Corticosteroid Side Effects: Topical, Intralesional, Systemic

Overview / DefinitionCorticosteroids are a class of steroid hormones that are produced in the adrenal cortex and have significant anti-inflammatory and immunosuppressive properties. In dermatology, they are commonly used to treat a variety of skin conditions including eczema, psoriasis, and dermatitis. While effective, corticosteroids can lead to numerous side effects, which vary based on the route of administration.EpidemiologyCorticosteroids are among the most frequently prescribed medications in dermatology. A significant proportion of patients using topical corticosteroids experience side effects, particularly with prolonged use. The incidence of systemic side effects is notably lower but can occur in patients receiving high-dose or prolonged therapy.Pathophysiology / MechanismCorticosteroids exert their effects by binding to glucocorticoid receptors, leading to alterations in gene expression and inhibition of inflammatory mediators. This results in reduced inflammation, immunosuppression, and modulation of cellular proliferation. However, the same mechanisms can lead to adverse effects, particularly with chronic use.Clinical PresentationSide effects of corticosteroids can be categorized based on the route of administration:Topical Corticosteroids: Skin atrophy, striae, telangiectasia, perioral dermatitis, and rebound flare upon discontinuation.Intralesional Corticosteroids: Local skin atrophy, hypopigmentation, and rarely, systemic effects if absorbed in significant quantities.Systemic Corticosteroids: Weight gain, osteoporosis, hypertension, hyperglycemia, and increased risk of infections.Diagnosis / WorkupThe diagnosis of corticosteroid-related side effects is primarily clinical. A thorough patient history and physical examination are essential to identify symptoms that may arise from corticosteroid therapy. Laboratory tests may be warranted in cases of suspected systemic effects, such as blood glucose levels or bone density assessments.Treatment / Management