Vulvar Skin Atrophy Induced by Topical Glucocorticoids

Johnson, Elisabeth; Groben, Pamela A.; Eanes, Alisa; Iyer, Priya S; Joseph, Ugoeke,; Zolnoun, Denniz

doi:10.1111/j.1542-2011.2012.00189.x

Cited by 13 publications

(7 citation statements)

References 8 publications

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“…2a). Consistent with prior studies [18, 29], treatments with topical GC delayed permeability barrier homeostasis (Fig. 2b).…”

Section: Resultssupporting

confidence: 92%

Topical Applications of a Heparinoid-Containing Product Attenuate Glucocorticoid-Induced Alterations in Epidermal Permeability Barrier in Mice

Wen

et al. 2021

Skin Pharmacol Physiol

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Introduction: Either systemic or topical glucocorticoids (GCs) can cause significant adverse effects on cutaneous structure and function. Although some products and ingredients can improve GC-induced abnormalities in epidermal permeability barrier, the efficacy is moderate. Prior studies in normal mice showed that topical applications of a heparinoid-containing product, Hirudoid® cream, improve epidermal barrier function by upregulation of epidermal proliferation, expression of mRNA for epidermal differentiation, and lipid production. Objective: The objective of this study was to assess whether topical applications of this product could prevent GC-induced changes in epidermal function in murine skin. Materials and Methods: One group of C57BL/6J mice was treated topically with 0.05% clobetasol propionate twice daily for 6 days, while another group was treated topically with Hirudoid® cream 30 min after each application of clobetasol propionate. Untreated mice served as normal controls. Transepidermal water loss (TEWL) rates, stratum corneum hydration, and skin surface pH were measured using respective probes connected to an MPA5 physiology monitor. qPCR was used to measure the expression levels of mRNA for keratinocyte differentiation-related proteins and lipid synthetic enzymes. Results: Co-applications of Hirudoid® cream with GC minimally, but significantly, increased skin thickness in comparison to GC treatment alone (p < 0.05), in parallel with increased expression levels of mRNA for PCNA in both the dermis and the epidermis. Moreover, Hirudoid® cream largely prevented GC-induced elevation in basal TEWL (p < 0.001) and delay in barrier recovery (p < 0.05), accompanied by upregulation in the expression levels of mRNA for epidermal involucrin, HMGCoA, and SPT1. However, both stratum corneum hydration and skin surface pH were comparable in the skin treated with GC alone versus GC + Hirudoid® cream. Conclusion: Topical heparinoid-containing product can partially prevent GC-induced alterations in some epidermal functions.

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“…2a). Consistent with prior studies [18, 29], treatments with topical GC delayed permeability barrier homeostasis (Fig. 2b).…”

Section: Resultssupporting

confidence: 92%

Topical Applications of a Heparinoid-Containing Product Attenuate Glucocorticoid-Induced Alterations in Epidermal Permeability Barrier in Mice

Wen

et al. 2021

Skin Pharmacol Physiol

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“…As epidermal proliferation is required for permeability barrier formation (reviewed in ), and topical GC inhibits epidermal proliferation , we next assessed whether topical hesperidin could prevent the GC‐induced reduction in epidermal proliferation. As expected, GC‐treated epidermis became much thinner, with flattened keratinocytes, and a decrease in mitotic figures (Figure S4a vs b), and marked reduction of PCNA‐positive cells in GC‐treated epidermis (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…While systemic or topical GC often demonstrate numerous short-term benefits, significant side effects, including generalised infections, diabetes, Cushing's syndrome and osteoporosis, can limit their usage (6)(7)(8)(9)(10)(11)(12)(13). Topical GC are among the most widely used form of antiinflammatory therapy in dermatology, but physicians also often are reluctant to deploy them due to their atrophogenic side effects, including skin hypopigmentation, telangiectasia, delayed wound healing and impaired cutaneous innate immunity (14)(15)(16)(17)(18)(19). GC also induce side effects on the epidermis, including defects in epidermal structure (thinning) and permeability barrier function, which can be attributed, in large part, to an inhibition of epidermal proliferation, differentiation and lipid production (20)(21)(22)(23).…”

Section: Introductionmentioning

confidence: 99%

Topical hesperidin prevents glucocorticoid‐induced abnormalities in epidermal barrier function in murine skin

Man

Mauro

Kim

et al. 2014

Experimental Dermatology

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Systemic and topical glucocorticoids (GC) can cause significant adverse effects not only on the dermis, but also on epidermal structure and function. In epidermis, a striking GC-induced alteration in permeability barrier function occurs that can be attributed to an inhibition of epidermal mitogenesis, differentiation and lipid production. As prior studies in normal hairless mice demonstrated that topical applications of a flavonoid ingredient found in citrus, hesperidin, improve epidermal barrier function by stimulating epidermal proliferation and differentiation, we assessed here whether its topical applications could prevent GC-induced changes in epidermal function in murine skin and the basis for such effects. When hairless mice were co-treated topically with GC and 2% hesperidin twice-daily for 9 days, hesperidin co-applications prevented the expected GC-induced impairments of epidermal permeability barrier homoeostasis and stratum corneum (SC) acidification. These preventive effects could be attributed to a significant increase in filaggrin expression, enhanced epidermal β-glucocerebrosidase activity and accelerated lamellar bilayer maturation, the last two likely attributable to a hesperidin-induced reduction in stratum corneum pH. Furthermore, co-applications of hesperidin with GC largely prevented the expected GC-induced inhibition of epidermal proliferation. Finally, topical hesperidin increased epidermal glutathione reductase mRNA expression, which could counteract multiple functional negative effects of GC on epidermis. Together, these results show that topical hesperidin prevents GC-induced epidermal side effects by divergent mechanisms.

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“…Additionally, genital skin demonstrates an exaggerated response to irritants compared with other areas of the body (Britz and Maibach, 1979). Localized atopic dermatitis is commonly managed with topical corticosteroid treatments, but application of higher-potency steroid ointments to the genital area may result in treatment-related adverse effects, such as skin atrophy and increased risk of a secondary infection (Johnson et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Recalcitrant anal and genital pruritus treated with dupilumab

Yang

Murase

2018

International Journal of Women's Dermatology

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Chronic anogenital pruritus can significantly impair affected patients’ quality of life by disrupting their sleep, mood, sexual function, and personal relationships. Although a significant portion of these patients can be managed with hygiene measures, topical therapy, oral anti-pruritics, and allergen avoidance after patch testing, guidelines to treat patients who do not respond to standard therapy have yet to be established. We describe the therapeutic response of a case of anogenital pruritus recalcitrant to multiple topical and systemic therapies. Treatment of this patient with dupilumab, an interleukin-4 receptor alpha blocker, resulted in clinical remission at 1 year from the initiation of the therapy, without significant adverse effects.

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Vulvar Skin Atrophy Induced by Topical Glucocorticoids

Cited by 13 publications

References 8 publications

Topical Applications of a Heparinoid-Containing Product Attenuate Glucocorticoid-Induced Alterations in Epidermal Permeability Barrier in Mice

Topical Applications of a Heparinoid-Containing Product Attenuate Glucocorticoid-Induced Alterations in Epidermal Permeability Barrier in Mice

Topical hesperidin prevents glucocorticoid‐induced abnormalities in epidermal barrier function in murine skin

Recalcitrant anal and genital pruritus treated with dupilumab

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