Adverse effects of topical glucocorticosteroids

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Presentation transcript:

Adverse effects of topical glucocorticosteroids Ulrich R. Hengge, MD, Thomas Ruzicka, MD, Robert A. Schwartz, MD, Michael J. Cork, MD Journal of the American Academy of Dermatology Volume 54, Issue 1, Pages 1-15 (January 2006) DOI: 10.1016/j.jaad.2005.01.010 Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 1 Regional variation in percutaneous penetration of hydrocortisone in human beings, according to Feldmann and Maibach5 and Wester and Maibach.6 Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 2 A, Steroid atrophy on the dorsum of the left hand with hyperpigmentation as a consequence of easy bruising caused by rarefaction of connective tissue. Stellate pseudoscars and increased wrinkling are also apparent in this 37-year-old man. B, Thickened lichenified skin, severe epidermal atrophy, and erythema after inappropriate use of high-potency corticosteroids on the eyelids. A yellow crust indicates that impetigo contagiosa (streptococci) on the upper eyelid is also present. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 3 Striae distensae rubrae as a sign of topical corticosteroid abuse on the right thigh in a nonobese 27-year-old man. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 4 A, Long-term inadvertent use of corticosteroids for treatment of perioral and cheek dermatitis. B, Closer view of the left cheek showing atrophic skin and white scarring, along with telangiectases after uncontrolled use of high-potency steroids for 9 months. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 5 Steroid acne on the face characterized by pustules, erythema, and several open and closed comedones on the forehead. Free margins around the vermilion border are apparent. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 6 Steroid abuse in a patient with atopic dermatitis showing generalized facial erythema, patchy hyperpigmentation on the forehead, increased atrophy, and wrinkles around the eyes. This patient has continued treatment with stronger derivatives because of loss of effect (tachyphylaxis). Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 7 Hypopigmentation and hyperpigmentation due to easy bruising, as well as increased telangiectases and atrophy on the left forearm. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 8 Tinea incognito of the leg. This patient underwent treatment with corticosteroids that masked the diagnosis of tinea. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 9 Severe granuloma gluteale infantum in a 2-year-old child who underwent treatment for diaper dermatitis. Succulent red to livid granulomatous plaques appear on the thighs, the buttocks, the vulva, and the lower portion of the abdomen. Candida albicans was cultured from the inguinal fold. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions

Fig 10 Photoaged skin showing increased bruising, brownish discoloration of the skin, and scarring in a 74-year-old woman with atopic dermatitis. Journal of the American Academy of Dermatology 2006 54, 1-15DOI: (10.1016/j.jaad.2005.01.010) Copyright © 2006 American Academy of Dermatology, Inc. Terms and Conditions