Back issues No.1 - 1986 / Original Study  

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Side Effects of Topical Corticosteroids Therapy - I: Clinical Observation
Hamm-Ming Sheu, Hsin-Su Yu
Dermatol Sinica 4: 7-18, 1986

We investigated 113 patients suffering from adverse effects of topical corticosteroids therapy. The results were as follows: (1) More than 80% of side effects were produced by potent or very potent steroids. Although topical 1% hydrocortisone has a relatively good safety record, 3 patients developed perioral dermatitis after 3, 10 and 18 months use of the weakest preparation.(2) The faces of women and the inguinal areas of men were particularly at risk of developing side effects from topical steroids.(3) The most common side effects included rosacea-like dermatitis (24.8%), skin atrophy (22.1%), erythema (21.2%), telangiectasia (21.2%), acneform eruption (20.3%), atrophic striae (10.6%), perioral dermatitis (7.1%), hypopigmentation (7.1%), folliculitis (7.1%) and purpura (3.5%).(4) The relationships between duration of topical corticosteroids application and the appearance of side effects were as follows: a 1-2 weeks application of potent steroids on the face may produce acneform eruption, followed by erythema, telan-giectasia, and skin atrophy; when continuing application for 2-6 months, rosacealike dermatitis, perioral dermatitis, folliculitis and hypopigmentation increased in numbers; usually when atrophic striae and purpura occurred, they appeared last.(5).Cushing's syndrome occurred in two psoriatic patients. One patient had been applying 0.25% desoximetasone or 0.064% betamethasone dipropionate 40-60 g each week during the past 3 years; the other patient was using 0.05% clobetasol 17-propionate ointment 80-90 g each week by simple application for 6 weeks. We would like to emphasize that more attention should be paid to the likelihood of patients' systemic side effects both when they have long term use of small quantities of potent topical steroids (40 g/week) and short term use of large quantities (80 g or more/week) of potent steroids.

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