Side Effects of Topical Corticosteroids and their Prevention
The goal of topical corticosteroid therapy is to maximise the clinical benefits of this highly effective group of drugs, while minimising their adverse effects. Many types of steroid-induced skin lesions and skin atrophy can occur by such mechanisms as the suppression of cell proliferation, immunosuppression, or hormonal activity, and a trend towards an increased incidence of steroid-induced dermatological disturbances has been observed in recent years. Systemic effects have also been documented.
To reduce the risk of local and systemic effects, it is necessary to consider factors such as the intrinsic potency of a drug, type of vehicle used and frequency of application. A potent drug may be changed to a less potent one, or the dosage reduced. Once-daily application is often as effective as three-times-daily application, and intermittent application can also be recommended.
The concept of an ‘ante-drug’ promises new developments in topical corticosteroid therapy. An ‘ante-drug’, e.g. difluprednate, has potent efficacy but fewer side effects than conventional therapy, since it acts at the application site and then is metabolised to less active or inactive compounds before reaching the systemic circulation. It is likely that future corticosteroids will have the attributes of an ante-drug, thus greatly reducing the risk of systemic effects. At present, however, it is still necessary to recognise the influence of various drug and patient factors that contribute to side effects, in order to balance clinical efficacy with an acceptable side effect profile.
KeywordsTopical Corticosteroid Beclomethasone Dipropionate Skin Atrophy Clobetasol Propionate Betamethasone Valerate
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- Frosch PJ, Wendt H, Kligman AM. The Duhring chamber test for assaying corticosteroid atrophy in humans, p. 185, Academic Press Inc., London, 1981Google Scholar
- Fujino A, Ohta S, Shinozawa N, Mukouyama H, Yanagida Y, el al. Studies on the metabolic fate of difluprednate (DFBA) (2): absorption, distribution and excretion after dermal application to rats and rabbits. Oyo Yakuri 29: 701–712, 1985Google Scholar
- Fujino A, Ohta S, Shibata K, Ichihara N, Gotoh A, et al. Studies on the metabolic fate of difluprednate (DFBA) (3): metabolism in rats and rabbits after subcutaneous administration. Oyo Yakuri 29: 713–723, 1985Google Scholar
- Takeda K. Cautions upon continued and prolonged use of the drug — topical corticosteroids. Clinical Drug Intelligence 2: 92–98, 1983Google Scholar
- Takeda K. Various topical steroids and their evaluation of clinical effects. Rinsho Derma (Tokyo) 26: 631–647, 1984Google Scholar
- Takeda K. Methaderm® symposium, Tokyo, 3rd April, 1987. Excerpta Medica Conference Bulletins, Excerpta Medica, 1987Google Scholar
- Takeda K, Harada T, Asato T, Ishimoto A, Nomoto M. Review on systemic effects of topical corticosteroids — with special reference to adrenocortical suppression following percutaneous absorption. Journal of Clinical and Experimental Medicine 101: 817–829, 1977Google Scholar
- Takeda K, Arase S, Nagai R. Usefulness of topical steroids and their application — with special reference to new topical steroids. Progress Medical 6: 3007–3014, 1986Google Scholar
- Takeda K, Arase S, Nagai R. How to use topical steroids. Japan Medical Journal 3313: 3–10, 1987aGoogle Scholar
- Takeda K, Kukita A, Asada Y, Shimao S, Watanabe Y, et al. Studies on clinical efficacy and percutaneous systemic and/or topical effects of a new synthetic corticoid. Abstract, part II. 17th World Congress of Dermatology, p. 325, 1987bGoogle Scholar
- Van der Harst LCA, de Jonge H, Pot F, Polano MK. Comparison of two application schedules for clobetasol 17 propionate. Acta Dermato-Venereologica 62: 270–273, 1982Google Scholar
- von Hinz E, Lubach D. Untersuchungen über Entstehung und Rückbildung der dermalen Kortikosteroid-Atrophie. Dermatosen 34: 174–178, 1986Google Scholar
- Watanabe Y, Ohkawara A, Toda K, Sakuma M, Mizuno J, et al. A double blind clinical comparative study with hydrocortisone 17-butyrate 21-propionate (HBP). Skin Research 23: 828–844, 1981Google Scholar