7 horrible side effects of topical corticosteroids or steroid creams

Topical corticosteroids or steroid creams are being prescribed even by beauticians.

Topical steroids, topical corticosteroids or steroid creams are a boon to those who suffer from inflammatory conditions like eczema, psoriasis, rash and dermatitis. Common ones include hydrocortisone, mometasone, fluocinolone etc. The strong anti-inflammatory actions of the steroid cream work by suppressing the immune response of the body, preventing inflammation at the site. Although it has been a wonder drug with an ability to treat a wide variety of skin ailments, medics have noted a rapid rise in the improper use of the drug by patients and sometimes even doctors. While steroid creams are used for the treatment of skin disorders like psoriasis, vitiligo, they are also being prescribed for undiagnosed skin conditions like rashes.

In India, thanks to our obsession with fairer skin tones, non-specialists like beauticians have been selling steroid creams to their clients for their skin-lightening effects. Sometimes, the patient self-medicate or prescribe the cream to others. Some of them don't follow-up with the doctors and end up using topical steroids for a very long time.

This is a potentially scary situation since steroid creams are very potent. In fact, both physicians and patients should exercise caution while prescribing and using topical steroids. Abusing them could cause a host of horrible side effects, especially when used on areas like the face and genitalia. Some of may also be irreversible. Here are some of the side effects of indiscriminate use of topical steroids.

Endocrine functions will get suppressed: Hormonal activities in your body can go for a toss if topical steroids are overused. The Hypothalamic-Pituitary-Adrenal Axis, as the endocrine system is known, gets affected by all types of steroid creams. The suppression happens especially if the cream used has a higher concentration and if the person applies the cream on a large surface area of the body.

Creams like Betamethasone dipropionate and diflorasone diacetate suppress kidney functions. Apart from this other serious endocrine disorders like Cushing's syndrome, Addison's disease and growth retardation. Death has also been reported in some cases. ^{1 2 3}

Hyperglycemia and diabetes

If the patient has been using steroid creams indiscriminately for a long time, eventually he will notice a sharp spike in his blood glucose levels. Risk of diabetes mellitus also goes up with constant use. Complications will worsen if the person already has liver conditions.³

Swelling in the body

Edema happens when the body starts accumulating fluid between the skin and the cavities of the body, causing pain and discomfort. As a result, the face, hands and legs look abnormally swollen. Edema or swelling is one of the rarer side effects of using too much topical corticosteroids, especially hydrocortisone and 9-a-fluoroprednisolone, which are prescribed very commonly.³

Hypocalcemia

Prolonged treatment with steroid creams can lead to hypocalcemia or low levels of calcium in the blood. This could cause further complications such as muscle cramps, neurological problems, memory loss, depression and hallucinations.³

Skin degeneration

Although it is used to treat skin disorders, excessive use of topical corticosteroids can cause atrophic changes in the skin. Thinning of the skin, hypopigmentation, wrinkles, stretch marks and worsening of the texture and quality of skin are seen in people who are addicted to steroid creams. Prolonged exposure to hydrocortisone hydrocortisone-17-butyrate and budesonide causes contact allergy, infections, acne, rosacea, purpura and ulcerations of skin.³

Glaucoma

Usage of topical steroids around the eyes can cause glaucoma, which damages the optic nerves. This is because the skin around the eyes is 300 times more capable of absorption as compared to other areas of your face. ²

Delayed wound healing

Wound healing gets impaired if there is an overuse of topical steroids. The steroids cause epidermal atrophy, delayed wound healing and reduced collagen supply causing wounds to not heal for a long duration.

References:

1. Gupta, R., & Fonacier, L. S. (2016). Adverse Effects of Nonsystemic Steroids (Inhaled, Intranasal, and Cutaneous): a Review of the Literature and Suggested Monitoring Tool. Current allergy and asthma reports, 16(6), 44.

2. Gupta, R., & Fonacier, L. S. (2016). Adverse Effects of Nonsystemic Steroids (Inhaled, Intranasal, and Cutaneous): a Review of the Literature and Suggested Monitoring Tool. Current allergy and asthma reports, 16(6), 44.

3. Hengge, U. R., Ruzicka, T., Schwartz, R. A., & Cork, M. J. (2006). Adverse effects of topical glucocorticosteroids. Journal of the American Academy of Dermatology, 54(1), 1-15.

Coondoo, A., Phiske, M., Verma, S., & Lahiri, K. (2014). Side-effects of topical steroids: A long overdue revisit. Indian Dermatology Online Journal, 5(4), 416 425. http://doi.org/10.4103/2229-5178.142483