Indiscriminate use of topical corticosteroids: a review of cutaneous and systemic adverse effects

Abstract

Introduction: Glucocorticoids, isolated in the late 1930s, have broad anti-inflammatory, immunomodulatory, and antineoplastic properties and are used in a variety of pathologies, such as autoimmune, rheumatic, respiratory, and neoplastic diseases. However, their use in high doses or for prolonged periods can cause serious adverse effects, including adrenal suppression, metabolic, cardiovascular, bone, and psychiatric alterations, as well as the risk of acute adrenal insufficiency. Involved use, especially through self-medication, increases these risks, as the corticosteroids described are readily available without a prescription, favoring systemic administration, especially in children and the elderly, who are more susceptible to systemic fragility. Despite the proven efficacy of these medications, contraindications and complications are often not disclosed, contributing to inappropriate use. Studies show that self-medication and lack of medical monitoring increase the occurrence of systemic and cutaneous adverse events, justifying the need for critical scientific investigation into the impacts of the misuse of topical corticosteroids and safe prescription strategies. Objective: To investigate the scientific literature on the adverse effects of the indiscriminate use of topical corticosteroids. Material and Methods: Integrative literature review of the Virtual Health Library (VHL), PubMed, and Cochrane Library databases, using the descriptors "corticosteroids," "adverse effects," and "skin disease," with the Boolean operator AND. Articles in Portuguese or English, with full text and free access, published between 2020 and 2024, were included. Duplicates, unavailable in full, or with thematic leakage were excluded. Results and Discussion: Thirteen articles were selected. An association was identified between prolonged use of topical corticosteroids and adverse effects such as skin atrophy and hypothalamic-pituitary-adrenal axis dysfunction. Alternative strategies, such as immunobiologicals and Janus kinase inhibitors, have shown promise in reducing steroid use. Final Considerations: Inappropriate use of topical corticosteroids can lead to significant complications. The importance of medical guidance and the adoption of safe and personalized practices is emphasized.