Tachyphylaxis to topical glucocorticoids; what is the evidence?

Abstract

Background: Common belief holds that as topical glucocorticoids are used over time the less effective they become, a phenomenon called tolerance or tachyphylaxis. Objective:To determine what evidence supports the concept of tachyphylaxis to glucocorticoids. Methods:We searched Medline and Google Scholar for articles on tachyphylaxis to glucocorticoids published through October 2012.Results: Rapid tolerance, tachyphylaxis, to non-clinical effects of glucocorticoids has been reported in literature. However, clinically significant tolerance to topical glucocorticoids has not been identified in clinical trials. We did not identify any evidence that clinical efficacy of glucocorticoids in inflammatory skin diseases significantly diminishes during long term continuous use.Limitations: Tachyphylaxis or tolerance to clinical effects of topical glucocorticoids in inflammatory skin diseases is not fully characterized or well studied. Conclusion:Based on available data in literature, there is no clinical trial supporting the concept that topical glucocorticoids lose effectiveness over time, nor that intermittent use of topical glucocorticoids is more effective than continuous use. BackgroundTopical glucocorticoids are the foundation of dermatological treatment, with potent anti-inflammatory properties. Glucocorticoids act on a wide range of cells and have a wide range of mechanisms of action. Most of the effects of glucocorticoids on cells are mediated via the glucocorticoid receptor [1][2][3]. Glucocorticoids inhibit phospholipase A2, reducing the amount of arachidonic acid, decrease the release of interleukin (IL)-1α and IL-2, inhibit leucocyte migration to sites of inflammation, and interfere with the functions of endothelial cells, granulocytes, mast cells and fibroblasts [4][5][6][7][8][9][10]. Glucocorticoids also reduce T cell proliferation and increase T cell apoptosis, increase monocyte apoptosis, deplete the number of Langerhans cells, decrease histamine content of mast cells, and suppress eosinophil maturation, recruitment, and survival [11,12]. Topical glucocorticoids reduce protein synthesis

Glucocorticoids and COVID-19

“…Regarding the topical use of GCs, the loss of their efficacy over time commonly referred to as tolerance or tachyphylaxis is not fully characterized [84] .…”