What are the potential side effects of topical corticosteroids used in the management of discoid lupus erythematosus?

The potential side effects of topical corticosteroids, which are used in the management of discoid lupus erythematosus (Jessop et al., 2009; Jessop et al., 2017), include irreversible skin atrophy and striae ³. Continuous use of potent or very potent corticosteroids can also lead to the treated condition becoming unstable ³. Systemic side effects may occur when these medications are applied continuously to extensive areas, defined as more than 10% of the body surface area ³.

Local adverse effects include skin irritation, particularly when applied to the face, flexures, or genital areas, where there is a greater risk of skin atrophy ¹. Children and older people are more susceptible to adverse effects due to their thinner epidermis, and older individuals also have decreased dermal collagen ². Topical corticosteroids can worsen infections such as impetigo, herpes simplex, or tinea corporis ². Hypersensitivity reactions are also a potential side effect ².

To minimise the risk of adverse effects, topical corticosteroids should be used appropriately ². This includes stopping the topical corticosteroid once the skin is clear or nearly clear ¹. Potent or very potent topical corticosteroids should not be prescribed to the face, flexures, or genital areas ¹. Very potent corticosteroids should not be used continuously at any site for longer than 4 weeks, and potent corticosteroids for no longer than 8 weeks ³. A break of 4 weeks between courses of potent or very potent corticosteroids is recommended ³. Children and young people should not use very potent corticosteroids ³. More frequent monitoring is required for people using topical corticosteroids in intertriginous areas, on the face and neck, or under occlusion, as adverse effects are more likely due to increased systemic absorption ². For children aged 12 months or over, potent topical corticosteroids should be used for as short a time as possible, not exceeding 14 days, and not on the face or neck ⁴. Potent topical corticosteroids should not be used in children under 12 months without specialist dermatological supervision ⁴.