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Plate 2.10 Steroid acne. A curiously confined grouped of acne lesions with open and closed comedones induced by over-enthusiastic use of potent topical steroids.

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Plate 2.11 Perioral dermatitis. Note the scores of tiny sore red 'bumps' scattered over the lower face with striking sparing just around the vermillion of the lips. This side-effect of grade I and II topical corticosteroids is virtually never seen with grade IV steroids and rarely with grade III. It responds well to oral tetracycline.

Acne, or rosacea can be local, potentially reversible side-effects on the face for some individuals (Plate 2.10). Perioral dermatitis is a similar condition around the mouth, usually of younger people, and particularly women (Plate 2.11). Increased sebaceous activity can lead also to other acneform eruptions. Hirsutism is an occasional side-effect, caused by stimulation of steroid dependent hair follicles. Bacterial, fungal and viral infections may be exacerbated, or disguised. Although potent topical steroid use can cause skin lightening by inhibiting melanocyte function, the normally increased melanocyte activity induced by sun exposure is also inhibited by the inflammatory process itself. This is a reversible phenomenon. The risk of local side-effects Many studies of local side-effects, both experimental on healthy skin, and clinical on diseased skin (not always atopic eczema) have been published in recent years. Although certain overall observations are possible from a review of this research, it remains difficult to generate from these investigations any firm guiding principles. As in all fields of investigation, there are difficulties in comparing different studies. There are differences in terminology and definition, inherent difficulties in assessment, differences in study design and problems in comparing the effects on healthy skin with those seen in disease. That experimental studies of topical steroid effects show more evidence of skin thinning than is demonstrated by clinical studies is striking. Unfortunately it is not always clear if atrophy is being used as a general term including reversible epidermal thinning, or whether it is being reserved for the irreversible changes outlined above. Moreover most studies only report on these important

Profile for Christopher Bridgett

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients

Atopic Skin Disease - A Manual For Practitioners  

An account of a new behavioural approach to the treatment of atopic eczema, written for practitioners, but also for patients