Skin Thinning Steroid Cream

Content:
  • Steroid Creams Won't 'Thin' Skin of Kids with Eczema
  • Topical Steroid-Damaged Skin
  • Steroid atrophy - Wikipedia
  • Steroid Creams Won't 'Thin' Skin of Kids with Eczema
  • Steroid Creams Can Help with Skin Inflammation but Are Not a Cure – Mayo Clinic News Network
  • How to Keep Your Skin from Thinning

    Steroid Creams Won't 'Thin' Skin of Kids with Eczema

    skin thinning steroid cream Topical steroids are available in creams, ointments, solutions and other vehicles. There is little point in diluting a topical steroid, as their potency does not depend much on concentration and diluting the product does not reduce the risk of adverse effects. After the first 2 or 3 applications, there is no additional benefit from applying a topical steroid skin thinning steroid cream than once daily. Absorption also depends on the vehicle in which the topical steroid is delivered and is greatly creeam by occlusion. Several formulations are available for topical steroids, skin thinning steroid cream to suit the type of skin lesion and its location. Creams and lotions are general purpose and are the most popular formulations.

    Topical Steroid-Damaged Skin

    skin thinning steroid cream

    Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. This article aims at bringing awareness among practitioners, about the cutaneous side effects of easily available, over the counter, topical steroids. This makes it important for us as dermatologists to weigh the usefulness of topical steroids versus their side effects, and to make an informed decision regarding their use in each individual based on other factors such as age, site involved and type of skin disorder.

    Topical steroids were introduced in , when Sulzberger and Witten first used topical hydrocortisone. In this way steroids act as a double-edged sword, which makes it important to use it with the utmost caution. Topical steroids cause the synthesis of lipocortin, which inhibits the enzyme phospholipase A2.

    Phospholipase A2 acts on the cell membrane phospholipids, to release arachidonic acid which causes the inflammation.

    The inhibition of phospholipase A2 results in the reduction of inflammation, mitotic activity and protein synthesis. Topical steroid use causes skin to go through three phases—preatrophy, atrophy and finally tachyphylaxis. Atrophy causes a burning sensation, and further steroid use causes vasoconstriction and soothing of the burning. This occurs due to the effect of steroids on nitric oxide in the endothelium.

    Factors that increase chances of atrophy are: Extremities of age, body site e. Steroid-induced telangiectasia occurs due to stimulation of release of nitric oxide from dermal vessel endothelial cells leading to abnormal dilatation of capillaries. The pathogenesis of topical steroid-induced acne has been proposed to be due to the degradation of the follicular epithelium, resulting in the extrusion of the follicular content. Factors predisposing to steroid acne are high concentration of the drug, application under occlusion, young adults below age 30, whites in preference to blacks and application to acne-prone areas of face and upper back.

    Topical steroids increase the proliferation of Propionibacterium acnes , and Demodex folliculorum , leading to an acne rosacea-like condition within 6 months. Facial perioral dermatitis, more commonly seen in females, presents with follicular papules and pustules on an erythematous background, with sparing of the skin near the vermillion border of the lips.

    Steroid-induced perioral dermatitis is differentiated from common perioral dermatitis by history and clinical examination. Steroid-induced dermatitis has more erythema, inflammation, and scaling than its counterparts. Patients with steroid-induced dermatitis present with squeezed tubes of steroids that they have used and abused in hope of resolution of the skin condition. Substitution of hydrocortisone for fluorinated steroids resulted in the improvement of steroid-induced perioral dermatitis.

    Steroid-induced protein degradation leads to dermal atrophy and loss of intercellular substance, which further cause blood vessels to lose their surrounding dermal matrix, resulting in the fragility of dermal vessels, purpuric hypopigmented, and depressed scars. Tinea versicolor, onychomycosis, dermatophytosis and Tinea incognito [ Figure 3 ] are the common cutaneous infections aggravated by topical steroids.

    Granuloma gluteale infantum is a persistent reddish purple, granulomatous, papulonodular eruption on the buttocks and thighs of infants. It occurs when diaper dermatitis is treated with topical steroids.

    Delayed wound healing may occur due to various reasons. Inhibition of keratinocytes may cause epidermal atrophy and delayed re-epithelialization. Inhibition of fibroblasts-reduced collagen and ground substance may result in dermal atrophy and striae. Inhibition of vascular connective tissue may cause telangiectasia and purpura.

    Delayed granulation tissue formation may be caused by inhibition of angiogenesis. Contact sensitization may occur due to prolonged use of steroids and application of certain drugs e.

    It is associated with cream formulations of steroids more often than ointments. Contact sensitization to topical steroids occurs due to the binding to amino acid arginine as part of certain proteins. Contact sensitization to steroids must be differentiated from hypersensitivity to other constituents e.

    Allergic contact dermatitis to topical steroids, presents as absence of response to treatment or as worsening of the dermatitis. It is usually seen in children with atopic dermatitis. Also, mild potent, steroids used commonly in children like desonide and hydrocortisone butyrate have an allergic property due to their structural instability. Some commonly used potent steroids are rare allergens, e.

    Patients with atopic and seborrheic dermatitis on chronic topical steroids, develop a flare around the eyes within days after stoppage of steroids. Topical corticosteroids may induce tachyphylaxis with chronic use. This is why the frequency of application of ultrahigh-potency topical corticosteroids is reduced after the first 2 weeks to no more than four or five times a week. Initially, steroids are effective; however, as time passes, patients stop responding to the same topical steroid and require oral steroids.

