Potent topical corticosteroids should be used sparingly, and screening for type 2 diabetes should continue to be a routine part of chronic disease prevention and management, according to a critical appraisal published in the British Journal of Dermatology.1
Although topical corticosteroids are widely used to treat inflammatory or pruritic skin conditions, the impact of their systemic absorption on the risk for hyperglycemia and subsequent type 2 diabetes is unclear.1 Anderson et al conducted 3 analysis studies that found that topical corticosteroid use was associated with incident type 2 diabetes, and 2 of the studies demonstrated a dose-response relationship with higher potencies of topical corticosteroids.2 Consequently, the investigators made a strong recommendation to consider alternative treatments to high-potency topical corticosteroids that are potentially diabetogenic.
The studies had several strengths, including the replication of results across case-control and cohort designs with large, high-quality datasets and the inclusion of major confounders related to patient demographics, clinical comorbidities, and healthcare utilization.1 However, healthcare data do not capture actual medication use and exposure definitions do not fully reflect how topical corticosteroids are often used intermittently in practice. In addition, the “association between topical corticosteroid use and incident type 2 diabetes may be less clear” because itchiness and other inflammatory skin conditions are both associated with diabetes and topical corticosteroid prescribing, as noted in the appraisal.
The authors concluded that these findings suggest, “there is a potential signal for an association with incident type 2 diabetes but should not be used to infer causality.”1 They added that, “potent topical corticosteroids should continue to be used sparingly, weighing the benefits and risks, and screening for type 2 diabetes should continue to be a routine part of chronic disease prevention and management.”
- Wong L, Tadrous M. Topical corticosteroids and type 2 diabetes mellitus: a critical appraisal [published online December 28, 2019]. Br J Dermatol. doi: 10.1111/bjd.18853
- Andersen YMF, Egeberg A, Ban L, et al. Association between topical corticosteroid use and type 2 diabetes in two European population-based adult cohorts. Diabetes Care. 2019;42(6):1095-1103.