Steroid Side Effects — SCE Dermatology MCQ

Correct answer: D — Striae from topical corticosteroids are usually irreversible and permanent

The correct answer is D: striae from topical corticosteroids are usually irreversible and permanent. Potent steroids such as betamethasone valerate 0.1%, especially under occlusion, suppress dermal fibroblast activity and inhibit collagen and elastin synthesis; once the dermal architecture ruptures and scars, no amount of stopping the drug restores normal fibre alignment. UK primary care guidance explicitly lists this among the recognised adverse effects of topical corticosteroids, describing it as an irreversible change rather than a transient one. Clinically the lesions evolve from erythematous/purple (striae rubrae) to pale atrophic bands (striae albae) but the dermal thinning and disorganised collagen persist indefinitely, which is why prevention (lowest effective potency, limited duration, avoiding occlusion on flexural/thin skin) is emphasised over any expectation of cure. Why the other options are wrong: A. Fully reversible after stopping the steroid: stopping the drug halts further progression but does not repair the already-scarred dermal collagen and elastic fibres, so established striae remain. C. Applying a more potent steroid will heal them: a stronger corticosteroid would worsen dermal atrophy and collagen breakdown, increasing the risk of further striae rather than reversing existing ones. E. Only reversible with laser treatment: laser and other cosmetic modalities (e.g. pulsed dye laser, microneedling) can improve the appearance and colour of striae but do not restore normal dermal structure, so they do not truly reverse them. B. They will completely resolve within 6 months: striae rubrae may fade in colour over months to years as vascularity decreases, but the depressed, atrophic texture persists long term and does not fully resolve. Key point: Topical corticosteroid-induced striae reflect permanent dermal collagen and elastin damage, so they are irreversible regardless of stopping the drug or subsequent treatment, making prevention through appropriate potency and duration essential.

Reference: UK Topical Corticosteroid Treatment Factsheet (Primary Care Dermatology/APC guidance), 'thinning of the skin, irreversible striae atrophicae...' https://surrey.res.services/PAD/Content/Documents/2/PAD/Topical%20corticosteroid%20treatment%20factsheet%20Oct%2025(2).pdf