With the continuous improvement of living standards, skin beauty has become a growing concern for people, and the development and treatment of some cosmetic skin diseases affecting the face are gradually receiving attention from dermatologists. In recent years, there has been a sharp increase in facial cosmetic skin damage caused by inappropriate topical corticosteroid preparations on the face, and the resulting clinical reports of facial hormone-dependent dermatitis are also increasing, with a variety of treatment methods. The concept, etiology, clinical features, diagnostic criteria and treatment methods of this disease are reviewed as follows.
1.Concept
Facial glucocorticoid-dependent dermatitis is an inflammatory dermatosis that occurs when the facial skin becomes dependent on hormones after long-term topical application of glucocorticoids. It manifests as skin atrophy, capillary dilation, pigmentation disorders, burning sensation, atrophic lines, hirsutism, acne and rosacea-like rash. Patients feel burning, itching and pain, which is aggravated by heat and reduced by cold. After discontinuing the drug, the original symptoms of the skin are significantly aggravated and are difficult to control by general drugs.
2.Etiology
The cause of hormone-dependent dermatitis is undoubtedly the improper use of topical hormones, which induces the patient’s skin to become dependent on hormones.
(1) Wrong choice of indications
Glucocorticoids have obvious anti-inflammatory and anti-allergic effects, and have obvious non-specific inhibitory effects on skin inflammation caused by various reasons (such as infection, allergy, physical factors, etc.), which can lead to rapid improvement and symptom reduction after topical application, and thus are very widely used in clinical practice. However, due to the lack of understanding of the scope of application and adverse effects of corticosteroids by patients, long-term abuse has led to adverse consequences.
A few people use hormonal topical drugs instead of skin creams to apply on the face, and use them on the normal face for a long time, feeling good at the beginning, and the skin becomes tender and white, but over time, they will develop dependent dermatitis. Some primary care doctors and general practitioners who do not know much about the role of hormones do not diagnose some common skin diseases such as acne, seborrheic dermatitis, ringworm, impetigo and other bacterial and fungal infectious skin diseases, eczema, dermatitis and other allergic skin diseases, and make patients misuse hormone therapy, especially for the face, because it is easier for corticosteroids to be absorbed. The side effects of long-term topical application of stronger hormone preparations can easily occur and cause hormone-dependent dermatitis.
(2) Excessive doses of topical hormones for too long
It can cause epidermal atrophy and inhibit the synthesis of dermal collagen. Continuous topical application of hormones in the same area for more than 3 weeks can cause local hormone-dependent dermatitis, with symptoms such as skin atrophy, thinning, capillary dilation, pigmented spots, inflammatory papules, rosacea-like dermatitis and increased skin sensitivity. In addition, due to the different thickness of the skin in different parts of the body, the absorption of hormones is also different, and the thinner and more tender parts absorb more, such as the face, which can cause adverse reactions even if the medication is used for a short time. Long-term topical application of hormones can lead to weakened skin barrier function and increased absorption of drugs, forming a vicious circle. The high dose and long duration of medication is the most important reason for hormone dependent dermatitis.
(3) Improper selection of topical hormone drugs
The topical preparations of corticosteroids are divided into strong (Class I, Class II, Class III), medium (Class IV) and weak (Class V). Strong-acting preparations can easily cause side effects such as skin atrophy, and are not recommended for use on weak skin areas such as the face and pubic area. However, because strong hormone preparations are readily available in pharmacies, and because users do not know much about them and blindly succumb to advertisements, these drugs are abused. The literature reports that most of the hormones used by patients are strong or super-potent hormone preparations containing fluoride such as fluorine relaxation, clobetasol propionate and clofloxacin.
(4) Confusion in the beauty market and abuse of beauty cosmetics
Many beauty salons’ so-called skin care serums and special whitening products are adulterated with hormones to deceive consumers, causing hormone-dependent dermatitis to appear on the faces of many consumers who are eager for beauty care.
3.Pathogenesis
Modern medicine believes that the main reason for hormone-dependent dermatitis is that capillaries are sensitive to steroid hormones, and short-term application causes vasoconstriction, long-term use causes atrophy and thinning of vascular endothelial cells, smooth muscle cells and skin elastic fibers, and the skin loses elasticity and becomes flaccid, so that the originally unclear capillaries become thick and obvious, accompanied by more serious itching, which is a phenomenon of skin nerve endings to hormones. This is a kind of dependence phenomenon of skin nerve endings on hormones. In addition, under the action of hormones, sebaceous gland cells atrophy, sebum secretion decreases, and the skin becomes dry, allergy-prone, and hairy. When an inflammatory reaction occurs, arachidonic acid in tissue cells synthesizes inflammatory substances such as prostaglandins through cyclooxygenase, and causes symptoms such as redness, swelling, and pain. Prostaglandins enhance receptor sensitivity, and a component of prostaglandins such as prostacyclin has the effect of causing vasodilation and increased capillary permeability causing exudation, resulting in swelling at the site of inflammation.
