The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.
If a steroid cream is purchased over the counter, the package should disclose the steroid used, and the strength, such as one percent hydrocortisone cream. Generally, the cream should not be used for more than a week, unless a doctor has specifically recommended an over the counter product for extended use. If the condition does not respond or grows worse, the over the counter cream should be discontinued, and an appointment should be made with a dermatologist , who can examine the site and prescribe a different medication or course of treatment.