Steroids are used to fight inflammation and speed healing. For injuries, this treatment may be a good idea, but for most back pain scenarios, I always ask, where is the inflammation? As Dr. Sarno has pointed out time and time again, there is rarely evidence of any inflammatory process in the majority of chronic pain complaints. Even in cases where inflammation exists, steroids are not a very good option, since they are often completely ineffectual or only provide short term benefits, sometimes only due to the placebo effect.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.