Skin atrophy local corticosteroids

The main adverse effect of pimecrolimus is local skin irritation, with a stinging or burning sensation, which occurs in 30% of patients. Typically, children have less skin irritation than adults. Adverse effects such as local immunosuppression and an increased risk of local bacterial and viral infections (notably eczema herpeticum) are less common than with topical glucocorticoids (5). In addition, there is a lack of skin atrophy (6,7). However, topical corticosteroids have the advantage of better skin penetration than pimecrolimus and will therefore continue to be used for more heavily keratinized skin such as in psoriasis (8). 

There are hundreds of topical steroid preparations that are available for the treatment of skin diseases. In addition to their aforementioned antiinflammatory effects, topical steroids also exert their effects by vasoconstriction of the capillaries in the superficial dermis and by reduction of cellular mitosis and cell proliferation especially in the basal cell layer of the skin. In addition to the aforementioned systemic side effects, topical steroids can have adverse local effects. Chronic treatment with topical corticosteroids may increase the risk of bacterial and fungal infections. A combination steroid and antibacterial agent can be used to combat this problem. Additional local side effects that can be caused by extended use of topical steroids are epidermal atrophy, acne, glaucoma and cataracts (thus the weakest concentrations should be used in and around the eyes), pigmentation problems, hypertrichosis, allergic contact dermatitis, perioral dermatitis, and granuloma gluteale infantum (251). 

Corticosteroids 2-i times/day Local tissue atrophy, degeneration, and striae epidermal thinning acneiform eruptions baderial or fungal skin infections glucocorticoid systemic effects... 

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