Corticosteroid-induced atrophy and barrier impairment measured by non-invasive methods in human skin.
OBJECTIVE
Atrophy is a distressing side effect of potent corticosteroids. After open application of a high potency steroid, we monitored atrophogenicity by a variety of non-invasive methods.


METHODS
Volar forearms were treated twice daily for 3 or 4 weeks, with clobetasol propionate cream (Temovate). The following methods were used: 1) confocal microscopy, 2) transepidermal water loss (TEWL), 3) dimethyl sulfoxide whealing, 4) sodium hydroxide erosions, 5) analysis of stratum corneum lipids, and 6) B-scan ultrasound.


RESULTS
Confocal microscopy revealed thinning of the epidermis, decreased microvasculature and decreased size of keratinocytes. Evaporimetry demonstrated transepidermal water loss. Whealing to dimethyl sulfoxide was enhanced. Sodium hydroxide erosions formed more quickly. The amount of ceramides, cholesterol, and free fatty acids was reduced. Ultrasound showed thinning of the dermis.


CONCLUSIONS
Non-invasive methods are very useful for quantifying the atrophogenicity of topical corticosteroids.
Kolbe
L
L
S.K.I.N. Inc., Conshohocken, PA, USA.
Kligman
A M
AM
Schreiner
V
V
Stoudemayer
T
T
D000287:Administration, Topical; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002990:Clobetasol / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000494:pharmacology*; D004121:Dimethyl Sulfoxide / Q000494:pharmacology; D004817:Epidermis / Q000737:chemistry; D005260:Female; D005938:Glucocorticoids; D006801:Humans; D008055:Lipids / Q000032:analysis; D018613:Microscopy, Confocal; D008875:Middle Aged; D009824:Ointments; D012867:Skin / Q000187:drug effects* / Q000648:ultrastructure; D012972:Sodium Hydroxide / Q000494:pharmacology; D014870:Water Loss, Insensible / Q000187:drug effects
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D008055:Lipids; D009824:Ointments; D012972:Sodium Hydroxide; D002990:Clobetasol; D004121:Dimethyl Sulfoxide