33471024 https://jamanetwork.com/journals/jamadermatology/article-abstract/2775150