There are concerns about long-term use of steroids, however, most of the side-effects are related to the systemic, rather than the topical steroids. Skin atrophy, or thinning, is the most common side effect of topical steroids. This occurs most often when potent or superpotent steroids are used over a long period of time without a break. Some people can develop stretch marks. When these are noticed early and treatment is discontinued, the stretch marks may disappear. Longer use can cause permanent stretch marks. According to National Eczema Association , "these medications are safest when used intermittently, in an appropriate quantity, and for an appropriate length of time."
The effects of glucocorticoids are mediated by cytosolic glucocorticoid receptors and result from both genomic and nongenomic mechanisms that also have a role in the therapeutic effects of these agents [ 1-3 ]. The AEs appear to result largely from transactivation that leads to increased expression of regulatory and antiinflammatory proteins [ 2 ]; by contrast, many of the clinically desirable effects appear to result primarily from transrepression, which results in the decreased production of proinflammatory proteins. Nongenomic effects of glucocorticoids include rapid, nonspecific interactions of glucocorticoids with cellular membranes, nongenomic effects medicated by cytosolic glucocorticoid receptors, and specific interactions with membrane-bound glucocorticoid receptors [ 2 ].