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.
Prescriptions written for topical steroids should include explicit instructions about where and how often to apply the preparation, and the body areas where use must be avoided. Pharmacists should ensure these directions are included on the dispensing label. Prescribers should bear in mind that patients may keep unused or leftover corticosteroid skin preparations for some time after they are prescribed and thus forget the original indication or instructions for use. The prescribing of unnecessarily large quantities should be avoided. Patients should be warned not to share their topical steroid preparation with other people as this may result in unsafe application to unsuitable areas such as the face, as well as the potentially inappropriate treatment of undiagnosed skin conditions.
Compliance raises very specific questions in dermatology related to the frequent use of local treatments: creams or ointments, including topical corticosteroids. The adherence in dermatology is a complex issue. It is difficult to quantify objectively because of the patient subjectivity, the constant adaptation to changes in the course of the disease, and due to the lack of adapted device. Moreover poor compliance may be related to topical corticosteroid phobia, defined as a fear vis-à-vis the topical corticosteroids, rational or not. The topical corticosteroid phobia is very common in the management of chronic inflammatory skin diseases especially in atopic dermatitis.