title: Evaluation of the atrophogenic potential of hydrocortisone 1% cream and pimecrolimus 1% cream in uninvolved forehead skin of patients with atopic dermatitis using optical coherence tomography.
abstract: Topical corticosteroids are widely used to treat atopic dermatitis (AD), but their anti-inflammatory mode of action can be accompanied by several unwanted side effects including skin atrophy and telangiectasia. In this 8-week, investigator-blinded, intraindividual right-left comparison study with patients with mild-to-moderate AD, hydrocortisone 1% cream (HCT) was applied twice daily for 4 weeks on one side of forehead skin without clinical signs of AD and pimecrolimus 1% cream (PIM) on the other. Epidermal and dermal thickness were assessed by optical coherence tomography (OCT) and high-frequency ultrasound, respectively. Skin atrophy and telangiectasia were assessed by contact dermatoscopic photography (Dermaphot(®)). Treatment with HCT leads to a significant decrease in epidermal thickness after only 2 weeks of treatment, while the decrease in PIM-treated sites was less pronounced and was not statistically significant. By 4 weeks after the end of treatment, epidermal thickness returned to baseline values. No dermal thinning or development of telangiectasia could be observed by means of ultrasound or Dermaphot(®), respectively. In summary, this study indicates that a 2-week single course of topical treatment with a mildly potent steroid can cause transient epidermal thinning, an effect not seen in the PIM group. The slight decrease with PIM - although not significant - could be due to normalization of the increased skin thickness caused by a subclinical inflammation in AD. This study suggests that PIM may be safer for treatment of AD in sensitive skin areas like the face, especially when repeated application is required.
authors.affiliation: Department of Dermatology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Roland.Aschoff@uniklinikum-dresden.de
authors.forename: Roland
authors.initials: R
authors.lastname: Aschoff
authors.forename: Jochen
authors.initials: J
authors.lastname: Schmitt
authors.forename: Peter
authors.initials: P
authors.lastname: Knuschke
authors.forename: Edmund
authors.initials: E
authors.lastname: Koch
authors.forename: Matthias
authors.initials: M
authors.lastname: Bräutigam
authors.forename: Michael
authors.initials: M
authors.lastname: Meurer
mesh_terms: D000328:Adult; D001284:Atrophy / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000473:pathology; D065095:Calcineurin Inhibitors; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000473:pathology*; D003879:Dermatologic Agents / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016037:Single-Blind Method; D012867:Skin / Q000000981:diagnostic imaging / Q000187:drug effects / Q000473:pathology; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D041623:Tomography, Optical Coherence; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D065095:Calcineurin Inhibitors; D003879:Dermatologic Agents; C117268:pimecrolimus; D006854:Hydrocortisone; D016559:Tacrolimus