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Steroid-induced skin atrophy is thinning of the skin as a result of prolonged exposure to topical steroids. In people with psoriasis using topical steroids it occurs in up to 5% of people after a year of use. [5] Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning. [6] [7] [8]
Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids for 2 weeks or longer and then discontinue use. [ 4 ] [ 5 ] [ 2 ] [ 1 ] Symptoms affect the skin and include redness, a burning sensation, and itchiness, [ 2 ] which may then be followed by peeling.
Cortisone is a pregnene (21-carbon) steroid hormone.It is a naturally-occurring corticosteroid metabolite that is also used as a pharmaceutical prodrug. Cortisol is converted by the action of the enzyme corticosteroid 11-beta-dehydrogenase isozyme 2 into the inactive metabolite cortisone, particularly in the kidneys.
Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility. [11] The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body.
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The neuropsychiatric effects are partly mediated by sensitization of the body to the actions of adrenaline. Therapeutically, the bulk of corticosteroid dose is given in the morning to mimic the body's diurnal rhythm; if given at night, the feeling of being energized will interfere with sleep. An extensive review is provided by Flores and Gumina ...
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