title: Intranasal steroids and the myth of mucosal atrophy: a systematic review of original histological assessments.
abstract: BACKGROUND
  Intranasal corticosteroids (INCSs) are well established in the treatment of allergic rhinitis, chronic rhinosinusitis, and nasal polyposis. Although reversible atrophy of keratinized skin is seen with corticosteroids, the respiratory mucosa is histologically very different and but concerns remain among patients and some health-care professionals over local side effects on nasal respiratory mucosa. A systematic review and meta-analysis were performed of the available evidence for nasal mucosal atrophy as an adverse effect of INCSs in patients with sinonasal disease.
  
  
  METHODS
  A systematic search of Embase (1974-) and Medline (1946-) databases to September 27, 2013 was performed. Inclusion criteria selected any study where the histopathology of nasal mucosa was assessed in patients with sinonasal disease using intranasally administered corticosteroids with or without a control group.
  
  
  RESULTS
  Twenty-three hundred sixty-four publications were retrieved with a subsequent full text review of 149 publications for 34 articles that met the selection criteria. These articles included 11 randomized controlled trials, 5 cohorts, and 20 case series. Duration of treatment varied from 5 days to 5.5 years. "Mucosal atrophy" as an outcome was reported in 17 studies. The definition of "mucosal atrophy" was highly variable with a definition given in only 10 studies. One hundred thirty-six patients were represented in controlled studies of atrophy with only one study reporting the event in both groups with an odds ratio of "mucosal atrophy" at 0.51 (95% CI, 0.09-3.11; p = 0.47).
  
  
  CONCLUSIONS
  The concept of nasal mucosal atrophy is poorly defined and there is no histological evidence for deleterious effects from INCS use on human nasal mucosa.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, and Freeman Hospital, Newcastle University, Newcastle-upon-Tyne, UK.
authors.forename: Misha M
authors.initials: MM
authors.lastname: Verkerk
authors.forename: Daman
authors.initials: D
authors.lastname: Bhatia
authors.forename: Janet
authors.initials: J
authors.lastname: Rimmer
authors.forename: Peter
authors.initials: P
authors.lastname: Earls
authors.forename: Raymond
authors.initials: R
authors.lastname: Sacks
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Harvey
mesh_terms: D000281:Administration, Intranasal; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D001284:Atrophy; D006801:Humans; D009297:Nasal Mucosa / Q000187:drug effects* / Q000473:pathology; D012220:Rhinitis / Q000188:drug therapy; D012852:Sinusitis / Q000188:drug therapy
chemical_list: D000305:Adrenal Cortex Hormones