Clinical, Cosmetic and Investigational Dermatology (Dec 2020)
Glucocorticoid-Induced Skin Atrophy: The Old and the New
Abstract
Elena Niculet,1 Carmen Bobeica,2 Alin L Tatu3– 5 1Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania; 2Department of Dermato-Venereology, Doctoral School, University of Medicine and Pharmacy “Gr. T. Popa”, Iași, Romania; 3Clinical Department, Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, Galati, Romania; 4Research Center in the Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, Galati, Romania; 5Dermatology Department, “Sf. Cuvioasa Parascheva” Clinical Hospital of Infectious Diseases, Galati, RomaniaCorrespondence: Carmen Bobeica Department of Dermato-VenereologyDoctoral School, University of Medicine and Pharmacy “Gr. T. Popa”, 16th University Street, Iași 700115, RomaniaTel +40744368150Email [email protected]: Glucocorticoids are major therapeutic agents highly used in the medical field. Topical glucocorticoids have biologic activities which make them useful in dermatology – anti-inflammatory, vasoconstrictive, immune suppressive and antiproliferative, in treating inflammatory skin disorders (allergic contact eczema, atopic hand eczema, nummular eczema, psoriasis vulgaris or toxic-irritative eczema). Unfortunately, the beneficial effects of topical glucocorticoids are shadowed by their potential for adverse effects – muscle or skin atrophy, striae distensae, rubeosis or acne. Skin atrophy is one of the most prevalent side-effects, with changes found in all skin compartments – marked hypoplasia, elasticity loss with tearing, increased fragility, telangiectasia, bruising, cutaneous transparency, or a dysfunctional skin barrier. The structure and function of the epidermis is altered even in the short-term topical glucocorticoid treatment; it affects stratum corneum components, subsequently affecting skin barrier integrity. The dermis is altered by directly inhibiting fibroblast proliferation, reducing mast cell numbers, and loss of support; there is depletion of mucopolysaccharides, elastin fibers, matrix metalloproteases and inhibition of collagen synthesis. Atrophogenic changes can be found also in hair follicles, sebaceous glands or dermal adipose tissue. Attention should be paid to topical glucocorticoid treatment prescription, to the beneficial/adverse effects ratio of the chosen agent, and studies should be oriented on the development of newer, innovative targeted (gene or receptor) therapies.Keywords: glucocorticoids, atrophy, skin, side-effects
