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.
Maintenance therapy with either azathioprine or methotrexate is initiated if remission has occurred after three to six months of induction therapy. Steroid dosage is tapered during this phase. Patients may need to continue maintenance treatment for up to 24 months. 24 Maintenance treatment for up to five years is recommended in patients with Wegener granulomatosis and patients who remain ANCA-positive. 19 Some patients may require treatment indefinitely. Disease relapse may occur anytime after the remission. Serial measurements of ANCA are not closely associated with disease activity; therefore, treatment should not be solely guided on the basis of an increase in ANCA. 25 Relapsing disease can be managed with an increase in steroid dose, optimization of the current immunosuppressant, or combination of an immunosuppressant with an increased dose of steroid.
Not shortly after Roger Maris record was broken, another baseball player, Jason Giambi and various other athletes were either suspected of, or proven to have, taken anabolic steroids. Again, Congress convened a hearing, and just as they did the first time in 1990, they did not determine that steroids were a danger, but rather that the danger was more in protecting professional sports organizations. The updated statute has been updated to proscribe pro-hormones also The definition of an anabolic steroid as defined currently in the United States under (41)(A) is that "anabolic steroid" means any drug or hormonal substance, chemically and pharmacologically related to testosterone (other than estrogens , progestins, corticosteroids, and dehydroepiandrosterone (7).