Steroid-induced skin atrophy

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Steroid-induced skin atrophy
Steroid induced atrophy arm.png
Skin atrophy
Specialty Dermatology
Symptoms telangiectasias, [1] purpura, striae, hypopigmentation [2]
Complications Possible HPA axis involvement [2]
Usual onsetwithin the first 7 days of daily superpotent TCS application under occlusion, within 2 weeks of daily use of less potent TCS or superpotent TCS without occlusion. [2]
CausesChanges in gene regulation and transcription of various mRNA [2]
Risk factors higher potency corticosteroids, more frequent application, extended duration of treatment, [3] use of occlusion, infancy/childhood, location [2]
Diagnostic method Visual inspection of skin for visible signs of skin atrophy [1]
PreventionIntermittent maintenance therapy; increasing duration of interval between applications [4]
ManagementDiscontinuation of treatment
Prognosis Most signs of atrophy resolve by 1 to 4 weeks after discontinuation of the TCS; striae are permanent [2]
Frequencyup to 5% after a year of use (in psoriasis) [5]

Steroid-induced skin atrophy is thinning of the skin as a result of prolonged exposure to topical steroids. In people with psoriasis using topical steroids it occurs in up to 5% of people after a year of use. [5]

Contents

Skin atrophy can occur with both prescription and over the counter steroids creams. [6] Low doses of prednisone by mouth can also result in skin atrophy.

Signs and symptoms

Steroid-induced atrophy Steroid atrophy palms.png
Steroid-induced atrophy

It can also present with telangiectasia, easy bruising, purpura, and striae. Occlusive dressings and fluorinated steroids both increase the likelihood of developing atrophy. [7]

Prevention

In general, use a potent preparation short term and weaker preparation for maintenance between flare-ups. While there is no proven best benefit-to-risk ratio, [8] if prolonged use of a topical steroid on a skin surface is required, a pulse therapy should be undertaken.

Pulse therapy refers to the application of a corticosteroid for 2 or 3 consecutive days each week or two. This is useful for maintaining control of chronic diseases. Generally a milder topical steroid or non-steroid treatment is used on the in-between days. [9]

Strong steroids should be avoided on sensitive sites such as the face, groin and armpits. Even the application of weaker or safer steroids should be limited to less than two weeks on those sites.

Treatment

The obvious priority is immediate discontinuation of any further topical corticosteroid use. Protection and support of the impaired skin barrier is another priority. Eliminating harsh skin regimens or products will be necessary to minimize potential for further purpura or trauma, skin sensitivity, and potential infection. Steroid-induced skin atrophy [10] [11] is often permanent, though if caught soon enough and the topical corticosteroid discontinued in time, the degree of damage may be arrested or slightly improve. However, while the accompanying telangiectasias may improve marginally, the stretch marks are permanent and irreversible. [12]

See also

Related Research Articles

<span class="mw-page-title-main">Dermatitis</span> Inflammation of the skin

Dermatitis is inflammation of the skin, typically characterized by itchiness, redness and a rash. In cases of short duration, there may be small blisters, while in long-term cases the skin may become thickened. The area of skin involved can vary from small to covering the entire body. Dermatitis is often called eczema, and the difference between those terms is not standardized.

<span class="mw-page-title-main">Corticosteroid</span> Class of steroid hormones

Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are involved in a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels, and behavior.

<span class="mw-page-title-main">Psoriasis</span> Skin disease

Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by patches of abnormal skin. These areas are red, pink, or purple, dry, itchy, and scaly. Psoriasis varies in severity from small localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.

<span class="mw-page-title-main">Pimecrolimus</span> Chemical compound

Pimecrolimus is an immunomodulating agent of the calcineurin inhibitor class used in the treatment of atopic dermatitis (eczema). It is available as a topical cream, once marketed by Novartis under the trade name Elidel.

Antipruritics, abirritants, or anti-itch drugs, are medications that inhibit the itching often associated with sunburns, allergic reactions, eczema, psoriasis, chickenpox, fungal infections, insect bites and stings like those from mosquitoes, fleas, and mites, and contact dermatitis and urticaria caused by plants such as poison ivy or stinging nettle. It can also be caused by chronic kidney disease and related conditions.

