steroid cream for hypopigmentation

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Steroid cream for hypopigmentation

Seen in eczema, scarlet fever. Annular lesions: nummular eczema, secondary syphilis. Lichenification: chronic eczema, often becomes hyperpigmented. Keloid formation: scars. Ulcerative reactions: prominent in SS anemia, lupus, chicken pox. Vesiculobullous reactions very common in children: insect bites, chicken pox.

Granulomatous reactions: sarcoid. Pigmentary reactions Inflammation, trauma and medications used for topical treatments often result in hypopigmentation or hyperpigmentation. Congenital hypopigmentation, usually midline, is common. Mongoloid spots. Vitiligo is a major cosmetic problem, noted earlier in pigmented skin. Post inflammatory hypopigmentation commonly seen with superficial dermatitis such as seborrheic dermatitis, diaper dermatitis, pityriasis alba on face in children.

Scratching and secondary infection produce hyperpigmentation in eczema, pityriasis rosea and chicken pox. Treat aggressively and early to prevent itching and infection. Medications commonly cause pigment changes: fluorinated steroids cause hypopigmentation.

Use of bleaching creams is common in African Americans and West Africans Hair straighteners commonly cause chemical dermatitis and burns. Visits to the Southeast US are associated with infected insect bites, impetigo, tinea versicolor in children. Traumatic alopecia and folliculitis from corn rowing, tight hair braids or tufts.

Circular burns used to treat severe febrile illness and hepatitis in E. Africa — burn scars are located periumbilical, wrists, ankles. Herpes vesicles are on an erythematous base and usually clustered. The lesions of TNPM are scattered and on a pigmented macule. TNPM leaves a hyperpigmented macule that fades with time 3 weeks to 3 months.

Acropustulosis of Infancy — Pustules on distal extremities, palms and soles predominantly in black male infants in 1st years of life. Lesions are intensely pruritic and recur. Often confused with scabies. Antihistamines give some relief. Need to check for G6PD deficiency before treating. Childhood Problems Tinea capitis is very common in Blacks and is due to trichophyton tonsurans.

Selenium sulfide shampoo helps prevent spread of spores in household. Antibiotics not needed even though looks pustular. Koushik Lahiri, b Telangiectasia overlying vitiligo patch on eyelid. Kaushik Lahiri, b Telangiectasia with bacterial infection. Shyam Verma, b Perilesional diffuse hypopigmentation Courtesy Dr. Shyam Verma. Skin atrophy is the commonest side effect, reported to be caused by all topical TS. Epstein et al. Microscopic degenerative changes in epidermis are evident following days of treatment.

Initially epidermis becomes thin due to reduction in epidermal cell size, which reflects a decreased metabolic activity. After prolonged exposure there is a reduction in cell layers, that is, stratum granulosum disappears and stratum corneum becomes thin. Synthesis of stratum corneum lipids and keratohyalin granules and formation of corneodesmosomes required for structural integrity of stratum corneum are suppressed. Inhibition of the function of melanocytes may occur, giving rise to localized hypopigmentation.

Topical steroids induce resorption of mucopolysaccharide ground substance in the dermis. Repeated use in the same area causes epidermal thinning and changes in connective tissue of dermis leading to lax, transparent, wrinkled and shiny skin along with striae, fragility, hypopigmentation and prominence of underlying veins. The loss of connective tissue support for dermal vasculature results in erythema, telangiectasia and purpura. Degree of skin atrophy is influenced by age, body site, potency and presence of occlusion.

It is caused by suppressive action on cell proliferation and inhibition of collagen synthesis. Dermal atrophy is caused by decreased fibroblast growth and reduced synthesis of collagen, acid mucopolysaccharides and stimulation of human dermal microvascular endothelial cells.

Intertriginous areas are particularly susceptible due to thinner skin, increased moisture, elevated temperature and partial occlusion provided by the skin in these sites. Striae due to TS use need to be distinguished from those that occur due to excessive weight gain and pregnancy. Contact hypersensitivity to TS may cause persistence or worsening of skin diseases. It is rare, but its risk increases with prolonged exposure. Nonfluorinated TS e. Binding to the amino acid arginine is probably required for development of contact allergy.

