Topical Corticosteroid Use in Everyday Clinical Practice: Cautionary Tales.

Area of Science:

• Dermatology
• Pharmacology

Background:

• Topical corticosteroids (TCS) are frequently prescribed for chronic inflammatory skin diseases.
• Despite advancements in targeted therapies, TCS remain the most common dermatologic treatment.
• A persistent misconception exists regarding the rarity of adverse effects associated with TCS use.

Observation:

• This case series presents real-world patient examples demonstrating the risks of TCS.
• Even short-term and prescribed TCS use carries inherent risks.
• Long-term or intermittent TCS application can lead to permanent skin alterations, potentially outlasting the initial condition.

Findings:

• Overuse of TCS can result in severe adverse events, necessitating hospitalization, such as adrenal suppression, infections, and sepsis.
• Patient dissatisfaction with alternative treatments may drive a search for more potent TCS, leading to misuse and 'doctor hopping'.
• Repurposing TCS prescriptions for different body areas, especially sensitive skin, can cause irreversible damage.

Implications:

• Clinicians must be vigilant about the potential harms of TCS, even when used as directed.
• Patient education is crucial to prevent misuse and manage expectations regarding TCS efficacy and safety.
• A balanced approach is needed, considering TCS risks alongside benefits for chronic inflammatory skin conditions.