Steroid-induced skin atrophy
| Steroid-induced skin atrophy | |
|---|---|
| Skin atrophy | |
| Specialty | Dermatology |
| Symptoms | telangiectasias, purpura, striae, hypopigmentation |
| Complications | Possible HPA axis involvement |
| 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. |
| Causes | Changes in gene regulation and transcription of various mRNA |
| Risk factors | higher potency corticosteroids, more frequent application, extended duration of treatment, use of occlusion, infancy/childhood, location |
| Diagnostic method | Visual inspection of skin for visible signs of skin atrophy |
| Prevention | Intermittent maintenance therapy; increasing duration of interval between applications |
| Management | Discontinuation of treatment |
| Prognosis | Most signs of atrophy resolve by 1 to 4 weeks after discontinuation of the TCS; striae are permanent |
| Frequency | up to 5% after a year of use (in psoriasis) |
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. Topical steroids are typically prescribed for psoriasis, atopic dermatitis (eczema), and other itchy rashes. In people with psoriasis using topical steroids it occurs in up to 5% of people after a year of use. Intermittent use of topical steroids for atopic dermatitis is safe and does not cause skin thinning.
Skin atrophy can occur with both prescription and over the counter steroids. Potency of the topical steroid will influence its propensity to cause skin atrophy. Oral prednisone and intralesional steroids may also result in atrophied skin. Alternatives to topical steroids are available, depending on skin condition, with a reduced and different side effect profile.