Contact sensitivity can develop not only to constituents e. Sensitivity to more than one TS is common. Risk factors for development of contact sensitivity include history of multiple patch test positivity to non-TS allergen, treatment resistant eczema, leg ulcers, stasis dermatitis, perineal dermatitis and chronic actinic dermatitis. It presents as chronic dermatitis not responding to locally applied steroids or rarely, as acute eczema, urticaria, acute local edema, immediate-type reaction, or id eruption like spread over the body.

Mucocutaneous infections tinea versicolor, onychomycosis due to Trichophyton and Candida species, dermatophytosis are common during treatment with TS, occurring early in the therapy. When dermatophyte infections are treated with TS, the symptoms and signs improve transiently, giving rise to tinea incognito. TS suppress the normal cutaneous immune response to dermatophytes leading to enchantment of fungal infections. Granuloma gluteale infantum a persistent reddish-purple, granulomatous, papulonodular eruption seen on buttocks, thighs or inguinal fold in children, is a well-known consequence of diaper dermatitis being treated with TS, caused by impairment of immune response to Candida by TS.

Similar effects on mitigation or prolongation of herpes simplex, molluscum contagiosum and scabies infection have also been reported; hence TS should not be used in presence of these infections. TS also facilitate proliferation of Propionibacterium acnes and Demodex folliculoroum leading to acne-rosacea like condition.

Reactivation of Kaposi sarcoma has also been reported. Systemic corticosteroid therapy, in some cases intravenous or inhaled TS are known to induce acneiform lesions. The eruption consists of small and uniformly sized monomorphic inflammatory papules and pustules with few or no comedones, located predominantly on trunk and extremities, with less involvement of the face. In the case of inhaled steroids, lesions occur in and around nose or mouth. Anti-inflammatory effects of TS may initially suppress inflammatory lesions and erythema, but flare-ups occur on stopping TS.

The eruption subsequently resolves after discontinuation of the TS. Topical steroids induce comedone formation by rendering follicular epithelium more responsive to comedogenesis. They also lead to increased concentration of free fatty acids in skin surface lipids and increased numbers of bacteria in the pilosebaceous duct. Free fatty acids, formed in pilosebaceous ducts by breakdown of triglycerides in the sebaceous secretion, may contribute to comedogenesis.

Topical steroids induced rosacea is seen in middle-aged woman, presenting with papules and pustules. These are initially controlled with low potency TS, but lesions may reappear and require continued use of higher potency TS. Perioral dermatitis occurs in females on the face and is caused by long term use of potent TS on face.

It presents as follicular papules and pustules on an erythematous base seen in a perioral distribution, with sparing of skin adjacent to the vermilion border. It is also seen in men and children. Steroids promote vellus hair growth by unknown mechanism. Local and disseminated hypertrichosis due to TS is rare, seen commonly with systemic steroids.

Even months after withdrawal of TS the darker hairs may persist. Hypopigmentation after topical use is quite common, but not noticed frequently in very light skinned individuals. TS probably interfere with the melanin synthesis by smaller melanocytes, causing patchy areas of hypopigmentation which are reversible after discontinuation of steroids.

Hyperpigmentation after intralesional steroids has been well-documented. These develop after severe steroid induced dermal atrophy and loss of intercellular substance, causing blood vessels to lose their dermal matrix support. The resulting fragility of dermal vessels leads to purpuric, irregularly shaped, hypopigmented, depressed pseudoscars over extremities. Continued misuse of TS can also lead to ulceration. Tachyphylaxis is characterized by decreasing efficacy of TS during continued treatment.

It occurs commonly in psoriasis patients. Withdrawal of TS is followed by a disease flare. As the tissue becomes less sensitive tachyphylaxis , increasingly potent preparations are required to achieve comparable effects, leading to more severe side effects. Withdrawal of potent TS applied to the extensive area of psoriasis for a prolonged period may result in a relapse or a papulopustular flare and may even precipitate unstable or severe generalized pustular psoriasis.

