Category Archives: Arthritis Effects The Skin

Does Corticosteroid Medication Harm The Skin

Glucocorticoids have anti-inflammatory effects and are used to treat conditions that involve inflammation.

Synthetic or semisynthetic glucocorticoids, derived chiefly from cortisol, include prednisone, prednisolone, dexamethasone, methylprednisolone, triamcinolone, and betamethasone.

Glucocorticoids-mediated skin atrophy involves thinning of the epidermis and dermis (and even hypodermis), 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.

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 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.

Skin Anatomy
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.

Special attention should be paid when applying topical corticosteroids in the presence of an infection, as there is a risk of exacerbation. Topical corticosteroids can inhibit the skin’s ability to fight against bacterial or fungal infections.

Sourced from:
Int J Endocrinol. 2012
Mechanisms of Action of Topical Corticosteroids in Psoriasis
Luís Uva, Diana Miguel, Catarina Pinheiro

Corticosteroid Drugs

Corticosteroid drugs: any one of several synthetic or naturally occurring substances with the general chemical structure of steroids. They are used therapeutically to mimic or augment the effects of the naturally occurring corticosteroids, which are produced in the cortex of the adrenal gland. Corticosteroids are very powerful drugs that affect the entire body; even corticosteroids used on large areas of skin for long periods are absorbed in sufficient quantity to cause systemic effects.

Corticosteroids, as well as adrenocorticotropic hormone (ACTH), the pituitary gland substance that stimulates the adrenal cortex, have modifying effects on many diseases. Some corticosteroid derivatives mimic the action of the naturally occurring steroid hormone aldosterone, causing increased sodium retention and potassium excretion. Others have the same effects as the naturally occurring steroids cortisone and cortisol, which are classed as glucocorticoids; these affect carbohydrate and fat metabolism, reduce tissue inflammation, and suppress the body’s immune defense mechanisms.

Cortisone and hydrocortisone are used to treat Addison’s disease, a disorder caused by underproduction of the adrenal cortex hormones. These and synthetic steroids are used extensively to treat arthritis and other rheumatoid diseases, including rheumatic heart disease. They are also used in some cases of autoimmune diseases such as systemic lupus erythematosus, in severe allergic conditions such as asthma, in allergic and inflammatory eye disorders, and in some respiratory diseases. The anti-inflammatory, itch-suppressing, and vasoconstrictive properties of steroids make them useful when applied to the skin to relieve diseases such as eczema and psoriasis and insect bites.

Because corticosteroids lower the resistance to infection, patients on steroid therapy cannot be vaccinated for smallpox or immunized. The administration of corticosteroids also causes underproduction of the natural hormones by the adrenal cortex, and so ACTH or corticosteroid therapy must always be withdrawn gradually. In addition, when used in large doses for long periods of time, the drugs can cause atrophy of the adrenal cortex. Side effects of steroid therapy include glaucoma, excess hair growth, and imbalance of many substances, including calcium, nitrogen, potassium, and sodium. Many of the synthetic corticosteroids, such as prednisone, prednisolone, triamcinolone, and betamethasone, are more potent than the naturally occurring compounds.

Source: The Columbia Electronic Encyclopedia, 6th ed. Copyright © 2012, Columbia University Press. All rights reserved.
hydrocortisone – another name for the steroid hormone cortisol.

Rheumatoid Arthritis Changes to the Skin

Rheumatoid arthritis is a chronic inflammatory disease that causes pain, weakness and malformation of the joints. Early rheumatoid arthritis tends to first affect the small joints in the hands and feet. As the disease progresses, symptoms often spread to the knees, ankles, elbows, hips and shoulders. Long-term inflammation can cause general changes to the skin’s texture, color and durability, and acute skin lesions and infections may also arise. The goal of rheumatoid arthritis skin treatment is to control symptoms and prevent complications.

The incidence of rheumatoid arthritis is typically two to three times higher in women than men. The onset of rheumatoid arthritis, in both women and men, is highest among those in their sixties.

General Skin Symptoms
Rheumatoid arthritis can cause a variety of changes to the skin. Commonly, the skin becomes thin, wrinkled and fragile (skin atrophy), which can lead to easy bruising. The skin on the back of the hands can turn pale in color and even appear translucent.

Rheumatoid Vasculitis
Rheumatoid arthritis can also progress to vasculitis conditions. When vasculitis involves the small arteries and veins that nourish the skin of the fingertips and skin around the nails, small pits in the fingertips or small sores causing pain and redness around the nails can occur. Involvement of somewhat larger arteries and veins of the skin can cause a painful red rash that often involves the legs. If the skin is very inflamed, ulcers can occur and infection becomes a complicating risk.

Vasculitis is an inflammatory process affecting the vessel wall and leading to its compromise or destruction and subsequent hemorrhagic and ischemic events. Cutaneous vasculitis manifests most frequently as palpable purpura or infiltrated erythema indicating dermal superficial, small-vessel vasculitis. Nodular erythema, livedo racemosa, deep ulcers, or digital gangrene implicates deep dermal or subcutaneous, muscular-vessel vasculitis.