<span class="mw-page-title-main">Clobetasol propionate</span> Clobetasol Propionate Cream usp 0.05

Clobetasol propionate is a corticosteroid used to treat skin conditions such as eczema, contact dermatitis, seborrheic dermatitis, and psoriasis. It is applied to the skin as a cream, ointment, or shampoo. Use should be short term and only if other weaker corticosteroids are not effective. Use is not recommended in rosacea or perioral dermatitis.

<span class="mw-page-title-main">Dyshidrosis</span> Human disease

Dyshidrosis is a type of dermatitis that is characterized by itchy blisters on the palms of the hands and bottoms of the feet. Blisters are generally one to two millimeters in size and heal over three weeks. However, they often recur. Redness is not usually present. Repeated attacks may result in fissures and skin thickening.

<span class="mw-page-title-main">Desonide</span> Chemical compound

Desonide (INN) is a low-potency topical corticosteroid anti-inflammatory that has been available since the 1970s. It is primarily used to treat atopic dermatitis (eczema), seborrheic dermatitis, contact dermatitis and psoriasis in both adults and children. It has a fairly good safety profile and is available as a cream, ointment, lotion, and as a foam under the tradename Verdeso Foam. Other trade names for creams, lotions, and ointments include Tridesilon, DesOwen, Desonate. It is a group VI corticosteroid under US classification, the second least potent group.

<span class="mw-page-title-main">Erythroderma</span> Inflammatory skin disease with redness and scaling

Erythroderma is an inflammatory skin disease with redness and scaling that affects nearly the entire cutaneous surface. This term applies when 90% or more of the skin is affected.

<span class="mw-page-title-main">Calcipotriol</span> Chemical compound

Calcipotriol, also known as calcipotriene, is a synthetic derivative of calcitriol, a form of vitamin D. It is used in the treatment of psoriasis. It is safe for long-term application in psoriatic skin conditions.

<span class="mw-page-title-main">Perioral dermatitis</span> Medical condition

Perioral dermatitis, also known as periorificial dermatitis, is a common type of skin rash. Symptoms include multiple small (1–2 mm) bumps and blisters sometimes with background redness and scale, localized to the skin around the mouth and nostrils. Less commonly the eyes and genitalia may be involved. It can be persistent or recurring and resembles particularly rosacea and to some extent acne and allergic dermatitis. The term "dermatitis" is a misnomer because this is not an eczematous process.

<span class="mw-page-title-main">Alclometasone</span> Chemical compound

Alclometasone is a synthetic corticosteroid for topical dermatologic use, possessing anti-inflammatory, antipruritic, and vasoconstrictive properties.

<span class="mw-page-title-main">Clocortolone</span> Pharmaceutical drug

Clocortolone (Cloderm) is a topical steroid. It is used in the form of an ester, clocortolone pivalate, and applied as a cream. It is used for the treatment of dermatitis and is considered a medium-strength corticosteroid. It is unusual among steroids in that it contains a chlorine atom and a fluorine atom.

<span class="mw-page-title-main">Amcinonide</span> Chemical compound

Amcinonide is a topical glucocorticoid used to treat itching, redness and swelling associated with several dermatologic conditions such as atopic dermatitis and allergic contact dermatitis. Amcinonide can also be classified as a multi-functional small molecule corticosteroid, which has been approved by the FDA and is currently marketed as an ointment, lotion, or cream. It acts as both a transcription factor for responses to glucocorticoids and modulator for other transcription factors while also regulating phospholipase A2 activity.

In medicine, a finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger of an adult. The "distal skin-crease" is the skin crease over the joint nearest the end of the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a "handprint". Two FTUs are approximately equivalent to 1 g of topical steroid.

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash and eczema. Topical steroids have anti-inflammatory properties and are classified based on their skin vasoconstrictive abilities. There are numerous topical steroid products. All the preparations in each class have the same anti-inflammatory properties but essentially differ in base and price.

