Topical steroids for dermatological indications are available in ointments, creams, gels, solutions, shampoos, and rinses. Glucocorticoids for ophthalmological indications come as eye drops (aqueous solutions and suspensions) and ointments; intra-articular application is usually in form of crystal suspensions. Glucocorticoids are also used as inhalants in patients with lung disease. Topical therapy can provide high concentrations of a potent glucocorticoid at a specific site while reducing systemic side effects. However, topical glucocorticoids can be absorbed to a certain extent, exerting the same adverse reaction as systemically administered steroids. The extent of percutaneous absorption depends on various factors, including the preparation vehicle, ester form of the steroid (greater lipid solubility enhances percutaneous absorption), integrity of epidermal barriers (., absorption is increased in case of inflammation), size of treated area, and duration of treatment. Absorption is enhanced by use of occlusive wraps and possibly by clipping the skin ( Behrend and Kemppainen, 1997; Boothe and Mealey, 2012 ). Systemic effects (., suppression of the HPA axis) may also occur with inhaled glucocorticoids and in conjunction with intra-articular, intra-lesional, or ocular application.
Pregnancy Category C: Corticosteroids are generally teratogenic in laboratory animals when administered systemically at relatively low dosage levels. The more potent corticosteroids have been shown to be teratogenic after dermal application in laboratory animals. There are no adequate and well-controlled studies in pregnant women on teratogenic effects from topically applied corticosteroids. Therefore, topical corticosteroids should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus . Drugs of this class should not be used extensively on pregnant patients, in large amounts, or for prolonged periods of time.