DISCLAIMER: Kátha Soma does not provide medical advice, diagnosis or treatment. The information provided in this web site is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Rheumatoid Arthritis Joint & Skin

The immune system is a normal part of the body that is designed to protect us from infections due to germs/viruses from the environment. The immune system also helps ward off cancer cell development in our bodies. When the immune system gets out of balance and starts attacking bodily tissues, this is called “autoimmunity.” In this situation, blood proteins called autoantibodies are produced that bind to and injure bodily tissues. Rheumatic diseases such as rheumatoid arthritis, lupus, dermatomyositis, and scleroderma are thought to be autoimmune diseases.
In a disease like rheumatoid arthritis, immune system abnormalities can attack the lining of the joints. This produces arthritis or inflammation in the joints. The term “inflammation” means a combination of pain, tenderness, swelling, and redness. The same type of immunological abnormalities that occur in the joint of a rheumatoid arthritis patient also can occur in the skin. As a result, skin lesions in patients with rheumatoid arthritis can reflect the state of activity of the immunological abnormalities inside of that patient.
In rheumatoid arthritis, one of the more common ways that the skin is affected is through inflammation in the walls of the blood vessels of the skin producing a condition called vasculitis. Since vasculitis also can occur in internal tissues, like nerves, in rheumatoid arthritis, it is necessary to treat patients having this type of skin problem with drugs by mouth or by vein that can dampen down the autoimmune abnormalities that are producing the inflammation in the blood vessel walls.
Drugs like the corticosteroids (“steroids”) suppress the immune response in a broad fashion and can be useful in a number of autoimmune diseases including the rheumatic diseases (corticosteroids are commonly referred to as “cortisone” type drugs). Corticosteroids like prednisone taken by mouth can suppress various manifestations of rheumatoid arthritis including the skin changes like vasculitis. However, long-term use of corticosteroids by mouth can produce troublesome and serious side effects.
Almost all of the rheumatic diseases . . . lupus, dermatomyositis, and scleroderma are thought to be conditions in which the immune system is not working properly.


Psoriatic Arthritis

Psoriatic arthritis is a condition in which a person has both psoriasis and a related form of arthritis. Psoriasis is a common skin condition. A person with psoriasis typically has patches of raised red skin with scales. The affected skin can look different depending on the type of psoriasis the individual has. Arthritis is joint inflammation. Psoriatic arthritis is a particular type of aggressive and potentially destructive, inflammatory arthritis.

Psoriatic arthritis (sore-ee-at-ic arthritis ) is an autoimmune disease, meaning that your cells and antibodies (part of your immune system) attack your own tissues. Rarely, a person can have psoriatic arthritis without having obvious psoriasis. Usually, the more severe the skin symptoms are, the greater the likelihood a person will have psoriatic arthritis.

Sourced From: WebMD, Inc.

Types of Psoriatic Arthritis

Psoriatic arthritis is a chronic (long-lasting) disease in which a person with psoriasis develops the symptoms and signs of arthritis joint pain, stiffness and swelling. Psoriasis is a common, inherited skin condition that causes grayish-white scaling over a pink or dull-red skin rash.

Approximately 5% to 10% of the 3 million people who have psoriasis develop psoriatic arthritis. Psoriatic arthritis affects men and women equally and usually begins between ages 30 and 50. However, the disease can also occur in children. Most people have mild symptoms, but in some cases, the symptoms can be quite severe.

Types of Psoriatic Arthritis
There are five types of psoriatic arthritis. They are classified by their severity, whether both sides of the body are equally affected and which joints are involved.

• Asymmetric inflammatory arthritis – Often the knee, ankle, wrist or finger are involved, with a total of one to four inflamed joints. Usually, the arthritis does not affect both sides of the body equally (that is, the disease is not symmetric).

• Symmetric arthritis – Multiple joints are inflamed, often more than four, and the same joints on both sides of the body are affected. Fingernails often are ridged and pitted. This condition can mimic rheumatoid arthritis.

• Psoriatic spondylitis – One or both sacroiliac joints (the joints linking the spine and pelvis at the lower back), and sometimes other spine joints, are inflamed, causing morning stiffness in the back.

• Isolated finger involvement – This often involves only the last finger joint near the nail. One or more of these joints may be inflamed.

• Arthritis mutilans – This is the most severe and rarest form of psoriatic arthritis. In this form, the fingers shorten because of destruction of the joints and nearby bones.

Although each type of psoriatic arthritis is somewhat distinct, some people show a blending of symptoms or have more than one type.

Psoriasis can develop before or after the arthritis, but psoriasis develops first in about 75% of cases. A person may begin to get morning joint stiffness before the arthritis is recognized. People who have psoriasis that involves the nails, especially nail pitting, are much more likely to develop arthritis than those without this problem (50% versus 10%).

The cause of psoriatic arthritis is unknown. There is some evidence that infection or trauma can play a role in the development of the disease. For example, psoriatic arthritis seems to flare up in people whose immune systems are affected by human immunodeficiency virus (HIV) infection. Also, heredity seems to play a role. Up to 40% of people with psoriatic arthritis have a family history of skin or joint disease. Certain genes seem to be involved in certain types of psoriatic arthritis.

Symptoms can include:
• A pink or dull-red, scaly skin rash occurring in patches, especially on the back of the arms, front of the legs and scalp
• Inflammation of the joints, especially in the fingers, toes or spine
• Morning joint stiffness
• Lower back pain

Psoriatic arthritis can affect other parts of the body. For example, fatigue and anemia are common in people with active psoriatic arthritis. Frequently, the arthritis is accompanied by inflammation of tendons and the spots where tendons attach to bones, such as in the heel or fingers.