Tachyphylaxis to topical glucocorticoids; what is the evidence?

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.