This is especially likely when steroids are used in large quantities or applied under occlusion. Similarly, abrupt withdrawal can cause eczema flares. Steroid addiction is known to occur after inadvertent application of potent TS usually on the face. Three phases have been described: 1 Initial treatment improves pustulation, pruritus, erythema and scaling; 2 with continued use, local immunosuppression increases microbial growth and 3 on treatment withdrawal, rebound flares of itching, redness, postulation and scaling are seen.

Misuse of TS on the face is seen all over India and its incidence appears to be increasing rapidly. TSDF has also been described under various names like steroid addiction, dermatitis rosaceaformis steroidica and red face syndrome. In this condition after long term application of TS on the face, there is severe rebound erythema, burning and scaling on the face on attempting to stop the application of TS.

Side effects caused by steroid eye drops are listed in Table 1. But there are few reports of such ocular complications due to TS. Blindness due to glaucoma following extended TS use on the face is reported. Topical steroids have demonstrated to impair wound healing and re-epithelialization in animal and human models. Topical steroids are known to decrease skin elasticity. This can be assessed by pulling the skin and observing incomplete retraction on mechanical stress cessation.

Skin aging pathophysiology is similar to the one that follows TS application. Marked skin thickness decrease, especially in light-exposed areas and delayed skin recovery are reported. Topical steroids application can lead to subtle changes in the epidermal barrier as observed by decreased formation of lipid lamellar bodies and delayed barrier recovery.

This effect, theoretically may worsen barrier impairment in atopic dermatitis and psoriasis, but it seems to be outweighed by reducing inflammation and permitting barrier repair. Vehicle of TS can potentiate the side effects of TS and cause local side effects of its own. Table 3 lists the components of the vehicle that cause side effect.

British National Formulary states that skin of children is sensitive so they are likely to be susceptible to side effects of TS, hence they should be avoided in children or, if necessary, used with care and for short periods. Food and Drug Administrations center for drug evaluations and research have reported TS side effects similar to those seen in adults. Some side effects not reported in adults but seen in children include local irritation, mood change, gynecomastia, genital hypertrichosis and staphylococcal infection.

Guidelines regarding TS use are available to prevent their misuse. General measures to prevent TS induced side effects are mentioned in Table 4 while Table 5 mentions measures to prevent site specific side effects. Topical corticosteroids misuse occurs at various levels. The pharmaceuticals manufacture and promote unethical combinations e.

The onus of countering this menace behoves on Indian dermatologists. A continuing chain of intensive awareness campaigns on their part with relentless interaction with the policy makers may halt the relentless progress of TC abuse. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U.

Indian Dermatol Online J. Author information Copyright and License information Disclaimer. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract The introduction of topical steroids TS of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. Keywords: Local systemic, side effects, topical steroids.

Side effects due to topical steroids TS are more prevalent than systemic reactions. Table 1 In the infection column, put comma between Granuloma gluteale infantum and genital ulceration. Open in a separate window.

Systemic adverse effects Systemic adverse effects from TS have also been described and they are more likely to develop when highly potent TS are used for prolonged periods on thin skin e. Mineralocorticoid effects Topical steroids have minimal or no mineralocorticoid activities, but hydrocortisone and 9-a-fluoroprednisolone, have measurable mineralocorticoid activity. Table 2 Rare systemic adverse effects of topical steroids[ 8 ]. Side effects due to intralesional steroids Hypopigmentation and skin atrophy can occur when TS are applied topically or injected locally.

NV ORGANON KLOOSTERSTRAAT

Many small, scattered, well-demarcated, hypopigmented macules on sun-exposed areas of the extremities; occurs in persons older than 50 years with dark skin tones. Hypopigmented patches with fine scaling and ill-defined borders; occurs in children with a history of atopy; typically involves the cheeks. Irregularly shaped, well-defined hypopigmented patch; history of corticosteroid injection in the local area. Depigmented macules and patches; often symmetric; usually affects the face, neck, and scalp, or areas of repeated trauma.

