What is hormone dependent dermatitis?

  Hormone-dependent dermatitis is a skin inflammation caused by long-term repeated inappropriate topical corticosteroid use. It is mostly seen on the face and manifests as localized erythema, papules, dryness, desquamation, atrophy, capillary dilatation, purpura, acne, pigmentation abnormalities, rosacea-like dermatitis, etc. It is accompanied by localized pronounced spontaneous pruritus or burning sensation. It is characterized by improvement after application of corticosteroids, but rapidly recurs or even worsens after discontinuation of the drug. The local “dependence” on corticosteroids is formed in the skin. In recent years, the incidence has been increasing year by year, reaching 3-10% of the outpatient volume in the Department of Dermatologic Allergic Diseases. Because of its persistence and difficulty in healing, it has become one of the major concerns of the skin metaplasia and cosmetology profession.  It is true that this disease is caused by the abuse and misuse of hormones, but there are many difficulties in treatment and prevention because it involves all aspects of medical, cosmetic, cosmetic and patient science knowledge. The traditional treatment method is to completely stop using hormones, treat the symptoms and let the skin recover on its own. But this process is long and painful. After discontinuing hormones the patient’s clinical signs are reduced, but the self-conscious symptoms still exist. Any subsequent application of skin care products will easily produce local irritation and become the so-called “problem skin”.  The pathogenesis of hormone-dependent dermatitis has not been fully clarified, and according to the diagnostic criteria of drug dependence, it does not belong to the traditional category of psychotropic drug dependence. According to previous studies, the long-term application of hormones has led to the thinning of the stratum corneum and the atrophy of the dermal papillae, resulting in the loss of the skin’s normal barrier against water loss, causing dryness, flaking and cracking, while capillary dilation may be a relative expression of skin atrophy. However, this hardly explains the papules, erythema and swelling of the skin. Recent clinical observations from the Department of Dermatologic Paradoxes of Changzheng Hospital in Tianjin have shown that Tacrolimus ointment has good clinical efficacy in the treatment of hormone-dependent dermatitis (internal data). However, Tacrolimus is an immunomodulator that blocks T-cell activation and restores TH1/TH2 balance, and its effect is related to the inhibition of T-lymphocytes, antigen-presenting cells, basophilic granulocytes and mast cells. Its good therapeutic effect brings thoughts on the pathogenesis of hormone-dependent dermatitis: 1. Is there any involvement of T-cell immune factors in hormone-dependent dermatitis?  2. Are there any differences between histopathological changes and dermatitis and eczema?  3. Is all hormone-dependent dermatitis “Steroid Dependence Dermatitis” and is there a possibility of Steroid Induced Dermatitis?  In addition, it should be noted that due to the difference in human qualities, the reports of hormone dependent dermatitis in foreign countries are rare. While domestic cases are clinically common, this is a social issue involving the popularization of science and guidance of proper drug use.