Side Effects of Topical Steroids

What You Need to Know

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While topical steroids have tremendous benefit in reducing inflammation, they also have significant side effects. Many of the following side effects are seen with long-term use, but some may occur within days of beginning therapy. Here is an overview of some of the most common side effects of topical steroid use.


Tachyphylaxis is the rapid decrease in response to a topical steroid following initial therapy.

It refers to the tolerance the skin develops to the vasoconstrictive action of topical steroids. After repeated use of topical steroids, the capillaries in the skin do not constrict as well, requiring higher doses or more frequent application of the steroid.

With high-potency steroids this effect has been documented after 4 days of applying a topical steroid three times a day. Blood vessels are able to constrict properly 4 days after stopping therapy.

Steroid Rosacea

This is a side effect commonly observed in fair-skinned people who already have rosacea. A typical example of steroid rosacea occurs when a person applies a very mild steroid to the face to counteract the facial flushing. The steroid produces pleasing results at first, but a tolerance develops, causing the person to switch to a more potent steroid. At this point any attempt to use a lower strength steroid cut back on steroid application or stop application altogether can cause intense facial redness and pustules.

Skin Atrophy

Repeated use of topical steroids in the same area can cause thinning of the epidermis and changes in the connective tissue of the dermis. The skin atrophies, becoming lax, wrinkled and shiny. Affected areas can be depressed below the level of normal skin with visible telangiectasias, hypopigmentation and prominence of underlying veins.

In most cases, atrophy is reversible once topical steroid use is stopped, but it may take months for the skin to “thicken” back up and return to normal.

Stretch Marks

Repeated use of topical steroids in areas where skin touches skin, such as the groin and armpits, can result in striae, or stretch marks. Stretch marks from topical steroids are permanent and irreversible. These stretch marks can be very itchy and may require a lower strength steroid to relieve the itching. It is recommended to progressively decrease the steroid strength until topical steroids therapy in these areas can be terminated.

Alteration of Infection

Because topical steroids change the way the immune system functions, they can inhibit the skin’s ability to fight off bacterial and fungal infections. A typical example of this is seen when someone applies a topical steroid to an itchy groin rash. If this is a fungal infection, the rash gets redder, itchier and spreads more extensively than a typical fungal infection would.

The resulting rash is a bizarre pattern of widespread inflammation with pustules called tinea incognito.

Topical Steroid Allergy

Some people are allergic to a component of the topical steroid base, or vehicle. Patch-testing of a group of patients with dermatitis revealed that 4 to 5 percent were allergic to topical steroids. People who have chronic skin conditions and use multiple prescriptions ​or over-the-counter topical steroids are at higher risk of developing allergies to topical steroids.


Glaucoma is a disease in which the pressure inside the eye increases to the point of damaging the optic nerve. There are isolated reports of people developing glaucoma after long-term use of topical steroids around the eyes. How topical steroids applied around the eyes cause glaucoma is not completely understood, but it is believed that enough of the steroid can be absorbed and get into the eye.

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