Which systemic effect is NOT associated with the use of topical glucocorticoids?

The appropriate recognition of systemic effects associated with the use of topical glucocorticoids hinges on understanding their pharmacology and potential side effects. Topical glucocorticoids are primarily designed to exert their effects locally on the skin, which minimizes systemic absorption compared to oral or injectable forms of glucocorticoids. However, when absorbed systemically in significant amounts, they can lead to a variety of adverse effects.

In contrast to liver toxicity, mood changes, osteoporosis, and adrenal insufficiency are known to occur with systemic exposure to glucocorticoids, even when they originate from topical applications in some cases, especially with high-potency formulations used over large surface areas or for extended periods. Mood changes can arise due to alterations in neurotransmitter levels or stress responses triggered by glucocorticoid effects. Osteoporosis is a concern because glucocorticoids can interfere with bone formation and calcium absorption. Adrenal insufficiency can develop when the hypothalamic-pituitary-adrenal (HPA) axis is suppressed due to excessive glucocorticoid exposure.

Liver toxicity, on the other hand, is not typically a concern with topical glucocorticoids. This effect is more commonly associated with certain oral medications, particularly