Side effects of corticosteroids
What are corticosteroids?
Corticosteroids are hormones produced naturally by our adrenal glands, and have vitally important actions on our metabolism, immune system and cardiovascular system. Corticosteroid deficiency can cause serious diseases (as can their excess). Synthetically, they can be used as anti-inflammatory and immunomodulatory drugs. Because most skin disorders are of inflammatory and/or autoimmune origin, they are the most widely used medication in their topical format (cream, ointment, solution, emulsion), oral or parenteral (intralesional, intramuscular, intravenous) within the specialty.
What is the action they have on skin diseases?
Their main action is anti-inflammatory: they reduce erythema (redness), pain or itching and oedema (swelling) typical of inflammatory lesions. They also reduce vasodilation and the increase in inflammatory cells (leukocytes and macrophages) also associated with inflammation. All these actions are the key to their effectiveness in the therapy of most skin ailments: atopic dermatitis, seborrheic dermatitis, psoriasis, lichen planus…
So, are they suitable for any skin disorder?
No. Only a dermatologist can advise you on their use, as they are contraindicated in infections (bacterial, fungal or viral) and are usually not useful in skin tumours . It is precisely the wrong application and inappropriate dosage that cause the appearance of side effects. Even in some inflammatory skin diseases their use is contraindicated, e.g. in rosacea.
Why are they drugs that are feared?
Corticosteroids, despite being old, high-safety drugs with a predictable and known side effect profile, arouse a certain aversion in patients (up to 73% report fear or anxiety about their prescription). It is common to hear phrases such as “Don’t give me cortisone because I’m going to swell” or “We don’t want to give cortisone to our child because it’s bad“. This fame is due to the fact that the misuse of corticosteroids leads to the appearance of unwanted adverse effects that have become very popular. If the administration guidelines recommended by your dermatologist are followed, side effects are unlikely to occur.
What are its side effects?
A distinction must be made between the adverse effects of topical and systemic corticosteroids. When topical corticosteroid preparations are used for a prolonged period in the same area, the following local side effects may occur: appearance of reddish stretch marks, atrophy of the skin and/or telangiectasias (capillaries). Only when the application of topical corticosteroids is extensive, prolonged, due to the use of high potencies or because they have been applied with occlusion (covered with an insulating dressing), a systemic absorption of the corticosteroid can occur. The systemic side effects of corticosteroids include: increased blood glucose, increased blood pressure, weight gain due to fluid retention, increased appetite, appearance of bruises and fragility of the skin, favoring osteoporosis…
Are they safe?
Without any doubt. Under medical prescription and control, corticosteroids are a pharmacological group with an excellent safety and effectiveness profile. Thanks to corticosteroids, many serious and banal diseases are cured or improved, and their discovery was a therapeutic milestone in medicine.
Are corticosteroid creams safe?
Yes. Adverse effects are exceptional if they are used as directed by your dermatologist: in short courses of treatment, even if we use high-potency corticosteroids, it is very rare for adverse effects to appear.
Are all cortisone creams the same?
No. There are corticosteroids of low, moderate, high and very high potency . Likewise, the potency of the corticosteroid can also be regulated depending on the excipient (cream, lotion, foam, ointment…) and the form of application (covered with a waterproof dressing). Your dermatologist will tell you which type of preparation and application is the most appropriate for your specific ailment.
Is systemic absorption of corticosteroids produced with cortisone creams?
If several factors are combined, it is possible: extensive application, use of powerful corticosteroids, occlusive cure (under waterproof dressing), for a prolonged period of time and/or in certain areas of the body (face, folds).
Can these creams be applied to children and babies?
Yes. Under medical prescription and indication, they are a common, effective and safe treatment. It is exceptional that adverse effects occur, and these are predictable as well as perfectly known.
Can corticosteroid cream be applied to a pregnant woman?
Under medical prescription and supervision, yes, as long as the risk/benefit ratio of the treatment has been assessed. For most indications, absorption is minimal or non-existent through the skin. In addition, corticosteroids are used in threats of premature birth to accelerate the maturation of the newborn.
CONCLUSIONS
· Corticosteroids are anti-inflammatory and immunomodulatory drugs that are very useful in the vast majority of non-infectious and non-tumour skin disorders.
· Controlled use under medical prescription has a very high efficacy and absence of adverse effects, making it the optimal therapeutic option in many skin disorders. They are an excellent group of drugs.
· Corticosteroid treatment should not be feared as long as it is under medical supervision: its adverse effects will occur only in cases of prolonged treatment, at moderate/high doses or with the misuse of these drugs (self-prescription, inappropriate use, excess dosage or duration of treatment).
· They can be used in pregnant women, children and babies when necessary and always on the advice of their dermatologist.
REFERENCES
· Aubert-Wastiaux H, Moret L, Le Rhun A, Fontenoy AM, Nguyen JM, Leux C, Misery L, Young P, Chastaing M, Danou N, Lombrail P, Boralevi F, Lacour JP, Mazereeuw-Hautier J, Stalder JF, Barbarot S. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011 Oct; 165(4):808-14
