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.
If you're going to use any injectable gear, then of course you're going to need some "darts." You can pick up syringes at your local pharmacy unless your state has certain restrictions. Also, you can purchase needles online. Just do a little searching around and you'll find several places that'll hook you up. Syringes will run you around 50 cents apiece. Note that it'll be more difficult to obtain needles (at least from the larger, more "legit" companies) if you live in California and Illinois. You'll usually need a doctor's prescription in those states. Still, if you look around enough, you can get what you need.
Guidance on prescribing topical steroids reminds practitioners to prescribe the least strong steroid which is effective for the least possible length of time. A balance must be struck between efficacy and reducing adverse effects. Education is crucial to maximise efficacy and reduce adverse effects. Use of printed information may be helpful (including detail of how to use emollients and topical steroids) and education involving practice nurses to help improve efficacy of treatments and information for patients. Examples can be obtained from the British Association of Dermatologists and the National Eczema Society.