Already a member or subscriber? Log in. Address correspondence to Ali Alikhan, MD, at alikhama ucmail. Reprints are not available from the authors. Joint and soft tissue injection. Am Fam Physician. Intra-articular corticosteroids: an updated assessment. Clin Orthop Relat Res. Linear rays of hypopigmentation following intra-articular corticosteroid injection for post-traumatic degenerative joint disease. Dermatol Online J.

Perilesional linear atrophy and hypopigmentation after intralesional corticosteroid therapy. Report of two cases and a review of the literature. J Am Acad Dermatol. Stapczynski JS. Localized depigmentation after steroid injection of a ganglion cyst on the hand. Ann Emerg Med. Ortonne JP, Passeron T. Vitiligo and other disorders of hypopigmentation. London, United Kingdom: Elsevier Saunders; — Hypomelanoses and hypermelanoses.

Fitzpatrick's Dermatology in General Medicine. This series is coordinated by John E. Delzell Jr. Previously published Photo Quizzes are now featured in a mobile app. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto aafp.

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Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Previous: Predictors of Acute Myocardial Infarction. Sep 1, Issue. Photo Quiz White Spot on the Wrist. Enlarge Print Figure 1. After prolonged exposure there is a reduction in cell layers, that is, stratum granulosum disappears and stratum corneum becomes thin.

Synthesis of stratum corneum lipids and keratohyalin granules and formation of corneodesmosomes required for structural integrity of stratum corneum are suppressed. Inhibition of the function of melanocytes may occur, giving rise to localized hypopigmentation. Topical steroids induce resorption of mucopolysaccharide ground substance in the dermis. Repeated use in the same area causes epidermal thinning and changes in connective tissue of dermis leading to lax, transparent, wrinkled and shiny skin along with striae, fragility, hypopigmentation and prominence of underlying veins.

The loss of connective tissue support for dermal vasculature results in erythema, telangiectasia and purpura. Degree of skin atrophy is influenced by age, body site, potency and presence of occlusion. It is caused by suppressive action on cell proliferation and inhibition of collagen synthesis.

Dermal atrophy is caused by decreased fibroblast growth and reduced synthesis of collagen, acid mucopolysaccharides and stimulation of human dermal microvascular endothelial cells. Intertriginous areas are particularly susceptible due to thinner skin, increased moisture, elevated temperature and partial occlusion provided by the skin in these sites. Striae due to TS use need to be distinguished from those that occur due to excessive weight gain and pregnancy.

Contact hypersensitivity to TS may cause persistence or worsening of skin diseases. It is rare, but its risk increases with prolonged exposure. Nonfluorinated TS e. Binding to the amino acid arginine is probably required for development of contact allergy.

Contact sensitivity can develop not only to constituents e. Sensitivity to more than one TS is common. Risk factors for development of contact sensitivity include history of multiple patch test positivity to non-TS allergen, treatment resistant eczema, leg ulcers, stasis dermatitis, perineal dermatitis and chronic actinic dermatitis. It presents as chronic dermatitis not responding to locally applied steroids or rarely, as acute eczema, urticaria, acute local edema, immediate-type reaction, or id eruption like spread over the body.

Mucocutaneous infections tinea versicolor, onychomycosis due to Trichophyton and Candida species, dermatophytosis are common during treatment with TS, occurring early in the therapy. When dermatophyte infections are treated with TS, the symptoms and signs improve transiently, giving rise to tinea incognito.

TS suppress the normal cutaneous immune response to dermatophytes leading to enchantment of fungal infections. Granuloma gluteale infantum a persistent reddish-purple, granulomatous, papulonodular eruption seen on buttocks, thighs or inguinal fold in children, is a well-known consequence of diaper dermatitis being treated with TS, caused by impairment of immune response to Candida by TS.

