Can steroids cause a burning sensation in the face and ears?

Burning Sensation from Steroids: Causes and Management

Yes, steroids can cause burning sensations in the face and ears, which is a recognized side effect that may indicate either a contact sensitivity reaction or a direct irritant effect.

Types of Burning Sensations Associated with Steroids

• Topical steroids can cause burning, stinging, and irritation upon application, particularly when used on sensitive areas like the face and ears 1
• These sensations may indicate contact dermatitis, which can be either irritant contact dermatitis (direct chemical damage) or allergic contact dermatitis (immune-mediated reaction) 1
• Burning sensations are among the most common local side effects reported with topical steroid use, especially with higher potency formulations 2

Mechanisms Behind Steroid-Induced Burning

• Irritant contact dermatitis occurs from direct chemical damage, leading to inflammatory mediator release that causes erythema, edema, scaling, itching, and burning pain 1
• Allergic contact dermatitis represents a true hypersensitivity reaction that occurs in susceptible individuals, estimated to affect 0.3-0.5% of the population 3
• Burning sensations may also occur with oral dysesthesia (burning mouth syndrome), which can be exacerbated by steroid treatments 1

Risk Factors for Developing Burning Sensations

• Application to thin-skinned areas like the face and ears increases risk of local side effects 2
• Higher potency steroids are more likely to cause burning sensations 1
• Pre-existing skin conditions like atopic dermatitis or stasis dermatitis increase the risk of developing contact dermatitis from topical steroids 3
• Prolonged or frequent use of steroids increases the likelihood of developing hypersensitivity reactions 3

Management of Steroid-Induced Burning Sensations

• If burning sensation occurs, consider discontinuing the steroid and consulting a healthcare provider 1
• For mild reactions, switching to a lower potency steroid may reduce symptoms 1
• For allergic contact dermatitis to steroids, patch testing can identify the specific steroid causing the reaction 3
• Topical calcineurin inhibitors (e.g., tacrolimus 0.1% ointment or pimecrolimus 1% cream) may be alternative anti-inflammatory options for those who cannot tolerate steroids 1

Prevention Strategies

• Use the lowest effective potency of topical steroid for the shortest duration possible 4
• Avoid applying high-potency steroids to sensitive areas like the face and ears 2
• Consider using a test application on a small area before widespread application 5
• For inhaled steroids, rinse the mouth after use and use a spacer device to prevent local side effects 6

When to Seek Medical Attention

• If burning sensation persists or worsens despite discontinuing the steroid 3
• If accompanied by other symptoms like rash, swelling, or difficulty breathing (which could indicate a more serious allergic reaction) 7
• If symptoms interfere with daily activities or quality of life 1

Special Considerations

• Children are more susceptible to steroid side effects due to their higher skin surface to body mass ratio 2
• Patients with a history of allergies or atopic conditions may be at higher risk for developing hypersensitivity reactions to steroids 7
• Burning sensations from topical steroids should be distinguished from other causes of facial burning, such as rosacea or neurological conditions 1

Remember that while burning sensations are a recognized side effect of steroid use, they should be evaluated by a healthcare provider to determine the appropriate management strategy and to rule out other potential causes.