Dermatologic treatment was greatly advanced when topical corticosteroids were introduced for the management of many inflammatory and pruritic dermatoses. Their use reduced or diminished most of the undiserable side effects which accompanied the systemic administration of these compounds. The good effects of topical application of hydrocortisone had been demonstration in the treatment of various dermatoses eg., atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. The halogenated derivatives followed and led to the trend to most of analogs now in use. Especially, fluocinolone acetonide cream greatly enhanced its therapeutic effectiveness in psoriasis, chronic discoid lupus erythematosus, pustular bacterid, granuloma and neurodermatitis circumscripta. But many side effects of topical corticosteroids such as steroid acne. stria were developed and also fluorinated topical corticosteroids resulted in telangiectasia, purpura, atrophy in skin. Weber reported that strong topical corticosteroids eg.. betamethasone valerate and fluocinolone acetonide were resulted in rosacealike dermatitis and it was steadily increased. These adverse side effcts of topical corticosteroids, especially steroid acne, were indisputable argument in dermatologic field, for the view that this topical corticosterodis is used for cosmetics and treatment of acne vulgaris in our country. Since the strong corticosteroid topical preparation, the peculiar form acne, so called steroid acne, was steadily increased in our clinic. Behrman and goodman reported that acneform eruption induced by hormone was not associated with oiliness and there were but few comedone. Sullivan and Zehgman reported that the the acneform eruption due to adrenal corticaa 1 hormone was uniform in size, small papule and few pustule, usually erythematous base. There were also differential histologic feature. The most important difference is the normal apperance of sebaceous glands in acneform eruption due to corticosteroids contrast with hyperplasia in acne vulgaris. Abscess formation was more frequent and more extensive in acne vulgaris.
Sutton Jr and Van Scott & MacCardle described that histologically, the major component in lesion of steroid acne was excessive keratinization of follicle. Castor and Baker demonstra-ted that topical application of corticosteroids resulted in decrease of sebaceous glands, decrease of mitosis and increased cornification in epidermis. The present study investigated clinical case of the steroid acne, which are induced by topical application and systemic administration of corticosteroids and experimentally induced the steroid acne with the topical application of corticosteroid. And also clinical cases and experimentally induced steroid acne were compared with acne vulgaris. Material and method Subjects are 13 Patients of steroid acne induced by strong topical corticosteroid eg., fluocinolone acetonide, fluocortolone, dexamethaone, betamethasone valerate and 4 patients of steroid acne induced by systemic administration of corticosteroid eg., prednisolone and also 10 patients of acne vulgaris. Biopsy was performed from 13 patients of topical steroid acne, 3 patients of steroid acne induced by systemic administration of steroid and one patient of acne vulgaris.
In order to induce steroid acne, experimentally, strong topical corticosteroid such as beta methasone valerate, fluocinolone acetonide and fluocortolone were applied on back. Comment and conclusion In Clinical feature, the steroid acne by topical application and systemic administration of corticosteroid and experimentally induced steroid acne had unique clinicall features, that showed absence of comedone and uniform sized follicular papule on deep seated erythematous scaly base. The topical steroid acne was distributed the region where were applied. But the eruption of the steroid acne induced by systemic administration of corticosteroids was distributed to face, neck, and scalp. Above findings are quite different form acne vulgaris. Histopathologically, the steroid acne induced by topical application and systemic administration of corticosterolds showed hypoplasia of sebaceous glands and excessive follicular keratinization. Occlusion of pilosebaceous opening by keratotic plug in severe case by long term application showed atrophy of epidermis and sparsity of sebaceous glands with hypokeratosis and parakeratosis. In experimentally induced steroid acne, it was definitely specific features which were absolutely identlcall with above clinical steroid acne.
|