Steroid-induced dermal atrophy. Investigations on discontinuous application

In this study several schedules of discontinuous application (DA) were tested, using various weak and strong topical corticosteroids (CS). The purpose of this study was to measure the influence of corticosteroids on skin thickness by means of a mechanical method. In a first experiment, betamethasone 17,21-dipropionate (Bet) and fluprednidene 21-acetate (Flu) were applied to the skin of the volar side of the forearm at a rhythm of 1:1 (1 day CS, 1-day interval) and 1:2 under occlusive dressing. The investigation period was 8 weeks. For comparison, Bet and Flu were applied continuously (CA) for 3 weeks. Flu thinned the skin to a lesser extent than Bet. With DA the skin was thinned to the same extent as with CA. In a second experiment, hydrocortisone 17-butyrate, betamethasone 17-valerate, desoxymethasone and hydrocortisone were tested. Here the treatment regimen was 5:9. The CS preparations were tested for 3 months on the volar side of the forearms under occlusive dressing. Skin thinning occurred during the 5 days of CS action and, in the beginning, receded again in the CS-free interval. However, this regressive process became weaker each time. At the end of the experiment the skin thinning persisted. With the exception of hydrocortisone, all CS tested produced statistically significant skin thinning after DA. The results of the investigation presented here show that thinning of the skin must also be expected with discontinuous application of topical CS.