Similar effects on mitigation or prolongation of herpes simplex, molluscum contagiosum and scabies infection have also been reported; hence TS should not be used in presence of these infections. TS also facilitate proliferation of Propionibacterium acnes and Demodex folliculoroum leading to acne-rosacea like condition. Reactivation of Kaposi sarcoma has also been reported. Systemic corticosteroid therapy, in some cases intravenous or inhaled TS are known to induce acneiform lesions. The eruption consists of small and uniformly sized monomorphic inflammatory papules and pustules with few or no comedones, located predominantly on trunk and extremities, with less involvement of the face.

In the case of inhaled steroids, lesions occur in and around nose or mouth. Anti-inflammatory effects of TS may initially suppress inflammatory lesions and erythema, but flare-ups occur on stopping TS. The eruption subsequently resolves after discontinuation of the TS. Topical steroids induce comedone formation by rendering follicular epithelium more responsive to comedogenesis. They also lead to increased concentration of free fatty acids in skin surface lipids and increased numbers of bacteria in the pilosebaceous duct.

Free fatty acids, formed in pilosebaceous ducts by breakdown of triglycerides in the sebaceous secretion, may contribute to comedogenesis. Topical steroids induced rosacea is seen in middle-aged woman, presenting with papules and pustules. These are initially controlled with low potency TS, but lesions may reappear and require continued use of higher potency TS.

Perioral dermatitis occurs in females on the face and is caused by long term use of potent TS on face. It presents as follicular papules and pustules on an erythematous base seen in a perioral distribution, with sparing of skin adjacent to the vermilion border. It is also seen in men and children. Steroids promote vellus hair growth by unknown mechanism. Local and disseminated hypertrichosis due to TS is rare, seen commonly with systemic steroids.

Even months after withdrawal of TS the darker hairs may persist. Hypopigmentation after topical use is quite common, but not noticed frequently in very light skinned individuals. TS probably interfere with the melanin synthesis by smaller melanocytes, causing patchy areas of hypopigmentation which are reversible after discontinuation of steroids.

Hyperpigmentation after intralesional steroids has been well-documented. These develop after severe steroid induced dermal atrophy and loss of intercellular substance, causing blood vessels to lose their dermal matrix support. The resulting fragility of dermal vessels leads to purpuric, irregularly shaped, hypopigmented, depressed pseudoscars over extremities. Continued misuse of TS can also lead to ulceration.

Tachyphylaxis is characterized by decreasing efficacy of TS during continued treatment. It occurs commonly in psoriasis patients. Withdrawal of TS is followed by a disease flare. As the tissue becomes less sensitive tachyphylaxis , increasingly potent preparations are required to achieve comparable effects, leading to more severe side effects.

Withdrawal of potent TS applied to the extensive area of psoriasis for a prolonged period may result in a relapse or a papulopustular flare and may even precipitate unstable or severe generalized pustular psoriasis. This is especially likely when steroids are used in large quantities or applied under occlusion.

Similarly, abrupt withdrawal can cause eczema flares. Steroid addiction is known to occur after inadvertent application of potent TS usually on the face. Three phases have been described: 1 Initial treatment improves pustulation, pruritus, erythema and scaling; 2 with continued use, local immunosuppression increases microbial growth and 3 on treatment withdrawal, rebound flares of itching, redness, postulation and scaling are seen.

Misuse of TS on the face is seen all over India and its incidence appears to be increasing rapidly. TSDF has also been described under various names like steroid addiction, dermatitis rosaceaformis steroidica and red face syndrome. In this condition after long term application of TS on the face, there is severe rebound erythema, burning and scaling on the face on attempting to stop the application of TS.

Side effects caused by steroid eye drops are listed in Table 1. But there are few reports of such ocular complications due to TS. Blindness due to glaucoma following extended TS use on the face is reported. Topical steroids have demonstrated to impair wound healing and re-epithelialization in animal and human models. Topical steroids are known to decrease skin elasticity.

This can be assessed by pulling the skin and observing incomplete retraction on mechanical stress cessation. Skin aging pathophysiology is similar to the one that follows TS application. Marked skin thickness decrease, especially in light-exposed areas and delayed skin recovery are reported. Topical steroids application can lead to subtle changes in the epidermal barrier as observed by decreased formation of lipid lamellar bodies and delayed barrier recovery.