    A study has shown the association of trichostasis spinulosa with topical steroids. It is characterized by dark-brown, follicular papules involving the face, neck, upper chest, arms, and antecubital areas with a rough sensation on palpation.

    On examination, tufts of hairs are visible projecting through each of the tiny papules. Treatment involves daily tretinoin 0. Striae due to steroids must be differentiated from those due to weight gain and pregnancy.

    Pathogenesis of striae, according to Shuster, is due to the cross linking of immature collagen in the dermis, resulting in intradermal tears causing striae [ Figure 4 ]. Persistent redness of the face, after peel or laser has been noted in patients using topical steroids before the procedure.

    Women with status cosmeticus cannot tolerate makeup and complain of a continuous burning sensation after any application. Patients present with erythema and burning disproportionate to the redness. Examination reveals atrophy, telangiectasia, and acneiform papules. With steroid withdrawal, the atrophy eventually clears.

    Patients present with facial erythema and lichenification on the face, forearms and upper neck. The difference between this condition and photo exacerbated dermatitis is that even though the rash is on the photo distributed area, it does not flare on sun exposure.

    The pattern of corticosteroid withdrawal is as follows: A week after corticosteroids are stopped, a mild erythema occurs at the site of the original dermatitis. This flare lasts for 2 weeks ending with desquamation. Dermatitis localized to the eyelids, face, scrotum, or perianal area often persists. A second flare usually occurs within 2 weeks. This pattern of flare and resolution repeats itself but each time smaller duration of flares and longer resolution periods.

    The length of the time for which steroids had been used initially determines the duration of the withdrawal phase. The key to safe use of topical steroid is short term use of appropriate potency steroid. However, when the skin condition remains resistant to treatment or affects a particular sensitive area, the prolonged use of steroids is not advisable.

    Selective glucocorticoid receptor agonists are being developed that have independent transrepression and transactivation action. This may lead to the development of a topical steroid without its adverse effects. National Center for Biotechnology Information , U.

    Journal List Indian J Dermatol v. Anil Abraham and Gillian Roga. Received May; Accepted May. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Topical steroids, commonly used for a wide range of skin disorders, are associated with side effects both systemic and cutaneous. Cutaneous , adverse , steroids.

    Topical corticosteroids, though very useful for treatment of dermatological disorders can produce various side effects. Introduction Topical steroids were introduced in , when Sulzberger and Witten first used topical hydrocortisone. Open in a separate window. Wrinkling and thinning of skin 4 weeks after irregular use of Mometasone. Physiology of skin atrophy due to topical steroids Topical steroids cause the synthesis of lipocortin, which inhibits the enzyme phospholipase A2.

    Pathogenesis of skin atrophy due to topical steroids Inhibitory effect on keratinocyte proliferation in the epidermis. Inhibition of fibroblasts and hyaluronan synthase 3 enzyme resulting in the reduction of hyaluronic acid in the extracellular matrix leading to dermal atrophy.

    Steroid-Induced Telangiectasia Steroid-induced telangiectasia occurs due to stimulation of release of nitric oxide from dermal vessel endothelial cells leading to abnormal dilatation of capillaries.

    Steroid Acne The pathogenesis of topical steroid-induced acne has been proposed to be due to the degradation of the follicular epithelium, resulting in the extrusion of the follicular content. Steroid Rosacea Topical steroids increase the proliferation of Propionibacterium acnes , and Demodex folliculorum , leading to an acne rosacea-like condition within 6 months. Topical steroid - dependent face. Used as fairness cream for 2 months.

    Perioral Dermatitis Facial perioral dermatitis, more commonly seen in females, presents with follicular papules and pustules on an erythematous background, with sparing of the skin near the vermillion border of the lips.

    Purpura, Stellate Pseudoscars, Ulcerations Steroid-induced protein degradation leads to dermal atrophy and loss of intercellular substance, which further cause blood vessels to lose their surrounding dermal matrix, resulting in the fragility of dermal vessels, purpuric hypopigmented, and depressed scars.

    Aggravation of Cutaneous Infections Tinea versicolor, onychomycosis, dermatophytosis and Tinea incognito [ Figure 3 ] are the common cutaneous infections aggravated by topical steroids. Delayed Wound Healing Delayed wound healing may occur due to various reasons.

    Contact Sensitization to Topical Steroids Contact sensitization may occur due to prolonged use of steroids and application of certain drugs e. Eyelid Dermatitis Patients with atopic and seborrheic dermatitis on chronic topical steroids, develop a flare around the eyes within days after stoppage of steroids.

    Tachyphylaxis Topical corticosteroids may induce tachyphylaxis with chronic use. Trichostasis Spinulosa A study has shown the association of trichostasis spinulosa with topical steroids. Striae Rubrae Distensae Striae due to steroids must be differentiated from those due to weight gain and pregnancy. Striae due to topical steroid applied for 3 weeks for atopic dermatitis. Post Peel Laser Erythema Syndrome Persistent redness of the face, after peel or laser has been noted in patients using topical steroids before the procedure.

    Status Cosmeticus Women with status cosmeticus cannot tolerate makeup and complain of a continuous burning sensation after any application.

    Steroid atrophy - Wikipedia

    skin thinning steroid cream

    Steroid Creams Won't 'Thin' Skin of Kids with Eczema

    skin thinning steroid cream

    Steroid Creams Can Help with Skin Inflammation but Are Not a Cure – Mayo Clinic News Network

    skin thinning steroid cream