Epidural steroid injections are generally very safe, but there are some rare potential complications. One of the most common risks is for the needle to go too deep and cause a hole in the dura, the tissue that surrounds the spinal cord and nerve roots. When this occurs spinal fluid can leak out through the hole and cause a headache . This headache can be treated with bedrest, or with a blood patch. A blood patch involves drawing some blood from the vein and the injecting it over the hole in the dura. The blood forms a seal over the hole and prevents any further fluid from leaking out.
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.