Skin atrophy

Clinical loss of normal skin markings without scarring is reported after multiple sessions of traditional Baker s peels. 

The main disadvantage of deep peel is the special set up needed for the procedure, due to the potential cardiotoxicity of phenol. In addition, special training is needed for the doctor and the office staff before the implementation of this technique in the daily practice. 

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The erythema of rosacea is caused by dilatation of the superficial vessels of the face. Visualization of the dermal capillaries is favored by skin atrophy due too photoaging. Edema can develop as a result of the increased blood flow in the superficial vessels. This edema might contribute to the late stage of fibroplasia and rhinophyma. 

It is important to remember that adverse effects of topical corticosteroids may be systemic in nature and hypothalamic-pituitary-adrenal axis suppression can occur, especially when high-potency corticosteroids are used. Infants and small children may be more susceptible due to their increased skin sur-face body mass ratio.18 Topical corticosteroids may also cause striae, skin atrophy, acne, telangiectasias, and rosacea.2,10,18 Atrophy can result in thin, fragile, easily lacerated skin. Striae are caused by tearing of dermal connective tissue and are irreversible.18 Due to their significant adverse-effect profile, it has been recommended that no topical corticosteroid be used regularly for more than 4 weeks without review and reassessment.2... 

Adverse effects from topical steroids are usually related to the potency of the steroid used, frequency of application, duration of therapy, and the site of application. Skin atrophy, hypopigmentation, striae, and steroid-induced acne are all possible side effects associated with long-term use.32,33... 

Korting, H. C., Vieluf, D. and Kerscher, M., 0.25% prednicarbate cream and the corresponding vehicle induce less skin atrophy than 0.1% betamethasone-17-valerate cream and 0.05% clobetasol-17-propionate cream. Eur. J. Clin. Pharmacol., 42, 159-61, 1992. 

Apply to affected area(s) bid-qid high potency, skin atrophy, systemic steroid effects. 

Lotrisone Antifungal Corticosteroid Cream Clotrimazole 1%, betamethasone dipropionate 0.05% [15,45 gm] Massage into affected areas bid skin atrophy and systemb steroid effects comrron. 

Mycolog-ll Corticosteroid Antifungal Cream, oint per gm Triamcinolone 1.0 mg, nystatin 100,000 U [15, 30, 60, 120 gm] Apply to the affected area(s) bid skin atrophy common. 

Atrophic changes Skin atrophy is common and may be clinically significant in 3 to 4 weeks with potent preparations. Certain areas of the body, such as the face, groin, and axillae, are more prone to atrophic changes than other areas of the body following treatment with corticosteroids. 

Other side effects include acne, striae, truncal obesity, deposition of fat in the cheeks (moon face) and upper part of the back (buffalo hump), and dysmenorrhea. Topical administration may produce local skin atrophy. In patients with AIDS who are treated with glucocorticoids, Kaposi s sarcoma becomes activated or progresses more rapidly. 

Allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy. Serious Reactions... 

Skin atrophy, hyperpigmentation, folliculitis Serious Reactions... 

Cushing s syndrome, numbness of fingers, skin atrophy... 

Hypertrichosis, hypopigmentation, maceration of skin, miliaria, perioral dermatitis, skin atrophy, striae... 

Blank, R.L., Use of Salicylic Acid for Regulating Skin Wrinkles and/or Skin Atrophy, U.S. Patent 5,780,456, July 14, 1998. 

Complications after steroid injection are minimal but can occur.The patient can expect slight discomfort at the injection site and occasionally subcutaneous white (steroid) deposits in the treated area. Depigmentation of the eyelid at the injection site, especially in dark-skinned individuals, and temporary skin atrophy can also occur. Skin depigmentation can be minimized by using a transconjunctival rather than a transepidermal injection in persons of color. When depigmentation occurs, it is... 

Long-term use. Skin atrophy can occur within... 

The local adverse effects of topical glucocorticoids (1,2) are listed in Table 1. They include transient local erythema, calcinosis cutis, cramps (due to injection of crystals into a vessel), amaurosis (a dubious report), depigmentation, skin atrophy, and skin necrosis (3,4). The systemic adverse effects of topical glucocorticoids (5-8), which are those to be expected from systemic use, are also listed in Table 1. 

The main adverse effect of pimecrolimus is local skin irritation, with a stinging or burning sensation, which occurs in 30% of patients. Typically, children have less skin irritation than adults. Adverse effects such as local immunosuppression and an increased risk of local bacterial and viral infections (notably eczema herpeticum) are less common than with topical glucocorticoids (5). In addition, there is a lack of skin atrophy (6,7). However, topical corticosteroids have the advantage of better skin penetration than pimecrolimus and will therefore continue to be used for more heavily keratinized skin such as in psoriasis (8). 

Side effects/ adverse reactions Frequent Burning, itching, skin irritation Occasional Erythema, dry skin, peeling, rash, worsening of psoriasis, dermatitis Rare Skin atrophy, hyperpigmentation, folliculitis... 

Possible slight skin atrophy Possible skin cancer decades after exposure... 

Possible skin atrophy, depigmentation, constant ulcer recurrence, or deformity... 

It makes little sense to combine tretinoin with a topical corticosteroid to limit the inflammatory reaction. It may well be that this combination is supposed to stop inflammation, but inflammation is beneficial in that it stimulates the process of skin repair, furthermore, the combined effect of corticosteroid and tretinoin could potentially cause telangiectasia. The tretinoin would stop skin atrophy as a result of the application of topical corticosteroid, whereas it should increase the thickness of the epidermis overall. A large part of the effect would therefore be lost, finally, corticosteroids should not be applied to the skin for a prolonged period, whereas long-term application of tretinoin is necessary. 

There is a risk of skin atrophy when all of the appendages of a treated area undergo necrosis. The skin does not have any source of supply to regenerate cells quickly. The ker-atinocyte clones can only come from the (distant) edges of the necrotic areas they cannot be produced in sufficient numbers for rapid skin regeneration if the lesion is more than a few centimeters in diameter. Lesions smaller than 1 cm in diameter, even in the deep reticular dermis, do not pose a high risk of scarring unless there is a secondary infection or the patient scratches the scabs. 

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