Steroid withdrawal dermatitis: Mechanism and treatment

  • 林 子凱

Student thesis: Doctoral Thesis

Abstract

Skin atrophy and telangiectasia are common side effects of topical corticosteroid (TCS) Rebound flare of dermatitis or hypersensitive skin often occurs after the cessation of TCS of long term use resulting in a rapidly evolving complex with intense redness scaling and dryness of skin Withdrawal dermatitis (WD) clinically appears sometimes as the dermatitis which flares after discontinuation of TCS The mechanism of this specific WD remains not yet fully investigated Some hypotheses include compensatory vessel dilation induced by unbalanced nitric oxide or negative effects on the skin barrier including permeability and antimicrobial functions Although TCS can improve the inflammation but it has been shown that TCS also impairs skin barrier function and could affect the evolution of these dermatoses making skin more vulnerable to a new inflammatory flare TCS use both short-term and long-term profoundly interferes with barrier maturation processes (for examples DNA synthesis mitotic rate lipid synthesis keratinocyte differentiation and lamellar body formation) thereby resulting in permeability barrier disruption and decreases in water content of the stratum corneum (SC) especially with mid- or high-strength TCSs Here we investigated the WD resulted from cessation of long term application of TCS regardless of the original dermatoses We proposed that barrier repair therapy might prevent the WD resulting from cessation of long-term application of TCSs The rationale for barrier repair therapy goes beyond trapping moisture and preventing dry skin because of the numerous protective functions of SC including its antimicrobial function Here we revealed that topical antihistamines can improve contact dermatitis effectively; not only topical antihistamines can enhance epidermal differentiation and proliferation but also it can facilitate the formation of intercellular lipid bilayers in the SC Therefore topical antihistamines can be one of the good candidate of barrier therapies for WD induced by TCSs In my thesis we demonstrated that (1) the barrier abnormalities and keratinocyte-derived cytokine cascade develop after discontinuation of TCS in long-term treatments in skin using murine models; (2) topical application of antihistamine receptor antagonist possesses anti-inflammatory effects as well as enhances epidermal barrier functions in murine models; (3) cimetidine can prevent WD of TCSs from several different aspects of skin barrier (mechanical barrier permeability barrier antimicrobial barrier) in murine models My results provide an evident basis for topical cimetidine as the new aspect of therapies for WD of TCSs in human which can be further studied in the future
Date of Award2016 Aug 31
Original languageEnglish
SupervisorYing-Jan Wang (Supervisor)

Cite this

Steroid withdrawal dermatitis: Mechanism and treatment
子凱, 林. (Author). 2016 Aug 31

Student thesis: Doctoral Thesis