Steroid atrophy is a side effect

Side effect

In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequences of the use of a drug.Occasionally, drugs are...

 of the use of topical steroid

Topical steroid

Topical steroids are the topical forms of corticosteroids. Topical steroids are the most commonly prescribed topical medications for the treatment of rash, eczema, and dermatitis. Topical steroids have anti-inflammatory properties, and are classified based on their vasoconstriction abilities. There...

s. It can be seen with other changes associated with chronic topical steroid use, including tinea incognito (fungus of the skin), steroid induced telengiectasia, steroid induced acne or rosacea, and steroid induced skin fragility. Long term use of an oral or systemic steroid can also cause skin fragility, although not as evident as topical steroid under occlusion.

Cause

Use of a topical steroid. Steroid atrophy can occur on any body surfaces, but the groin, buttock crease, face, arm pits, breast folds, and body folds are most commonly affected. Strong topical steroid (Class I, or fluorinated steroids) can induce the condition very quickly, while a weaker steroid (Class V and below) can induce it slowly over time. A favorite combination product that often can cause steroid atrophy is Lotrisone (topical betamethasone dipropionate

Betamethasone dipropionate

Betamethasone dipropionate is a glucocorticoid steroid with anti-inflammatory and immunosuppressive abilities. It is applied as a topical cream, ointment, lotion or gel to treat itching and other minor skin conditions such as eczema....

 with clotrimazole

Clotrimazole

Clotrimazole is an antifungal medication commonly used in the treatment of fungal infections such as vaginal yeast infections, oral thrush, and ringworm...

). Dermatophytes often are seen growing in the presence of this combination, especially in the groin. The topical steroid allows the fungus to grow, even in the presence of an effective antifungal

Antifungal

* Antifungal medication, a medication used to treat fungal infection s such as athlete's foot , ringworm, candidiasis, etc.* Antifungal protein, a protein family* an adjective referring to a fungicide compound...

. Other similar combinations are marketed (including triamcinolone

Triamcinolone

Triamcinolone is a long-acting synthetic corticosteroid given orally, by injection, inhalation, or as a topical ointment or cream....

 and clotrimazole), but are less likely to cause steroid atrophy if used correctly.

Findings

The skin appear to be shiny, thin, and lacking surface markings. Easy bruising is noted. Blood vessel

Blood vessel

The blood vessels are the part of the circulatory system that transports blood throughout the body. There are three major types of blood vessels: the arteries, which carry the blood away from the heart; the capillaries, which enable the actual exchange of water and chemicals between the blood and...

s can be seen easily through the near transparent skin. Associated inflammatory ane like lesions, and over growth of skin fungus (tinea corpora or tinea cruris

Jock itch

Tinea cruris, also known as crotch itch, crotch rot, Dhobie itch, eczema marginatum, gym itch, jock itch, and ringworm of the groin in American English is a dermatophyte fungal infection of the groin region in either sex, though more often seen in males...

) can often be seen as elevated red borders.

Treatment

Stop the offending topical steroid. Wean to a weaker topical steroid in a protective base like petroleum jelly

Petroleum jelly

Petroleum jelly, petrolatum, white petrolatum or soft paraffin, CAS number 8009-03-8, is a semi-solid mixture of hydrocarbons , originally promoted as a topical ointment for its healing properties...

. Use a topical antifungal cream to control any dermatophytes present. Unfortunately, if prolonged used of a strong topical steroid in a thin occluded skin area is suspected, the steroid induced changes will not be reversible.

Prevention

Judicious use of topical steroid. Strong topical steroid should be limited to areas of unocluded and thick skin such as the arms, and legs. Weaker topical steroid should be used on the face, groin, body folds, breast folds, and perineal area. Combination topical steroid and antifungal product should be avoided. If jock itch or tinea cruris is suspected, and antifungal cream should be used daily; while a mild topical steroid (class VI or less like hydrocortisone) should be used for no more than 1 week to control itching. If prolonged use of a topical steroid on a skin surface is required, it should be used on a week on, week off basis. Or alternately, on a 3 consecutive days on, followed by 4 consecutive days off.