<span class="mw-page-title-main">Hand eczema</span> Skin condition

Hand eczema presents on the palms and soles, and may sometimes be difficult or impossible to differentiate from atopic dermatitis, allergic contact dermatitis, and psoriasis, which also commonly involve the hands. Even a biopsy of all these conditions may not result in a definitive diagnosis, as all three conditions may demonstrate spongiosis and crusting on the hands.

<span class="mw-page-title-main">Topical steroid withdrawal</span> Medical condition

Topical steroid withdrawal, also known as red burning skin and steroid dermatitis, has been reported in people who apply topical steroids for 2 weeks or longer and then discontinue use. Symptoms affect the skin and include redness, a burning sensation, and itchiness, which may then be followed by peeling.

<span class="mw-page-title-main">Topical glucocorticoids</span>

Topical glucocorticoids are the topical forms of glucocorticoids. Topical glucocorticoids are used in the treatment of many skin conditions. They provide anti-inflammatory, antimitotic, and immune-system suppressing actions through various mechanisms.

References

  1. 1 2 Vázquez-López, F; Marghoob, AA (November 2004). "Dermoscopic assessment of long-term topical therapies with potent steroids in chronic psoriasis". Journal of the American Academy of Dermatology. 51 (5): 811–3. doi:10.1016/j.jaad.2004.05.020. PMID   15523365.
  2. 1 2 3 4 5 6 Camisa, Charles; Garofola, Craig (2021). "Topical Corticosteroids". Comprehensive Dermatologic Drug Therapy: 511–527.e6. doi:10.1016/B978-0-323-61211-1.00045-0. ISBN   9780323612111.
  3. Takeda, K; Arase, S; Takahashi, S (1988). "Side effects of topical corticosteroids and their prevention". Drugs. 36 (Suppl 5): 15–23. doi:10.2165/00003495-198800365-00005. PMID   3076129.
  4. Lubach, D; Rath, J; Kietzmann, M (1995). "Skin atrophy induced by initial continuous topical application of clobetasol followed by intermittent application". Dermatology (Basel, Switzerland). 190 (1): 51–5. doi:10.1159/000246635. PMID   7894098.
  5. 1 2 Castela, E; Archier, E; Devaux, S; Gallini, A; Aractingi, S; Cribier, B; Jullien, D; Aubin, F; Bachelez, H; Joly, P; Le Maître, M; Misery, L; Richard, MA; Paul, C; Ortonne, JP (May 2012). "Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy". Journal of the European Academy of Dermatology and Venereology. 26 (Suppl 3): 47–51. doi:10.1111/j.1468-3083.2012.04523.x. PMID   22512680. S2CID   27244679.
  6. Abraham, A; Roga, G (September 2014). "Topical steroid-damaged skin". Indian Journal of Dermatology. 59 (5): 456–9. doi: 10.4103/0019-5154.139872 . PMC   4171912 . PMID   25284849.
  7. "Disorders of collagen, Weedon's Skin Pathology (Third Edition), 2010: CORTICOSTEROID ATROPHY" via Elsevier.{{cite web}}: External link in |via= (help); Missing or empty |url= (help)
  8. Last, Allen R.; Ference, Jonathan D. (2009-01-15). "Choosing Topical Corticosteroids". American Family Physician. 79 (2): 135–140. PMID   19178066.
  9. "Course on topical steroids".
  10. Fukaya, Mototsugu (2000). Color Atlas of Steroid Withdrawal from Corticosteroids in Patients with Atopic Dermatitis. Tokyo, Japan: Ishiyaku Publishers, Inc. Archived from the original on 2014-12-23. Retrieved 2014-12-23.
  11. Fukaya, Mototsugu (June 2000). Atopic Dermatitis and Steroid Withdrawal (1st ed.). Japan: Ishiyaku Pub, Inc. p. 107. ISBN   978-4-263-20140-4. (skin atrophy caused during application of the steroid ointment).
  12. "Steroid Atrophy".