Long-term use of topical steroids can lead to secondary infection with fungus or bacteria (see tinea incognito), skin atrophy, telangiectasia (prominent blood vessels), skin bruising and fragility.The use of the finger tip unit may be helpful in guiding how much topical steroid is required to cover different areas of the body. Adverse effects
Hypothalamic–pituitary–adrenal axis (HPA) suppression
Cushings syndrome
Diabetes mellitus
Osteoporosis
Topical steroid addiction
Allergic contact dermatitis (see steroid allergy)
Steroid atrophy
Perioral dermatitis: This is a rash that occurs around the mouth and the eye region that has been associated with topical steroids. Ocular effects: Topical steroid drops are frequently used after eye surgery but can also raise intraocular pressure (IOP) and increase the risk of glaucoma, cataract, retinopathy as well as systemic adverse effects. Tachyphylaxis: The acute development of tolerance to the action of a drug after repeated doses. Significant tachyphylaxis can occur by day 4 of therapy. Recovery usually occurs after 3 to 4 days rest. This has led to therapies such as 3 days on, 4 days off; or one week on therapy, and one week off therapy. Delivery-related adverse effects
Other local adverse effects: These include facial hypertrichosis, folliculitis, miliaria, genital ulcers, and granuloma gluteale infantum. Long-term use has resulted in Norwegian scabies, Kaposis sarcoma, and other unusual dermatosis. Safety in pregnancy
A 2015 meta-analysis of observational studies of pregnancies found no association between mothers use of topical steroids and type of delivery, APGAR score, birth defects, or prematurity. Classification systems
Seven-class System
The U.S. utilizes 7 classes, which are classified by their ability to constrict capillaries and cause skin blanching.
Class IV (UK/NZ: class I)
Very potent (up to 600 times as potent as hydrocortisone)

Clobetasol propionate (Dermovate Cream/Ointment, Exel Cream)
Betamethasone dipropionate (Diprosone OV Cream/Ointment, Diprovate Cream)

Class III (UK/NZ: class II)
Potent (50–100 times as potent as hydrocortisone)

Betamethasone valerate (Beta Cream/Ointment/Scalp Application, Betnovate Lotion/C Cream/C Ointment, Fucicort)
Betamethasone dipropionate (Diprosone Cream/Ointment, Diprovate Cream, Daivobet 50/500 Ointment)
Diflucortolone valerate (Nerisone C/Cream/Fatty Ointment/Ointment)
Hydrocortisone 17-butyrate (Locoid C/Cream/Crelo Topical Emulsion/Lipocream/Ointment/Scalp Lotion)
Mometasone furoate (Elocon Cream/Lotion/Ointment)
Methylprednisolone aceponate (Advantan Cream/Ointment)
Halometasone 0.05%

Class II (UK/NZ: class III)
Moderate (2–25 times as potent as hydrocortisone) 

Clobetasone butyrate (Eumovate Cream)
Triamcinolone acetonide (Aristocort Cream/Ointment, Viaderm KC Cream/Ointment, Kenacomb Ointment)

Class I (UK/NZ: class IV)
Mild

Hydrocortisone 0.5–2.5% (DermAid Cream/Soft Cream, DP Lotion-HC 1%, Skincalm, Lemnis Fatty Cream HC, Pimafucort Cream/Ointment)

Allergy associations
The highlighted steroids are often used in the screening of allergies to topical steroid and systemic steroids. When one is allergic to one group, one is allergic to all steroids in that group. Group A
Hydrocortisone, hydrocortisone acetate, cortisone acetate, tixocortol pivalate, prednisolone, methylprednisolone, and prednisone

Group B
Triamcinolone acetonide, triamcinolone alcohol, amcinonide, budesonide, desonide, fluocinonide, fluocinolone acetonide, and halcinonide

Group C
Betamethasone, betamethasone sodium phosphate, dexamethasone, dexamethasone sodium phosphate, and fluocortolone

Group D
Hydrocortisone 17-butyrate, hydrocortisone-17-valerate, alclometasone dipropionate, betamethasone valerate, betamethasone dipropionate, prednicarbate, clobetasone-17-butyrate, Clobetasol-17 propionate, fluocortolone caproate, fluocortolone pivalate, fluprednidene acetate, and mometasone furoate

History
Corticosteroids were first made available for general use around 1950. See also
Topical medication
Glucocorticoid
Corticosteroid
Retrometabolic drug design


== References ==