the Risks: Steroid Side Effects in Dermatology Treatments

Steroid Side Effects Consultation

Hello Dr.
Wu, about three years ago, I developed a dark scar on the skin of the joints of both my thumbs.
It is not painful or itchy, but it affects my appearance and looks quite unsightly.
I have consulted several doctors, and they all diagnosed it as lichenification due to friction dermatitis.
Most of the doctors prescribed a transparent, oily corticosteroid ointment for me to apply, but the results were not satisfactory.
This year, I met a physician who injected a corticosteroid into the affected area, and the results were more noticeable.
After two injections, it disappeared, but it started to recur again in about two months.
I then consulted another doctor who injected another corticosteroid into the area.
Later, I learned that this type of injection is also a corticosteroid, which has made me somewhat concerned about potential side effects.

Doctor, I would like to ask you: Given that I have been using potent corticosteroid ointments on and off for the past two to three years (some doctors said that only strong ones would be effective, but I often forget to apply them after one to two weeks of little effect, and since the affected area is small, I rarely finish an entire tube), along with having received three corticosteroid injections in the affected area over the past six months, and recently having taken oral corticosteroids for a severe allergic cough after visiting the doctor twice, do you think the frequency and dosage of my corticosteroid use could lead to more serious or irreversible side effects? I have even read articles about corticosteroids inducing psychiatric disorders, which has made me quite worried.
Could you please provide me with some clarification? Thank you!

Mr. E, 20~29 year old female. Ask Date: 2021/10/19

Dr. Wu Yuxin reply Dermatology

No, injecting corticosteroids into the affected area is a common treatment method used in dermatology.
The dosage is very low, so there are no side effects on other organs in the body.

Reply Date: 2021/10/19

More Info

The use of topical steroids, such as Mometasone Furoate, is common in dermatology for treating various skin conditions, including eczema, psoriasis, and dermatitis. While these medications can be effective in reducing inflammation and alleviating symptoms, it is essential to understand their potential side effects, especially with prolonged use or high-frequency applications.

Topical steroids work by suppressing the immune response in the skin, which can help reduce redness, swelling, and itching. However, their use can lead to several side effects, particularly when used over extended periods or on sensitive areas of the skin. Some common side effects include:
1. Skin Thinning (Atrophy): Prolonged use of topical steroids can lead to thinning of the skin, making it more susceptible to bruising, tearing, and other injuries. This is particularly concerning in areas where the skin is already thin, such as the face or groin.

2. Tachyphylaxis: This refers to the phenomenon where the skin becomes less responsive to the medication over time, requiring higher doses or more potent steroids to achieve the same effect. This can lead to a cycle of increasing steroid use, which can exacerbate side effects.

3. Striae (Stretch Marks): The use of potent steroids can lead to the development of stretch marks, especially in areas where the skin is stretched or under tension.

4. Perioral Dermatitis: This is a condition that can occur with the use of topical steroids, particularly around the mouth and nose, leading to a rash that can be difficult to treat.

5. Systemic Absorption: Although rare, especially with topical formulations, there is a risk of systemic absorption of steroids, particularly when used on large areas of the body or under occlusive dressings. This can lead to side effects such as adrenal suppression, Cushing's syndrome, and other systemic effects.

6. Psychological Effects: While topical steroids are less likely to cause psychological side effects compared to systemic steroids, there have been reports of mood changes and anxiety in some individuals. However, these cases are relatively uncommon and often associated with higher doses or prolonged systemic steroid use.

Given your history of using topical steroids and receiving steroid injections, it is understandable to be concerned about the potential for serious side effects. The frequency and dosage of steroid use can indeed increase the risk of adverse effects, particularly if not monitored closely by a healthcare professional.

To mitigate these risks, consider the following recommendations:
- Regular Monitoring: It is crucial to have regular follow-ups with your dermatologist to monitor the condition of your skin and assess the effectiveness of the treatment. They can help determine if a different treatment approach is necessary.

- Alternating Treatments: If topical steroids are not providing the desired results, your doctor may suggest alternative treatments, such as calcineurin inhibitors (e.g., Tacrolimus or Pimecrolimus), which can be effective for conditions like eczema without the same risk of skin thinning.

- Moisturizers: Regular use of moisturizers can help maintain skin hydration and barrier function, potentially reducing the need for steroids.

- Educate Yourself: Understanding the potential side effects of any medication can help you make informed decisions about your treatment. If you have concerns about specific side effects, discuss them with your doctor.

- Mental Health Support: If you are experiencing anxiety or mood changes, consider speaking with a mental health professional who can provide support and coping strategies.

In conclusion, while topical steroids can be effective for managing skin conditions, their use should be carefully monitored to minimize the risk of side effects. If you have concerns about your treatment regimen or the potential for adverse effects, it is essential to communicate openly with your healthcare provider. They can help tailor a treatment plan that balances efficacy with safety, ensuring the best possible outcome for your skin health.

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