Steroid-induced skin atrophy

Steroid-induced skin atrophy
Skin atrophy
SpecialtyDermatology
Symptomstelangiectasias,[1] purpura, striae, hypopigmentation[2]
ComplicationsPossible 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 factorshigher potency corticosteroids, more frequent application, extended duration of treatment,[3] use of occlusion, infancy/childhood, location[2]
Diagnostic methodVisual inspection of skin for visible signs of skin atrophy[1]
PreventionIntermittent maintenance therapy; increasing duration of interval between applications[4]
ManagementDiscontinuation of treatment
PrognosisMost 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 at the level of the epidermis as a result of prolonged exposure to topical steroids. This is the most common side effect of overuse or misuse of topical steroids.[6] Topical steroids are typically prescribed for psoriasis, atopic dermatitis (eczema), and other itchy rashes.[7] 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.[8][9][10]

Skin atrophy can occur with both prescription and over the counter steroids.[11] Potency of the topical steroid will influence its propensity to cause skin atrophy.[12] Oral prednisone and intralesional steroids may also result in atrophied skin.[6][13] Alternatives to topical steroids are available, depending on skin condition, with a reduced and different side effect profile.[14][15][16]

  1. ^ 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): 811–813. doi:10.1016/j.jaad.2004.05.020. PMID 15523365.
  2. ^ a b c d e f Camisa C, Garofola C (2021). "Topical Corticosteroids". Comprehensive Dermatologic Drug Therapy. pp. 511–527.e6. doi:10.1016/B978-0-323-61211-1.00045-0. ISBN 978-0-323-61211-1.
  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. S2CID 23473646.
  4. ^ Lubach D, Rath J, Kietzmann M (1995). "Skin atrophy induced by initial continuous topical application of clobetasol followed by intermittent application". Dermatology. 190 (1): 51–55. doi:10.1159/000246635. PMID 7894098.
  5. ^ a b Castela E, Archier E, Devaux S, Gallini A, Aractingi S, Cribier B, et al. (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. ^ a b Hengge UR, Ruzicka T, Schwartz RA, Cork MJ (January 2006). "Adverse effects of topical glucocorticosteroids". Journal of the American Academy of Dermatology. 54 (1): 1–15. doi:10.1016/j.jaad.2005.01.010. PMID 16384751.
  7. ^ Ference JD, Last AR (January 2009). "Choosing topical corticosteroids". American Family Physician. 79 (2): 135–140. PMID 19178066.
  8. ^ Harvey J, Lax SJ, Lowe A, Santer M, Lawton S, Langan SM, et al. (October 2023). "The long-term safety of topical corticosteroids in atopic dermatitis: A systematic review". Skin Health and Disease. 3 (5) ski2.268: e268. doi:10.1002/ski2.268. PMC 10549798. PMID 37799373.
  9. ^ Chu DK, Chu AW, Rayner DG, Guyatt GH, Yepes-Nuñez JJ, Gomez-Escobar L, et al. (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. hdl:10576/50632. PMID 37678572. S2CID 261610152.
  10. ^ Axon E, Chalmers JR, Santer M, Ridd MJ, Lawton S, Langan SM, et al. (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.
  11. ^ Abraham A, Roga G (September 2014). "Topical steroid-damaged skin". Indian Journal of Dermatology. 59 (5): 456–459. doi:10.4103/0019-5154.139872. PMC 4171912. PMID 25284849.
  12. ^ Stacey SK, McEleney M (March 2021). "Topical Corticosteroids: Choice and Application". American Family Physician. 103 (6): 337–343. PMID 33719380.
  13. ^ Coondoo A, Phiske M, Verma S, Lahiri K (October 2014). "Side-effects of topical steroids: A long overdue revisit". Indian Dermatology Online Journal. 5 (4): 416–425. doi:10.4103/2229-5178.142483. PMC 4228634. PMID 25396122.
  14. ^ Atherton DJ (2003-10-25). "Topical corticosteroids in atopic dermatitis". BMJ (Clinical Research Ed.). 327 (7421): 942–943. doi:10.1136/bmj.327.7421.942. ISSN 1756-1833. PMC 259155. PMID 14576221.
  15. ^ Schneider S, Li L, Zink A (October 2021). "The New Era of Biologics in Atopic Dermatitis: A Review". Dermatology Practical & Conceptual. 11 (4): e2021144. doi:10.5826/dpc.1104a144. ISSN 2160-9381. PMC 8648434. PMID 35024236.
  16. ^ "Psoriasis: Learn More – Skin care and topical treatments", InformedHealth.org [Internet], Institute for Quality and Efficiency in Health Care (IQWiG), 2021-04-27, retrieved 2025-03-26
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