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Topical Corticosteroids

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Clinical and Basic Immunodermatology

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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.

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Authors and Affiliations

  1. Department of Dermatology, University of Dusseldorf School of Medicine, Immermannstr 10, Dusseldorf, 40210, Germany

    Ulrich R. Hengge MD

Authors
  1. Ulrich R. Hengge MD
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Correspondence to Ulrich R. Hengge MD .

Editor information

Editors and Affiliations

  1. School of Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA

    Anthony A. Gaspari

  2. Department of Dermatology, University of Texas Health Science Center, Houston, Texas, USA

    Stephen K. Tyring

  3. Department of Dermatology and Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

    Daniel H. Kaplan

Questions

Questions

  1. 1.

    Which of the following drugs inhibit the hepatic cytochrome P-450 system, requiring dose-lowering adjustments in glucocorticosteroids?

    1. (a)

      Rifampin

    2. (b)

      Ketoconazole*

    3. (c)

      Phenytoin

    4. (d)

      Phenobarbital

  2. 2.

    Which of the following modifications of glucocorticosteroids enhances the potency by improving activity within the target cell and decreasing breakdown into inactive metabolites?

    1. (a)

      Removing the 17-dihydroxyacetone side chain

    2. (b)

      Removing the 16-alpha hydroxyl group

    3. (c)

      Halogenation at the 9-alpha position*

    4. (d)

      Halogenation at the 16-alpha position

  3. 3.

    Glucocorticosteroids can induce acneiform eruptions by which mechanism?

    1. (a)

      Increased growth of P. acnes

    2. (b)

      Degradation of the follicular epithelium*

    3. (c)

      Inhibition of collagen synthesis

    4. (d)

      Inhibition of elastin synthesis

Answers

  1. 1.

    b

  2. 2.

    c

  3. 3.

    b

* indicates the correct answers to the questions

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Hengge, U.R. (2017). Topical Corticosteroids. In: Gaspari, A., Tyring, S., Kaplan, D. (eds) Clinical and Basic Immunodermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-29785-9_48

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