Eczema: Do cortisone creams have side effects?

There is a prevailing phobia today regarding the use of cortisone creams. Many parents hesitate to use them when their child suffers from eczema or apply too little. However, the risks of side effects from topical corticosteroids are minimal. Indeed, unlike oral cortisone, the topical application of this molecule is considered safe and has been the subject of numerous studies. Dermatologists agree that cortisone creams, when applied correctly, very rarely cause adverse effects and that the benefit-risk balance leans in favour of their use. The following side effects are generally attributed to topical corticosteroids:

• Depigmentation : This phenomenon is particularly observed in individuals with dark skin, where excessive use of cortisone creams can lead to hypopigmentation. Indeed, cortisone is believed to disrupt the synthesis of melanin. However, the stage of melanogenesis at which cortisone would interfere has not been determined.

• A temporary disturbance in vision : this side effect has occasionally been observed when applying unsuitable dermocorticoids to the sensitive area around the eye.

• An exacerbation of the rosacea : In genetically predisposed individuals, it has been observed that dermocorticoids tend to intensify the redness and manifestations of rosacea. This is thought to be due to a vasodilatory effect of cortisone. By increasing the dilation of blood vessels, it would intensify the symptoms of rosacea.

• Skin thinning : it is hypothesised that prolonged use of cortisone can in some cases inhibit the synthesis of collagen by fibroblasts, leading to a loss of skin structure and its weakening.

• The emergence of stretch marks : some cases of misuse of dermocorticoids have led to the appearance of stretch marks. Stretch marks are micro-lesions visible on the skin's surface and can be likened to scars. They are the result of a change in the structure of the dermis and a rupture of collagen fibres.

It should be noted that these various side effects are marginal and do not have a consensus. Studies on these subjects contradict each other and the conclusions of these studies remain cautious.

The most effective way to reduce the risk of side effects from cortisone creams is to use them strictly following the advice of your dermatologist. These healthcare professionals recommend applying topical corticosteroids once a day and only during eczema flare-ups. Dermatologists, however, advise not to wait until the flare-up reaches its peak to start using them, but rather to apply them at the onset of the flare-up. Finally, between eczema flare-ups, it is recommended to hydrate and nourish your skin with a standard emollient to restore its hydrolipidic film and combat xerosis (dry skin).