From the Guidelines
Long-term use of topical corticosteroids is most commonly associated with skin atrophy, which is a significant adverse reaction. This occurs because topical steroids inhibit collagen synthesis and reduce protein production in the skin, leading to thinning of the epidermis and dermis 1. Other adverse reactions include striae (stretch marks), telangiectasia (visible small blood vessels), hypopigmentation, acne-like eruptions, and increased hair growth in the treated area.
Key Points to Consider
- The incidence of adverse events with topical corticosteroids (TCS) is low, but skin atrophy is generally the most concerning for physicians and patients 1.
- Risk factors for atrophy include higher potency TCS use, occlusion, use on thinner and intertriginous skin, older patient age, and long-term continuous use 1.
- Higher potency steroids, occlusive dressings, and application to thin skin areas (face, genitals, skin folds) increase the risks of adverse reactions 1.
- To minimize adverse effects, use the lowest effective potency, avoid continuous long-term use especially on sensitive areas, consider steroid-sparing alternatives for maintenance therapy, and implement "weekend therapy" (using steroids only on weekends) for chronic conditions requiring long-term management.
Adverse Reactions
- Skin atrophy is the most significant adverse reaction associated with long-term use of topical corticosteroids 1.
- Other adverse reactions include:
- Striae (stretch marks)
- Telangiectasia (visible small blood vessels)
- Hypopigmentation
- Acne-like eruptions
- Increased hair growth in the treated area
- Red face syndrome and red scrotum syndrome, characterized by persistent redness of the face and scrotum respectively, may occur after prolonged use of TCS 1.
From the FDA Drug Label
atrophy and thinning of skin The answer is d. Skin atrophy 2.
From the Research
Adverse Reactions to Topical Corticosteroids
The question asks about the adverse reaction associated with long-term use of topical corticosteroids. Based on the provided evidence, the correct answer is:
- Skin atrophy
Evidence from Studies
The following studies support this answer:
- A 2020 study published in Clinical, cosmetic and investigational dermatology 3 found that skin atrophy is one of the most prevalent side-effects of topical glucocorticoids, with changes found in all skin compartments.
- A 2021 study published in American family physician 4 stated that the risk of adverse effects, including atrophy, increases with prolonged use of topical corticosteroids.
- A 2015 study published in Drug safety 5 reviewed clinical data on skin atrophy induced by topical corticosteroids and found that skin atrophy is an adverse effect of topical corticosteroids, especially with chronic use.
- A 2006 study published in Journal of the American Academy of Dermatology 6 listed atrophy as one of the most frequent adverse effects of topical corticosteroids.
- A 2013 study published in La Revue de medecine interne 7 mentioned skin atrophy as a metabolic side effect of glucocorticoids, associated with long duration of treatment and high dosage.
Comparison of Options
Comparing the options provided:
- Leukocytosis is not mentioned as a common adverse reaction to topical corticosteroids in the provided studies.
- Erythema is not specifically mentioned as a long-term adverse reaction to topical corticosteroids.
- Skin irritation is a possible adverse reaction, but it is not as strongly associated with long-term use as skin atrophy.
- Skin atrophy is consistently mentioned as a common adverse reaction to long-term use of topical corticosteroids in the provided studies 3, 4, 5, 6, 7.