One of the most common forms of dermatitis is eczema, which occurs more in children than adults. This skin condition presents as dry, itchy skin that leads to rashes due to itching, rubbing and irritation. When the person continues to itch and rub their skin, the skin will thicken causing lichenification. Genetic, environmental and lifestyle factors play a role in this condition. A common gene mutation observed in atopic dermatitis is Filaggrin, which is responsible for making the skin’s outer layer by forming corneocytes. People with eczema have a dysfunctional and unorganized skin barrier which causes dry skin since there is water and moisture loss. In addition, they have a decreased number of beta-defensins, which are host defense peptides so they are more prone to infections. The damaged skin provides less protections against irritants, allergens, viruses and bacterias. They are more prone to Staphylococcus aureus infections which can make eczema worse and need to be treated with antibiotics. Eczema herpeticum, a medical emergency, can also occur caused by the ****** simplex virus-1. Treatment and management of eczema are skin hydration and topical anti-inflammatory medications. Moisturizing products such as emollients and ointments are used to hydrate the skin and keep it from drying out. Steroid creams or topical pimecrolimus and tacrolimus can be used to treat flare-ups. Topical steroids shouldn’t be used daily because there are numerous long term side effects including atrophy, telangiectasia and rebound dermatitis. Oral antihistamines can be taken at bedtime to help with disturbed sleep caused by itching. It is essential to educate patients on eliminating and avoiding triggers and allergens that might cause flare-ups.
References
Nemeth V, Evans J. Eczema. [Updated 2020 Mar 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538209/
InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Eczema: Overview. 2013 Sep 26 [Updated 2017 Feb 23].Available from: https://www.ncbi.nlm.nih.gov/books/NBK279399/
Corticosteroids, both topical and systemic, are commonly used in dermatologic and non-dermatologic conditions due to their potent anti-inflammatory and immunosuppressive effects. However, prolonged or inappropriate use can lead to a variety of cutaneous adverse effects, some of which may be irreversible or significantly impact a patient's quality of life. Pharmacists play a key role in ensuring appropriate use, educating patients on application techniques, monitoring for side effects, and preventing misuse.
Topical corticosteroids are categorized into potency classes ranging from class I (superpotent) to class VII (least potent). Dermatologic adverse effects are often related to the potency, duration of therapy, site of application, and occlusion. The most commonly observed reactions include skin atrophy, striae (stretch marks), telangiectasia, hypopigmentation, and perioral dermatitis. Skin thinning is particularly concerning when steroids are applied to areas with thinner dermis (e.g., face, groin, intertriginous zones), especially in children or elderly patients. Overuse or long-term use may also predispose patients to secondary skin infections, including tinea and folliculitis.
Systemic corticosteroids (e.g., prednisone) may lead to dermatologic manifestations as part of broader endocrine and metabolic effects. These include acneiform eruptions, delayed wound healing, easy bruising, and purpura due to dermal collagen degradation. In patients on long-term therapy, skin fragility becomes more pronounced, increasing the risk of mechanical trauma even from minor friction. These effects are typically dose-dependent and more common with prolonged use.
Pharmacists are essential in guiding appropriate steroid selection, especially when choosing the correct potency, vehicle, and duration of topical therapy. Patient counseling should emphasize applying thin layers, avoiding high-potency agents on the face, and limiting duration unless otherwise directed. Systemic corticosteroid use should prompt discussions about risk-benefit, tapering protocols, and monitoring for both dermatologic and systemic side effects. Inhaled and intranasal corticosteroids may also lead to localized effects such as mucosal thinning or perioral dermatitis if not used correctly.
Inappropriate corticosteroid use remains a common issue, particularly with over-the-counter topical formulations or leftover prescriptions, leading to misapplication and complications. Pharmacists can help prevent misuse by providing clear instructions, recommending steroid-sparing alternatives when possible, and ensuring follow-up for high-risk patients.
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Oakley AM. Topical corticosteroid-induced side effects. In: DermNet NZ. Updated 2021. Accessed April 2025. https://dermnetnz.org/topics/topical-steroid
Callen JP. Systemic corticosteroids: adverse effects. In: Kang S, Amagai M, Bruckner AL, et al, eds. Fitzpatrick’s Dermatology. 9th ed. McGraw Hill; 2019.
Feldman SR, Strowd LC. Therapy for atopic dermatitis: corticosteroids. UpToDate. Updated 2024. Accessed April 2025. https://www.uptodate.com