Topical Corticosteroid Use in Everyday Clinical Practice: Cautionary Tales

Despite the development of advanced targeted topical treatments for chronic inflammatory skin diseases and recent calls for caution when prescribing topical corticosteroids (TCS), TCS continue to be the most prescribed dermatologic agent. Yet the perception that adverse effects are uncommon with TCS use persists. To combat this misperception, I selected examples of patients from my practice that illustrate the real-world risks associated with TCS use. This case series provides several key clinical pearls for managing TCS use in everyday clinical practice including: 1) Even using TCS for short periods and as prescribed is not without risks. 2) Long-term TCS use (even intermittent use) can result in permanent skin changes that can even outlast the disease the TCS was used to treat. 3) TCS overuse can have serious adverse effects resulting in hospitalization, including adrenal suppression, infection, and even sepsis. 4) Patients who are dissatisfied with older TCS-sparing treatments might continue to seek more potent TCS, resulting in doctor/clinic hopping and potential TCS misuse. 5) Patients might repurpose TCS prescriptions for other body areas, leading to high-potency TCS being applied to thin-skinned areas and irreversible skin damage.