1. Melton R, Thomas R. Corticosteroids. In: Melton R, Thomas R. 2001 Clinical Guide to Ophthalmic Drugs. Rev Optom suppl. 2001 May:18A-21A.
2. Skorin L. Uses and effects of ocular steroids. Rev Optom 2002 May;139(5):85-92.
3. Jaanus SD, Lesher GA. Anti-Inflammatory Drugs. In: Bartlett JD, Jaanus SD (eds). Clinical Ocular Pharmacology. Boston: Butterworth-Heineman, 1995:303-336.
4. Foster SC. Topical Steroid Treatment of Ocular Inflammation. In: Advances in Ocular Pharmacology, Ophthalmology Clinics of North America 1997 Sept;10(3):389-403.
5. Leibowitz HM, Kupperman A. Uses of Corticosteroids in the Treatment of Corneal Inflammation. In Leibowitz HM (ed). Corneal Disorders, Clinical Diagnosis and Management. Philadelphia: . Saunders, 1984:286-307.
6. Renfro L, Snow JS. Ocular effects of topical and systemic steroids. Dermatol Clin 1992 Jul;10(3):505-12.
7. Tripathi RC, Parapuram SK, Tripathi BJ, et al. Corticosteroids and glaucoma risk. Drugs and Aging 1999;15(6)439-450.
8. Carnahan MC, Goldstein DA. Ocular complications of topical, peri-ocular, and systemic corticosteroids. Curr Opin Ophthalmol 2000;11:478-483.
9. Whitcup SM, Ferris FL 3rd. New corticosteroids for the treatment of ocular inflammation. Am J Ophthalmol 1999 May;127(5):597-9.
10. Giles, CL, Mason GL, Duff IF, et al. The association of cataract formation and systemic corticosteroid therapy. JAMA 1962;182:719.
11. Urban RC, Cotlier E. Corticosteroid Induced Cataracts. Surv Ophthalmol 1986;31:102-110.
12. Anti-Inflammatory Agents. In: Bartlett JD (ed). Ophthalmic Drug Facts. St. Louis: Wolters Kluwer Health, 2005:87-99.
13. Reddy IK, Ganesan MG. Ocular Therapeutics and Drug Delivery: An Overview. In: Reddy ID (ed). Ocular Therapeutics and Drug Delivery: A Multidisciplinary Approach. Lancaster, Pa.: Technomic Publishing Co., 1996:3-29.
14. Howes JF. Development of Soft Drugs for Ophthalmic Use. In: Ocular Therapeutic and Drug Delivery: A Multidisciplinary Approach. Lancaster, Pa.: Technomic Publishing Co., 1996:363-374.
15. Foster CS, Alter G, DeBarge LR, et al. Efficacy and safety of rimexolone 1% ophthalmic suspension vs 1% prednisolone acetate in the treatment of uveitis. Am J Ophthalmol 1996 Aug; 122(2):171-82.
16. Nader N. Therapeutic effect of generic drug not always equal to brand. Ocular Surgery News 2002;20(11):47.
17. Wittpenn JR. Generic versus brand name drugs. Therapeutic Updates in Ophthalmology 2003;5(1):3.
18. Fiscella RG. Generic prednisolone suspension substitution. Arch Ophthalmol 1998 May;116(5):703.
The hypothesized etiology of hypopigmentation with corticosteroids relates to decreased melanocyte function. Friedman et al obtained a biopsy from a streak-like hypopigmented lesion in a young woman who had received four intralesional injections for keloids on her calf. Silver nitrate staining showed reduced melanin staining suggesting a reduced number or activity of the melanocytes [ 7 ]. Venkatesan and Fangman in 2009 performed Fontana-Masson staining and MART-1 staining on a punch biopsy specimen of a patient with right wrist hypopigmentation following intra-articular triamcinolone acetonide injections for de Quervain tendonitis. There was a decrease in pigment noted with Fontana-Masson staining, although intact melanocytes were noted along the dermal-epidermal junction, suggesting that melanocyte function may be impacted without the actual loss of melanocytes [ 11 ].
A common mistake is to be too cautious about topical steroids. Some parents undertreat their children's eczema because of an unfounded fear of topical steroids. They may not apply the steroid as often as prescribed, or at the strength needed to clear the flare-up. This may actually lead to using more steroid in the long term, as the inflamed skin may never completely clear. So, you may end up applying a topical steroid on and off (perhaps every few days) for quite some time. The child may be distressed or uncomfortable for this period if the inflammation does not clear properly. A flare-up is more likely to clear fully if topical steroids are used correctly.