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.
In recent years, Photodynamic Therapy has become a popular route for the treatment of cystic acne. This procedure topically applies photosensitizing cream then pulses controlled red or blue LED light exposure on top of the area. This process is meant to shrink down the sebaceous glands, reducing the amount of oil that sits in the pore and killing the bacteria inside the pores, effectively minimizing cystic acne lesions. This treatment comes with a hefty price tag, and requires multiple sessions over the course of months before true progress is made.