This effect, theoretically may worsen barrier impairment in atopic dermatitis and psoriasis, but it seems to be outweighed by reducing inflammation and permitting barrier repair. Vehicle of TS can potentiate the side effects of TS and cause local side effects of its own. Table 3 lists the components of the vehicle that cause side effect. British National Formulary states that skin of children is sensitive so they are likely to be susceptible to side effects of TS, hence they should be avoided in children or, if necessary, used with care and for short periods.

Food and Drug Administrations center for drug evaluations and research have reported TS side effects similar to those seen in adults. Some side effects not reported in adults but seen in children include local irritation, mood change, gynecomastia, genital hypertrichosis and staphylococcal infection. Guidelines regarding TS use are available to prevent their misuse.

General measures to prevent TS induced side effects are mentioned in Table 4 while Table 5 mentions measures to prevent site specific side effects. Topical corticosteroids misuse occurs at various levels. The pharmaceuticals manufacture and promote unethical combinations e. The onus of countering this menace behoves on Indian dermatologists. A continuing chain of intensive awareness campaigns on their part with relentless interaction with the policy makers may halt the relentless progress of TC abuse.

Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian Dermatol Online J. Author information Copyright and License information Disclaimer. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract The introduction of topical steroids TS of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. Keywords: Local systemic, side effects, topical steroids. Side effects due to topical steroids TS are more prevalent than systemic reactions.

Table 1 In the infection column, put comma between Granuloma gluteale infantum and genital ulceration. Open in a separate window. Systemic adverse effects Systemic adverse effects from TS have also been described and they are more likely to develop when highly potent TS are used for prolonged periods on thin skin e. Mineralocorticoid effects Topical steroids have minimal or no mineralocorticoid activities, but hydrocortisone and 9-a-fluoroprednisolone, have measurable mineralocorticoid activity.

Table 2 Rare systemic adverse effects of topical steroids[ 8 ]. Side effects due to intralesional steroids Hypopigmentation and skin atrophy can occur when TS are applied topically or injected locally. Figure 1. Koushik Lahiri, b Steroid acne. Figure Figure 2. Figure 3. Shyam Verma, b Comedonal and papular acne. Figure 4. Figure 5.

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Once the diagnosis of melasma has been confirmed, treatment options can be discussed. Many of these treatments are only available on prescription. Other chemical peels such as salicylic acid can also be effective. Chemical peels can have dangerous side effects, including cardiac arrhythmias, and facial scarring.

Always seek the advice of an experienced Consultant Dermatologist before choosing to use a chemical peel. Looking after your skin is hard work. Unfortunately, we all tend to ignore our skin when we are young, at our peril. Once skin lesions have developed from excessive exposure to sunlight, they are difficult to treat. We all fear skin cancer, but even benign abnormalities of the skin such as hyperpigmentation can cause much distress, embarrassment, and affect our self-confidence and our social lives.

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Open-source software as a force for good in local government July 14, Forensic treatment of young people as a chance July 13, Mobile :. Title :. Report Problem :. Home Premium Questions Home Suggest a cream for dark pigmentation and tanned spots on the feet. Question: Can you please suggest a cream for the tanfull and dark spots feet.

I used Momate Cream but cant see any result. Please suggest better one. Regards Above answer was peer-reviewed by : Dr. Answered by. Kakkar Dermatologist Practicing since : Answered : Questions. Ask me a question. The User accepted the expert's answer Ask a Dermatologist. Share on. Ask a Doctor Now. Instant Access to Doctors. Questions Answered. People also viewed. Dark spots on hands and feet Dark spots on arch of feet Dark spots on bottom of feet and palms of hand Theres dark spot under my feet Lower leg and feet discoloration dark spots Dark spots under feet Dark spots and peeling skin on feet Feet peeling dark spots itchy Brown spots on legs and feet suggestions Dark spots on bottom of feet symptoms.

Suggest a cream for dark pigmentation and tanned spots on the feet Brief Answer: Use a superpotent topical steroid cream e. Forgot Password?