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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.
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]
[10] [11] Side effects after long-term usage include eyesight damage, elevated blood sugar levels and adrenal gland disorders. [12] Topical hydrocortisone is available in several dosage forms such as solution, lotion, cream, ointment and spray. [19] Some brand names for topical hydrocortisone include Anusol HC, Cortizone 10, and Synacort. [19]
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.
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.
Steroid-induced rosacea is an iatrogenic condition (induced by the physician or patient) from the use of either systemic steroid or topical steroids. It is nearly identical to steroid induced acne from the standpoint of etiology. [1] Topical Steroid induced rosacea (left); after steroid withdrawal and photobiomodulation therapy (right).
In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. [1] The area of skin involved can vary from small to covering the entire body. [1] [2] Dermatitis is also called eczema but the same term is often used for the most common type of skin inflammation, atopic dermatitis. [7]
In a healthy body, blood cortisone and cortisol levels are roughly equimolar. [7] Cortisone reductase deficiency leads to an elevated level of inert cortisone to active cortisol in adipose tissue. Cortisone reductase deficiency is caused by dysregulation of the 11β-hydroxysteroid dehydrogenase type 1 enzyme, otherwise known as cortisone reductase.