Note: the enclosed information is a bit heavy on medical language, however this information does provide an excellent overview of how topical corticosteroids (steroid creams) over time damage the structure of the skin.
Psoriasis is a lifelong, chronic, immune mediated systemic disease with preferential skin involvement, which affects approximately 1–3% of the Caucasian population. Psoriasis may appear at any age; however, over 75% of patients belong to a clear subgroup, that develops the disease before the age of 40 (type 1 or early-onset psoriasis) The most common clinical variant is plaque-type psoriasis, characterized by erythematous scaly plaques, round or oval, variable in size, frequently located in scalp, lower back, umbilical region, intergluteal cleft, knees, and elbows.
As a clinically heterogeneous disease, psoriasis presents several degrees of severity and a wide array of presentations in different patients. Approximately 80% of psoriasis patients have mild disease, with skin plaques usually covering less than 10% of the body surface area. However, some patients have moderate to/or severe disease, with greater than 10% of body surface area involvement.
The different presentations of psoriasis require a variable approach to treatment and the current treatment concept advocates that the type of therapy prescribed should be appropriated to disease severity. Although there is a wide range of therapies available for the treatment of psoriasis, either systemic or topical agents, the use of topical therapy remains a key component of the management of almost all psoriasis patients.
Glucocorticoids (corticosteroid) mediated skin atrophy involves thinning of the epidermis and dermis, resulting in increased water permeability and, thus, in increased transepidermal water loss. The thinning is caused by a decreased proliferative rate of keratinocytes and dermal fibroblasts. The origin of the decreased proliferation lies in collagen turnover. Transforming growth factor β (TGF-β) is a signaling molecule that, among other actions, promotes production of collagen, using Smad proteins as second messengers. Activated GR negatively regulates Smad3 through a protein-protein interaction, in this way, blocking expression of the COL1A2 gene, which encodes a type I collagen chain.
Type I collagen represents roughly 80% of the total share of skin collagen. Therefore, glucocorticoids reduce collagen turnover through blocking of TGF-β actions. Coincidentally, TGF-β plays a central role in the epithelial-to-mesenchymal transition (EMT), an essential mechanism for cicatrisation (scar formation). Glucocorticoids also diminish synthesis of epidermal lipids.
Furthermore, glucocorticoids reduce collagenases, which are part of the matrix metalloproteinases (MMPs) and tissue inhibitors of the metalloproteinases TIMP-1 and TIMP-2. Striae (stretch marks) formation, which occurs in hypercortisolism and may occur after long-term topical treatment with glucocorticoids, may be explained by the skin tensile strength determined by type I and type III collagens. The thinning of epidermis caused by glucocorticoids’ long-term topical treatment appears also to be related with the repression of K5–K14 keratin genes, which are markers of the basal keratinocytes. Additionally, these drugs inhibit K6–K16 keratin genes, markers of activated keratinocytes, therefore promoting impaired wound healing.
Above Info Source From: Int Journal Endocrinol. 2012: 561018.
Mechanisms of Action of Topical Corticosteroids in Psoriasis
Luís Uva, Diana Miguel
Essentially, the ongoing use of topical corticosteroid often generates additional skin damage for psoriasis patients such as epidermal atrophy, degeneration of the dermal structure and collagen deterioration. Additionally, topical corticosteroids can inhibit the skin’s ability to protect against bacterial and fungal infections because they diminish the skins protective pH (acid mantle) antimicrobial peptide capacity.
Maállo is a nutrient enriched therapeutic skin ointment for use after topical corticosteroid medication. As a daily maintenance therapeutic Maállo suppresses the stimulus of psoriasis and supports the structure and function of the skin to reduce the dependency on topical corticosteroids. CLICK HERE to learn about Maállo Skin Ointment.
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