Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy

Castela, E.; Archier, E.; Devaux, S.; Gallini, Adeline; Aractingi, S.; Cribier, B.; Jullien, D.; Aubin, F.; Bachelez, Hervé; Joly, P.; Maître, Michel; Miséry, Laurent; Richard, M.‐A.; Paul, C.; Jp, Ortonne

doi:10.1111/j.1468-3083.2012.04523.x

Cited by 56 publications

(62 citation statements)

References 25 publications

(115 reference statements)

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“…Topical use of glucocorticoids can lead to the development of skin atrophy which is characterized by reduced skin thickness and elasticity, telangiectasia and purpura [3]. Glucocorticoids have been shown to reduce the proliferation and size of keratinocytes and to impair the skin barrier through inhibition of lipid synthesis [7, 15, 17].…”

Section: Introductionmentioning

confidence: 99%

Calcipotriol counteracts betamethasone-induced decrease in extracellular matrix components related to skin atrophy

Norsgaard

Kurdykowski²,

Descargues³

et al. 2014

Arch Dermatol Res

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The calcipotriol/betamethasone dipropionate fixed-combination gel is widely used for topical treatment of psoriasis vulgaris. It has been hypothesized that calcipotriol counteracts glucocorticoid-induced skin atrophy which is associated with changes in the extracellular matrix (ECM). To elucidate the combined effects of calcipotriol and betamethasone on key ECM components, a comparative study to the respective mono-treatments was carried out. The effect on collagen I synthesis, matrix metalloproteinase (MMP) secretion, and hyaluronic acid (HA) production was investigated in primary human fibroblast and keratinocyte cultures as well as in a human skin explant model. We show that calcipotriol counteracts betamethasone-induced suppression of collagen I synthesis. Similarly, calcipotriol and betamethasone have opposing effects on MMP expression in both fibroblasts and keratinocytes. Moreover, calcipotriol is able to restore betamethasone-impaired HA synthesis in keratinocytes and prevent betamethasone-induced epidermal thinning in minipigs upon treatment with the calcipotriol/betamethasone gel. In summary, our results show for the first time in primary human skin cultures that calcipotriol reduces early signs of betamethasone-induced skin atrophy by modulation of key ECM components. These results indicate that the calcipotriol component of the fixed-combination gel counteracts the atrophogenic effects of betamethasone on the skin.Electronic supplementary materialThe online version of this article (doi:10.1007/s00403-014-1485-3) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Calcipotriol counteracts betamethasone-induced decrease in extracellular matrix components related to skin atrophy

Norsgaard

Kurdykowski²,

Descargues³

et al. 2014

Arch Dermatol Res

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“…Extended steroid use leads to additional dermal deterioration and striae formation which, unlike epidermal atrophy, tend to be persistent or irreversible [22]. This aspect, along with a potential tendency to clinically underestimate steroidinduced skin atrophy in psoriatic plaques [6], emphasizes the need for an early objective determination of dermal atrophic changes prior to their clinical expression.…”

Section: Discussionmentioning

confidence: 99%

“…In plaque psoriasis, objective measurements of skin thickness have been widely used in clinical trials as indicators of effectiveness of therapy [11][12][13][14] and, to a lesser extent, as a means for early detection of steroidinduced skin atrophy [19,20]. More frequently, steroidinduced skin atrophy in psoriasis is assessed based on clinical examination [6]. In particular, use of low-potency corticosteroid for short periods of time is generally considered risk-free, with no development of skin atrophy [5].…”

Section: Introductionmentioning

confidence: 99%

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Conventional ultrasonography and sonoelastography in the assessment of plaque psoriasis under topical corticosteroid treatment – work in progress

et al. 2014

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Aims: The objective of the study was to compare the efficiency of 20 MHz skin ultrasonography and 40 MHz conventional ultrasonography in the assessment of plaque psoriasis and to assess the efficiency of 40 MHz real-time sonoelastography in the early detection of steroid-induced skin atrophy in psoriatic plaques. Patients and methods: Ultrasonographic blinded evaluation was performed on 16 plaques in three consecutive patients, at baseline and after hydrocortisone acetate 1% ointment six-week application. The parameters were epidermal and dermal thicknesses for gray-scale ultrasonography and strain ratio for sonoelastography. Strain ratio was computed between the dermis and the adjacent hypodermis. Student's t-test for paired samples was performed. A confidence level of p<.05 was considered significant. Results: At follow-up, epidermal thickness was significantly reduced with 20 MHz (p = .002) and 40 MHz sonography (p = .032), while dermal thickness varied insignifcantly with 20 MHz (p = .35) and 40 MHz sonography (p = .33). Measurements at 40 MHz were significantly higher than their 20 MHz counterparts at baseline (epidermis: p < .001; dermis: p = .003) and at follow-up (epidermis: p < .001; dermis: p = .001). Strain ratio revealed no significant change of dermal elasticity (p = .96). Conclusions: Although epidermal and dermal measurements varied significantly with 20 MHz and 40 MHz ultrasonography, both techniques efficiently quantified treatment response by measuring the reduction of epidermal thickness. Sonoelastographic findings were consistent with the expected outcome of short-term use of low-potency corticosteroid. Further studies are recommended.

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“…4 Treatment of skin disease with topical steroid ointments also rarely result in suppression of the HPA axis when used alone, unless highly potent corticosteroids are used or they are applied to an extensive area of the body surface for a long time. [5][6][7] In adults, the HPA axis may also be influenced by drugs that affect steroid metabolism through the cytochrome p450 pathway, including itraconazole and ritonavir.…”

Section: Long Answermentioning

confidence: 99%

A difficult case of atopic eczema

Garrett

Davies

Fiandeiro

et al. 2013

BMJ

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Topical corticosteroids in plaque psoriasis: a systematic review of risk of adrenal axis suppression and skin atrophy

Cited by 56 publications

References 25 publications

Calcipotriol counteracts betamethasone-induced decrease in extracellular matrix components related to skin atrophy

Calcipotriol counteracts betamethasone-induced decrease in extracellular matrix components related to skin atrophy

Conventional ultrasonography and sonoelastography in the assessment of plaque psoriasis under topical corticosteroid treatment – work in progress

A difficult case of atopic eczema

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