Glucocorticoids are the first line of treatment for various skin disorders such as atopic dermatitis, vitiligo, psoriasis etc (32-37). They are quite effective when applied topically and nontoxic to the skin in the short term. The factors that determine local penetration are the structure of the compound employed, the vehicle, the basic additives, occlusion versus open use, normal skin versus diseased skin, and small areas versus large areas of application. Fluorinated steroids (eg, dexamethasone, triamcinolone acetonide, betamethasone, and beclomethasone) penetrate the skin better than nonfluorinated steroids, such as hydrocortisone. However, fluorinated steroids also produce more local complications and may be associated with systemic absorption and side effects (2, 10, 14).
The complications of chronic topical skin use of glucocorticoids are mostly local (eg, epidermal atrophy and hypopigmentation, telangiectasia, or acne and folliculitis) or infrequently systemic, with the classic manifestations of Cushing's syndrome, growth retardation in children, and adrenal suppression. The frequency of systemic effects by topical corticosteroids is increased in newborns and small children compared to adolescents and adults, because glucocorticoids penetrate the skin of newborns and small children more easily and in larger proportional amounts. Systemic effects may also be observed in patients with hepatic disease or idiosyncratically because of decreased drug metabolism. Although most types of dermatitis are generally responsive to topical glucocorticoids, there are rare cases in which intralesional injections might be considered (eg, hypertrophic scars, acne cysts, or prurigo nodularis) (10, 14).
Patients with autoimmune or idiopathic inflammation of the anterior segment of the eye (eg, iritis and uveitis) may benefit from local administration of glucocorticoids. Also, patients with postsurgical or traumatic inflammation are given topical glucocorticoids to prevent local destruction from edema. Special care should be taken to avoid treating patients with herpes simplex conjunctivitis or keratitis during the infectious stage of the disease, because major spread of the infection may be precipitated (10, 14).
Glucocorticoid inhalation therapy is broadly used in patients with bronchial asthma and Croup. The existing preparations at the recommended doses have a remarkable therapeutic effect without causing manifestations of Cushing's syndrome, growth retardation, or clinically significant adrenal suppression. Systemic effects may be observed, however, because of increased intake of such preparations or because of altered steroid metabolism (38-46). Inhaled glucocorticoids have also been used in ventilator-dependent preterm infants to reduce the severity of respiratory distress syndrome and to facilitate the weaning from mechanical ventilation of infants with bronchopulmonary dysplasia (47-48). Their influence on the function of the immature HPA axis of these preterm neonates remains unclear (49-50).
Aerosols containing glucocorticoids are available for the treatment of allergic rhinitis, and topical steroid drops are used for the treatment of sinus ostia stenosis in the postoperative period. Frequent and chronic use should be avoided to prevent local and systemic complications (51, 52).