| Steroid-induced skin atrophy | |
|---|---|
 | |
| Skin atrophy | |
| Specialty | Dermatology |
| Symptoms | telangiectasias,[1] purpura, striae, hypopigmentation[2] |
| Complications | Possible HPA axis involvement[2] |
| Usual onset | within 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] |
| Causes | Changes 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] |
| Prevention | Intermittent maintenance therapy; increasing duration of interval between applications[4] |
| Management | Discontinuation of treatment |
| Prognosis | Most signs of atrophy resolve by 1 to 4 weeks after discontinuation of the TCS; striae are permanent[2] |
| Frequency | up 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] Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning.[6][7][8]
Skin atrophy can occur with both prescription and over the counter steroids creams.[9] Low doses of prednisone by mouth can also result in skin atrophy.
- ^ a b 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.
- ^ a b c d e f 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.
- ^ 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. S2CID 23473646.
- ^ Lubach, D; Rath, J; Kietzmann, M (1995). "Skin atrophy induced by initial continuous topical application of clobetasol followed by intermittent application". Dermatology. 190 (1): 51–5. doi:10.1159/000246635. PMID 7894098.
- ^ a b 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.
- ^ Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, Roberts A, Stuart B, Williams HC, Thomas KS (October 2023). "The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review". Skin Health and Disease. 3 (5): e268. doi:10.1002/ski2.268. PMC 10549798. PMID 37799373.
- ^ Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, Pérez-Herrera LC, Díaz Martinez JP, Brignardello-Petersen R, Sadeghirad B, Wong MM, Ceccacci R, Zhao IX, Basmaji J, MacDonald M, Chu X, Islam N, Gao Y, Izcovich A, Asiniwasis RN, Boguniewicz M, De Benedetto A, Capozza K, Chen L, Ellison K, Frazier WT, Greenhawt M, Huynh J, LeBovidge J, Lio PA, Martin SA, O'Brien M, Ong PY, Silverberg JI, Spergel JM, Smith Begolka W, Wang J, Wheeler KE, Gardner DD, Schneider L (December 2023). "Topical treatments for atopic dermatitis (eczema): Systematic review and network meta-analysis of randomized trials". The Journal of Allergy and Clinical Immunology. 152 (6): 1493–1519. doi:10.1016/j.jaci.2023.08.030. PMID 37678572. S2CID 261610152.
- ^ Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, Grindlay DJ, Muller I, Roberts A, Ahmed A, Williams HC, Thomas KS (July 2021). "Safety of topical corticosteroids in atopic eczema: an umbrella review". BMJ Open. 11 (7): e046476. doi:10.1136/bmjopen-2020-046476. PMC 8264889. PMID 34233978.
- ^ 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.