Topical steroids are a common pharmaceutical solution of treating skin disorders such as eczema and psoriasis. Topical corticosteroids are indicated only for short term use. Several side effects are observed when these medicines are used for extended periods, whether topically or systemically.
One of the side effects of topical corticosteroid overuse is atrophy. In such cases, the skin loses perfusion and becomes parched and wrinkly. Steroid-induced skin atrophy is thinning of the skin as a result of prolonged exposure to topical steroids steroids.
Physiology and Pathogenesis of Atrophy in Corticosteroid Use
Topical corticosteroids prevent inflammation by inhibiting an enzyme called Phospholipase A2. Phospholipase A2 is responsible for releasing arachidonic acid, which causes inflammation. Topical corticosteroids achieve this inhibition cycle through lipocortin, which directly inhibits Phospholipase A2.
However, Phospholipase A2 is not the only protein that topical steroids inhibits. Collagen, an essential structural protein, declines when corticosteroids are overused. This decline heralds the process of atrophy formation. This spreading atrophy causes a stinging or burning sensation, sending off a signal that results in vasoconstriction.
When the steroid is withdrawn, the constricted blood vessels become dilated once more. The longer the steroid was employed, the more dilation will occur when it is finally discontinued. This causes a ‘’trampoline-effect’’, where the resulting vasodilation outweighs the initial vasoconstriction it wishes to counterbalance.
Signs and Symptoms on Atrophy and Skin Thinning
Atrophied skin is dry, wrinkled and is very easily bruised. Atrophy often comes with telangiectasia, purpura and striae.
Bandage dressings and plasters that are too tight are known to worsen the signs of atrophy. Steroids combined with moisturzers are more likely to cause adverse effects.
Prevention of Steroid Induced Atrophy and Skin Thinning
The most obvious prevention of steroid induced atrophy is to not use topical steroids at all, however for many, that may not be possible or too late.
Common Recommendation by doctors:
When topical corticosteroids are used for short periods, doctor’s suggest there is a smaller risk of atrophy. Since topical steroids comes in various potency grades, it is common for doctors recommend to stick to the recommended class for a particular body part. For example, applying hydrocortisone cream once a day to the affected site is considered a Level 1 treatment. The higher strength steroid creams are often reserved for the trunk, while sensitive areas like the face and genitals are commonly treated with only low potency corticosteroids.
Many people with topical steroid withdrawal (also known as Red Skin Syndrome) do not agree with the above recommendation, however we have included it there for reference.
Treatment of Topical Steroid Withdrawal and Skin Atrophy
Due to topical steroid withdrawal being an adverse effect to the discontinued use of a pharmaceutical medicine, it is only just recently being recognised a medical phenomena. Currently there is no cure or standardized medical treatment. The time it to takes to heal from topical steroid withdrawal is still unknown and is unique from person to person.
Our Mission at TSW Assist
Our mission here at TSW Assist is to gather insights of medications, products, routines, supplements, and therapies that can help manage the symptoms experienced during withdrawal period from topical steroids. There is currently no cure for topical steroid withdrawal but these insights come directly people with TSW who have had success in symptomatic relief during their withdrawal period.