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Hydrocortisone creams and other topical steroids represented a medical break throughout almost 60 years ago as patients suffering from chronic auto-immune conditions could now have a way to find long-term relief and in some cases, maybe even complete remission of their symptoms. The applications of this medication can range from topical creams to deal with rashes or other dermal flare-ups or can be given orally for a more systemic treatment option for conditions like rheumatoid arthritis. 

These medications are effective because these corticosteroids suppress the immune system and help down-regulate the body essentially attacking itself. Unfortunately, even if the applications are wide-spread, side effects from these medications are also very likely, so physicians have to be smart when it comes to treatment regiments to make sure that a patient does not take these medications on a long-term basis [1]. 

On the surface, topical steroid creams represent a much more friendly type of medication than systemic treatments. The side effects of topical steroid creams are milder, while systemic medications can lead to rapid weight gain, kidney failure, changes in hormone levels and can even predispose patients to earlier occurrences of osteoporosis after only a few months of treatment. Although topical steroids are much less detrimental, you should not underestimate their potential to wreak havoc on your body. 

When it comes to describing the side effects possible with topical steroid usage, the best way to do it is breaking them into the two categories that physicians often need to worry about: 

  • local side effects, 
  • and systemic side effects. 

Risks that patients need to be aware of when they are prescribed topical corticosteroids are numerous. Some of the most likely adverse reactions that you will see are skin atrophy (dead skin), striae, rosacea, perioral dermatitis, acne, and purpura. Hypertrichosis, pigment alteration, delayed wound healing and exacerbation of skin infections are less frequent.

These issues arise because steroids are substances that reduce the immune response. Our skin is a layer of protection for outside infections and makes up one of the biggest components of the innate immune system. When you apply a topical cream to the tissue, immune responses will be lessened and allow opportunistic infections a chance to become problematic. 

Patients can notice these side effects in as short as 3 days and one of the first signs to appear will be skin atrophy. As you continue to apply topical steroids to your skin, the skin will naturally thin as the metabolic activity of the cell is muted. If usage is not discontinued, the tissue will eventually lose some of the blood supply and will become very fragile. 

Not only are patients at rest for short-term complications, long-term risks are also very noteworthy when you are taking topical steroids. These same side effects are possible when patients take oral dosages of the medication even if they are just applied to just the skin. When patients chronically utilize steroids, they run the risk of down-regulating hormone production in their bodies and cause Cushing's disease, which This is a condition where the body produces excessive sugars and salts and can lead to rapid weight gain. Other common side effects are osteoporosis, difficulty losing weight and a predisposition to diabetes mellitus. 

Because of these dangerous side effects, doctors recommend that patients only take steroids for as short a time as necessary in order to alleviate the symptoms and reduce the severity of the side effects that go in tandem with this disease. [2]

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