Steroid atrophy was first described by Epstein et al. in 1963 [1] and is known to occur following the use of topical as well as systemic corticosteroids [2]. Risk factors for the condition include the strength of the steroid formulation prescribed, duration and the frequency of use [2] [3]. Skin areas with a less depth of the dermal layer e.g. on the face and other areas e.g. groin, axilla, and vulva are more susceptible [4] [5] [6] while the palmar and plantar surfaces are less prone [7] to steroid atrophy.

Three stages in steroid atrophy have been reported: the first stage of pre-atrophy, followed by atrophy and the terminal stage of tachyphylaxis [8]. Patients present initially with a burning sensation in the area where the topical steroid is being applied. Continued use of the medication leads to vasoconstriction with a resolution of symptoms [8]. Atrophic thinning of the skin with telangiectasia is more common on the face while striae are more frequently seen in the axilla, groin, and vulva. The disorder is characterized by a transparent, fragile appearance of the skin, dryness, laxity with telangiectasia [9] [10] and an increased tendency for bruising, which has been described as steroid purpura [11].

The condition may improve if the medication is discontinued as soon as the patient presents with symptoms. Otherwise, long-term steroid use leads to irreversible striae and more prominent telangiectasias. Dermatological features of steroid atrophy resemble those of the skin in the elderly. However, steroid atrophy is usually not associated with malignant change while striae are not observed in aging skin.

• Sneezing

  Generally, nasal obstruction is more likely to improve than rhinorrhea or sneezing. It is of interest that most of these randomized trials of depot steroids were undertaken in Denmark. [waojournal.biomedcentral.com]

• Cardiac Signs and Symptoms

  Steroid shrinkage is not indicated in patients who have cardiac signs and symptoms combined with small mediastinums, or in patients who have large mediastinums without cardiac signs and symptoms. [pediatrics.aappublications.org]

• Strabismus

  For small hemangiomas around the periorbital area that pose no threat of amblyopia or strabismus, we believe that conservative management may still be the best approach. [healio.com]

• Subcutaneous Fat Atrophy

  Other names given to this finding are linear subcutaneous fat atrophy, perilymphatic atrophy, and linear atrophy of the skin following corticosteroid injections. [healio.com]

• Disfiguring Scar

  Here, we present the case of a young woman who developed disfiguring scarring after a depot steroid injection. This case highlights the risks of this form of treatment for allergic rhinitis. [waojournal.biomedcentral.com]

• Skin Tear

  Foy, Colin Pritchard and Andrew Kingsley, Pilot parallel randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people: ‘STOPCUTS’, Pilot and Feasibility Studies, 3, 1, (2017). Stephen M. [doi.org]

The diagnosis of steroid atrophy is based on the typical clinical appearance of the skin: increased skin transparency, consistency resembling that of a cigarette paper, and increased fragility with a tendency to bruise easily [2]. History will reveal either a short or long-term use of steroids, with symptoms related to the area in which the medication was applied.

As the condition in chronic stage is irreversible and as there is a potential for complications following an invasive procedure, surgical skin biopsies are not routinely performed. But if they are performed then, the following features are noted on histology: flattening of the epidermal-dermal areas [11], diminished epidermal width [10], reduced keratinocyte size [12], decreased number of fibroblasts [12] [13] and narrowing of the lipid lamella of the stratum corneum [14].

Several non-invasive techniques and assays to diagnose the condition have been devised both for clinical and experimental use. Evaporimeter assesses water loss from the transepidermal layer while the loss of cholesterol and fatty acids can be detected with stratum corneum lipid measurement [12]. Skin thinning can be measured using a screw gauge, laser microscope and ultrasound [12] [15]. However, these tests are cumbersome and patients have to use the medication for up to six weeks before results can be obtained [16].

Only four of these studies with three on body psoriasis evaluated the effect of long‐term treatment defined as 6‐month treatment duration or longer and did not identify HPA axis suppression by cortisol level measurement. [doi.org]

Excellent results with fat grafting for the treatment of steroid atrophy have been documented. [ncbi.nlm.nih.gov]

Before treatment all patients had very thin skin, severe laxity, purpura and echymoses and teleangiectasia. After treatment cure was achieved in all patients except for teleangiectasia in 36 cases. [llogo.hu]

Injected volumes of normal saline ranged from 5 to 20 cm3 per treatment session and three to six weekly treatments. The patients were completely satisfied with these results. Conclusion. [medications.com]

Generally a milder topical steroid or non-steroid treatment is used on the in-between days. [3] Strong steroids should be avoided on sensitive sites such as the face, groin and armpits. [en.wikipedia.org]

I am sorry to tell you that the side effects are having a very bad prognosis. However you can start using Silicone-based creams like Contractubex cream three or four times a day and massage properly in the area for the marks. [icliniq.com]

[…] should be avoided to reduce the risk of severe, persistent, or recurrent tinea infections. 31 Any rash treated with topical steroids that worsens or does not significantly improve should be reevaluated for the possibility of an undiagnosed infectious etiology [aafp.org]

Case Overview steroid atrophy Member Rated 0 Patient case no. 2035 Date added 18 May 2003 Patient details Age --Undetermined-- Localisation Lower limbs / feet / soles Primary Lesions Erythema Squames / scales Pustule / non follicular Pathophysiology adverse [dermquest.com]

Risk factors for reduced skin thickness and bone density: possible clues regarding pathophysiology, prevention, and treatment. J Am Acad Dermatol 1998;38(2 Pt 1):248-255. Havill S, Rademaker M. [medsafe.govt.nz]

You can prevent that easily. And how can you prevent testicular atrophy and testicular sensitivity from developing while you are on a steroid cycle? The answer is simple, you can avoid it by stacking HCG to your steroid cycle. [whatsteroids.com]

The paper focus on steroid-induced changes related to skin atrophy and the interest of calcipotriol/betamethasone dipropionate fixed-combination gel to prevent steroid-induced reduction of dermal extracellular matrix components. [genoskin.com]

[…] by applying pressure with gauze over the injection site as the needle is withdrawn to prevent leakage of corticosteroid along the needle track. 3 Soft tissue atrophy generally appears in 1 to 4 months and resolves 6 to 30 months later. 4 Patients with [mdedge.com]

Is there any way to prevent testicular shrinkage for steroid users? The best way to prevent damage is to not use to begin with. [dontcookyourballs.com]

You can help by adding to it. ( January 2019 ) Prevention [ edit ] In general, use a potent preparation short term and weaker preparation for maintenance between flare-ups. [en.wikipedia.org]

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