The hidden burden of topical corticosteroid misuse: a systematic review of dermatologic complications

Topical corticosteroids are widely prescribed for their anti-inflammatory, immunosuppressive, and antiproliferative effects in conditions such as atopic and contact dermatitis. However, their rapid symptomatic relief has contributed to misuse, particularly for cosmetic purposes, leading to multiple adverse effects. This study aimed to evaluate complications associated with topical corticosteroid misuse and the contributing factors.

Following PRISMA guidelines, a systematic search of PubMed, Scopus, and Web of Science was conducted to identify studies published between January 2016 and January 2026. Eligible studies reported primary data on topical corticosteroid misuse and associated factors. Extracted data included study characteristics, patterns of misuse, complications, prevalence of misuse-related adverse effects, and associated factors. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklist.

Twenty-three studies involving 8,619 participants were included. Misuse was commonly reported for cosmetic indications, including skin lightening, melasma, acne, and skin fairness. Betamethasone, mometasone, and clobetasol were the most frequently misused agents. Most participants experienced at least one adverse effect, including acneiform eruptions, pigmentation disorders, erythema, and worsening dermatophytosis. Factors associated with misuse included female gender, younger age, poor health-seeking behavior, and over-the-counter availability.

Topical corticosteroid misuse is an important public health concern, particularly where potent products are readily available without prescription. Reducing misuse requires prescription-based access to potent topical corticosteroids, pharmacist counselling at dispensing, clinician education on appropriate potency and duration, and targeted public education on cosmetic misuse and potential adverse effects.