Long-Term Use of Steroid Ointment for Keloids: Risks and Recommendations - Dermatology

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Long-term use of steroid ointments, particularly for conditions like keloids or hypertrophic scars, can be a complex issue that requires careful consideration of both benefits and risks. In your case, you have been prescribed "Ketrac" (also known as clobetasol propionate), which is a potent topical corticosteroid. While it can be effective in reducing inflammation and promoting healing in keloids, there are important factors to consider regarding its long-term use.


Risks of Long-Term Use of Steroid Ointments
1. Skin Atrophy: One of the most common side effects of prolonged use of topical steroids is skin thinning (atrophy). This can lead to increased fragility of the skin, making it more susceptible to bruising and tearing.

2. Tachyphylaxis: Over time, the skin can become less responsive to the steroid, a phenomenon known as tachyphylaxis. This means that the same dose may become less effective, leading to the temptation to increase the frequency or amount used, which can exacerbate side effects.

3. Striae (Stretch Marks): Long-term use of potent steroids can lead to the development of stretch marks, particularly in areas where the skin is thinner or more prone to stretching.

4. Perioral Dermatitis: This is a condition characterized by a rash around the mouth, which can occur with the use of topical steroids, especially if used on the face.

5. Systemic Absorption: Although rare, especially with topical applications, there is a potential for systemic absorption of steroids, particularly if used over large areas of the body or under occlusive dressings. This can lead to side effects associated with systemic steroid use, such as adrenal suppression.

6. Increased Risk of Infections: Steroids can suppress the local immune response, potentially increasing the risk of skin infections.


Recommendations for Use
1. Follow Doctor's Advice: It’s crucial to adhere to your dermatologist's recommendations regarding the duration and frequency of use. If your doctor has advised you to continue using the ointment until it is finished, ensure you have a follow-up appointment to reassess the situation.

2. Monitor for Side Effects: Keep an eye on your skin for any signs of adverse effects, such as thinning, discoloration, or unusual changes. If you notice any concerning symptoms, report them to your doctor immediately.

3. Consider Intermittent Use: If long-term use is necessary, some dermatologists recommend using the steroid ointment intermittently (e.g., applying it for a few days each week) rather than continuously. This approach can help mitigate some of the risks associated with prolonged use.

4. Alternative Treatments: Discuss with your dermatologist the possibility of combining treatments. For example, silicone gel sheets or other non-steroidal topical treatments can be effective for keloids and may reduce the need for long-term steroid use.

5. Regular Follow-Up: Schedule regular follow-ups with your dermatologist to evaluate the effectiveness of the treatment and make any necessary adjustments. This will also allow for early detection of any potential side effects.

6. Educate Yourself: Understanding your condition and the treatments available can empower you to make informed decisions about your care. Don’t hesitate to ask your doctor questions about the risks and benefits of any treatment.

In conclusion, while steroid ointments can be effective for treating keloids, their long-term use comes with risks that should not be overlooked. It’s essential to maintain open communication with your healthcare provider and to monitor your skin's response to treatment closely. Always prioritize safety and efficacy in your treatment plan.