Topical corticosteroids

Abstract

Since Marion Sulzberger introduced glucocorticosteroids (GCSs) in 1951, they have revolutionized clinical medicine. This chapter provides an updated overview of their mode of action, their use in dermatology, and their adverse-effect profile. While systemic GCSs have a long list of indications, topical corticosteroids represent the mainstay for treating inflammatory diseases of the skin. Adverse effects depend on the dose, the duration of treatment, and the preexisting medical conditions. For topical application, the nature of the drug, the vehicle, and the site of application determine the side-effect profile. The most frequent cutaneous adverse effects include atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. With lower frequency, hypertrichosis, pigmentation changes, delayed wound healing, and skin infections as well as contact sensitization are observed. Important systemic adverse effects include musculoskeletal, ophthalmologic, nervous system, metabolic, and cardiovascular manifestations. The main characteristics of GCSs are potent anti-inflammatory, antiproliferative, and immunosuppressive effects, which give them a long list of potential indications in medicine. In particular, GCSs are extremely effective in the treatment of many autoimmune and inflammatory diseases.