The potential side effects of topical corticosteroids, which are used in the management of discoid lupus erythematosus Jessop et al. 2009Jessop et al. 2017, include irreversible skin atrophy and striae NICE CG153. Continuous use of potent or very potent corticosteroids can also lead to the treated condition becoming unstable NICE CG153. Systemic side effects may occur when these medications are applied continuously to extensive areas, defined as more than 10% of the body surface area NICE CG153.
Local adverse effects include skin irritation, particularly when applied to the face, flexures, or genital areas, where there is a greater risk of skin atrophy NICE CKS. Children and older people are more susceptible to adverse effects due to their thinner epidermis, and older individuals also have decreased dermal collagen NICE CKS. Topical corticosteroids can worsen infections such as impetigo, herpes simplex, or tinea corporis NICE CKS. Hypersensitivity reactions are also a potential side effect NICE CKS.
To minimise the risk of adverse effects, topical corticosteroids should be used appropriately NICE CKS. This includes stopping the topical corticosteroid once the skin is clear or nearly clear NICE CKS. Potent or very potent topical corticosteroids should not be prescribed to the face, flexures, or genital areas NICE CKS. Very potent corticosteroids should not be used continuously at any site for longer than 4 weeks, and potent corticosteroids for no longer than 8 weeks NICE CG153. A break of 4 weeks between courses of potent or very potent corticosteroids is recommended NICE CG153. Children and young people should not use very potent corticosteroids NICE CG153. More frequent monitoring is required for people using topical corticosteroids in intertriginous areas, on the face and neck, or under occlusion, as adverse effects are more likely due to increased systemic absorption NICE CKS. For children aged 12 months or over, potent topical corticosteroids should be used for as short a time as possible, not exceeding 14 days, and not on the face or neck NICE CG57. Potent topical corticosteroids should not be used in children under 12 months without specialist dermatological supervision NICE CG57.
Key References
- CKS - Psoriasis
- CKS - Corticosteroids - topical (skin), nose, and eyes
- CG153 - Psoriasis: assessment and management
- CG57 - Atopic eczema in under 12s: diagnosis and management
- (Wollina and Hansel, 2008): The use of topical calcineurin inhibitors in lupus erythematosus: an overview.
- (Jessop et al., 2009): Drugs for discoid lupus erythematosus.
- (Jessop et al., 2017): Drugs for discoid lupus erythematosus.