Steroid allergy resulting in immediate hypersensitivity seem to be very rare relative to their worldwide use. The literature that was reviewed over 11 years identified 120 reactions, and 60% resulted in anaphylaxis. Some patients had more than 1 reaction on separate occasions and some responded to more than 1 preparation of steroids. The problem is most likely under diagnosed or under reported, particularly because steroids are a common therapy for allergy and hypersensitivity disorders. One should always be aware of this entity, even though it is rare. There are other safe alternative preparations through screening and allergy skin testing or a graded challenge. In rare cases when an alternative can no be used, desensitization by an experienced allergy specialist can be pursued.
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Acne is often present. Acne conglobata is a particularly severe form of acne that can develop during steroid abuse or even after the drug has been discontinued. Infections are a common side effect of steroid abuse because of needle sharing and unsanitary techniques used when injecting the drugs into the skin. These are similar risks to IV drug abusers with increased potential to acquire blood-borne infections such as hepatitis and HIV/AIDS . Skin abscesses may occur at injection sites and may spread to other organs of the body. Endocarditis or an infection of the heart valves is not uncommon.