Allergic sensitivity to a topical corticosteroid is usually only picked up when an eczematous dermatitis being treated by a topical corticosteroid fails to respond to treatment or worsens. In cases of persistent or exacerbating dermatitis treated with corticosteroid preparations, corticosteroid sensitivity should be considered. However, it may also be due to irritation from or allergy to other components of the preparation such as preservatives . Lanolin , ethylenediamine , quaternium-15 and the antibacterial agent neomycin , are all known to be potent sensitisers.
The most significant risk associated with administration of glucocorticoids is suppression of natural corticosteroid secretion. When the hormones are administered, they suppress the secretion of ACTH, which in turn reduces the secretion of the natural hormones. The extent of suppression varies with dose, drug potency, duration of treatment, and individual patient response. While suppression is seen primarily with drugs administered systemically, it can also occur with topical drugs such as creams and ointments, or drugs administered by inhalation. Abrupt cessation of corticosteroids may result in acute adrenal crisis (Addisonian crisis) which is marked by dehydration with severe vomiting and diarrhea, hypotension, and loss of consciousness. Acute adrenal crisis is potentially fatal.
Topical corticosteroids are available in a wide range of different strengths, from Class 1 (very strong) to Class 7 (very weak). Stronger corticosteroids are generally more effective in reducing moderate to severe symptoms, such as thick, chronic plaques, but are also more likely to cause side effects 2 . Lower strength corticosteroids are generally better for milder symptoms and for very sensitive areas of the body (such as the face or groin areas) and stronger strengths are better for areas with thicker skin (such as the knees and elbows).