Video Steroid atrophy
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Within two weeks of starting Topical Steroid treatment, and perhaps within a few days, microscopic degenerative changes can be seen in the epidermis by reducing cell size and number of cell layers. This effect may be rapidly reversible but with chronic administration, skin changes become apparent. There is inhibition of fibroblast mitotic activity which results in the reduction of collagen synthesis and glycosaminoglycans but perhaps the earliest evidence of dermal atrophy is the reduction in fibril diameter and then collagen collection to atrophy and separation. The latter effect has been reported to be caused by inhibition of collagenase by steroids. The elastin fibers in the upper layers of the dermis become thin and fragmented while those deeper into the compact tissue are compact. As a result of atrophic changes such as striae, telangiectasias, purpura and ecchymosis develop. The use of long-term steroids causes irreversible atrophy, while atrophy caused by short-term use may to some extent be reversible except for striae.
Corticosteroids are absorbed at different rates depending on the thickness of the stratum corneum. Mild topical steroids that work on the face can reach slightly in the palm of the hand. But a strong steroid can quickly cause side effects on the face.
For example:
- The forearm absorb 1%
- The underarms absorb 4%
- Face absorbs 7%
- Eyelids and genitals absorb 30%
- Palm absorbs 0.1%
- Sole absorbs 0.05%
Absorption is greater on the base of ointment, in the presence of a keratolytic agent such as salicylic acid and under occlusion. Strong topical steroids (eg, fluorinated steroids) can cause very rapid conditions, while weaker steroids may induce them slowly over time. Preparations of corticosteroids containing urea or salicylic acid are stronger than those containing corticosteroids alone, as they increase the absorption of steroids into the skin.
Maps Steroid atrophy
Findings
Common skin atrophy consists of decreased epidermal and dermal thickness, regression of the sebaceous glands, subcutaneous fat loss, and muscle-layer atrophy. This change is usually observed after 2 to 3 weeks of moderate to high topical corticosteroid use. A very strong topical steroid application can lead to a detectable ultrasound detectable skin thickness of up to 3 days. Even potentially low topical steroids can cause mild skin atrophy that is often reversed after discontinuation of drugs. Atrophy and striae are concerned with high-permeability skin areas, such as the face and intertriginous areas, but these side effects can occur anywhere, especially after long-term or high-grade long-term topical corticosteroids. While mild atrophy and telangiectasia may be reversible after corticosteroid discontinuation, significant changes in skin texture and striae are considered permanent manifestations of corticosteroid-induced and drug-resistant atrophy.
The effect of topical steroid therapy can be negated by the depletion of the resulting stratum corneum. Such depletion impairs the barrier function and allows transepidermal water loss which may cause skin irritation. Sometimes, visible changes and textures on the skin are described as looking like "cigarette paper." Skin thinning due to decreased production of fibroblasts and the accumulation of collagen and elastin are not normal. The loss of hyaluronic acid causes a decrease in skin moisture retention.
The structural changes and chronological signs and symptoms of skin age and those of corticosteroids caused by chronic atrophy of the skin are partially similar. Epidermal depletion and weakness and drought, purpura and echymosis occur in both conditions. However, chronologically striae of the skin is not observed, whereas in corticosteroid atrophy, premalignant or malignant tumors are rarely observed.
Steroid Phobia
View the image to the right for demonstration of steroid thinning after the use of Clobetasol.
Recent medical research has shown that the fear of "skin thinning" in many cases is unfounded and can lead to poor compliance and treatment failure as a result of unnecessary fears. In most cases topical corticosteroids when used appropriately and when supervised by a doctor there is little risk of skin thinning and serious side effects even with long-term use (months).
Treatment
A clear priority is immediate cessation of other topical corticosteroid use. Protection and support of impaired skin barriers is another priority. Eliminating any hard skin regimens or products will be needed to minimize the potential of purpura or trauma, skin sensitivity, and potential infections. Steroids Atrophy is often permanent, although if it is immediately caught and topical corticosteroids are stopped in time, the extent of damage can be captured or slightly improved. However, while the accompanying Telangectasia may increase slightly, Striae is permanent and irreversible.
Recent studies have shown the potential for treatment of permanent corticosteroids caused by skin atrophy.
Prevention
Use of a wise topical steroid, with strict attention to strength, application area, duration and vehicle (eg, ointment stronger than cream) Occlusive ointment properties increase steroid penetration). In general, use strong short-term preparation and weaker preparation for maintenance between flare-ups. Although there is no best benefit-to-risk ratio, if long-term topical steroid use on the skin surface is required, heart rate therapy should be performed.
Pulse therapy refers to the application of corticosteroids for 2 or 3 consecutive days every week or two. This is useful for maintaining the control of chronic diseases. Generally a lighter topical steroid or non-steroid treatment is used on intermediate days.
Strong steroids should be avoided in sensitive places such as the face, groin and armpits. Even the application of weaker or safer steroids should be limited to less than two weeks on these sites.
Patients who choose to discontinue the use of topical steroids should discuss these options with their physician and visit a supportive site that promotes the use of safe steroids and usage education.
References
Source of the article : Wikipedia
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