Corticosteroid-induced atrophy and barrier impairment measured by non-invasive methods in human skin

Background/aims: Atrophy is a distressing side effect of potent corticoster oids. After open application of a high potency steroid, we monitored atroph ogenicity by a variety of non-invasive methods. Methods: Volar forearms were treated twice daily for 3 or 4 weeks, with clo betasol propionate cream (Temovate(R)). The following methods were used: 1) confocal microscopy, 2) transepidermal water loss (TEWL), 3) dimethyl sulfo xide whealing, 4) sodium hydroxide erosions, 5) analysis of stratum corneum lipids, and 6) B-scan ultrasound. Results: Confocal microscopy revealed thinning of the epidermis, decreased microvasculature and decreased size of keratinocytes. Evaporimetry demonstr ated transepidermal water loss. Whealing to dimethyl sulfoxide was enhanced . Sodium hydroxide erosions formed more quickly. The amount of ceramides, c holesterol, and free fatty acids was reduced. Ultrasound showed thinning of the dermis. Conclusion: Non-invasive methods are very useful for quantifying the atroph ogenicity of topical corticosteroids.