The Chinese medicine believes that corticosteroids are the products that help Yang and generate heat, and their prolonged use hurts Yin and blood, damages the veins and blood, and affects the transmission of blood and fluid, resulting in hormone-dependent dermatitis.
4.Diagnosis
The diagnosis of hormone-dependent dermatitis is determined from four aspects: time of hormone use, dependence of the primary lesion on hormone, subjective symptoms and objective symptoms.
①History of topical hormone use for more than 1 month.
②Recurrence or aggravation of the original disease or lesion 2-10 d after discontinuation of hormone use.
③Subjective symptoms include pruritus, burning sensation, dry wrinkling sensation, and pain.
④Objective symptoms include inflammatory papules or pustules, erythema, flushing edema, dry skin, flaking, enlarged pores, hyperpigmentation, capillary dilation, and epidermal atrophy.
If you have ①, ② and ③, ④ each see 1 or more, you are diagnosed as hormone dependent dermatitis.
5.Treatment method
In the past 10 years, there have been many clinical reports on the treatment of hormone-dependent dermatitis, including Western medicine, combined Chinese and Western medicine, Chinese medicine and physical therapy. As the treatment of hormone dependent dermatitis is more difficult and the treatment time is longer, it should be appropriate to combine multiple treatment methods. The principle of treatment should first be to stop the use of hormone preparations (including immediate and gradual discontinuation), and to use local treatment that soothes and reduces local symptoms, so as to gradually eliminate the dependence on hormones.
(1) Western medical treatment
①Hormone replacement therapy
Use some immunosuppressive immunomodulators to replace hormones, so as to gradually eliminate the side effects of hormones. Lei Gong Deng has immunomodulatory, anti-inflammatory and anti-tumor effects. 0.5% Lei Gong Deng polysaccharide cream is applied topically 2-3 times/day for 4 weeks. Low molecular heparin sodium has anticoagulation, antithrombotic, anti-inflammatory, neutralize oxygen free radicals, improve microcirculation and other effects. Used for facial hormone-dependent dermatitis can increase capillary permeability. It improves local blood circulation, inactivates inflammatory mediators, promotes skin nutrient supply and metabolism, and effectively improves skin itching and other symptoms. The topical application of Heprin ointment (sodium heparin ointment) once in the morning and once in the evening, the course of treatment for 4 weeks, the efficiency of 76.7%. 5% flufenamic acid butanol ointment is a non-steroidal topical drug, with strong anti-inflammatory activity, without the side effects of glucocorticoids, especially for skin inflammation in exposed parts of the body, its anti-inflammatory mechanism is mainly in the body cells to block the production of arachidonic acid prostaglandins and leukotrienes and other inflammatory The anti-inflammatory mechanism is mainly to block the production of inflammatory mediators such as prostaglandins and leukotrienes by arachidonic acid in the body cells, thus achieving anti-inflammatory, anti-itch and analgesic effects. Use 5% flufenamic acid butanol ointment (Bute) topically on the affected area, 2 times/d for 8 weeks.
②Antihistamines
H1 receptor antagonists can treat skin allergic reactions and also have certain anti-itch effects. The literature reports that antihistamines can be used to treat facial hormone-dependent dermatitis.
③Promote the restoration of normal sebaceous membrane
The sebaceous film is a transparent milky film formed by the emulsification of sebum and sweat covering the skin surface, which has a moisturizing and protective effect on the skin. In hormone-dependent dermatitis, it is obvious that the sebaceous film has been damaged, so while treating the disease, the skin should be soothed and soothed to reduce the discomfort. Ionic spray and cold spray treatment can alleviate symptoms such as local burning and discomfort, cleanse the skin and allow it to fully absorb moisture, constrict the dermal capillaries, reduce the inflammatory response, and allow the rash to subside or improve. Allantoin and natural moisturizer sodium vitrate can inhibit skin hyperkeratosis and maintain skin elasticity and flexibility, thus softening and moisturizing the skin with anti-aging effects. Avène Soothing Revitalizing Spring Water and Soothing Moisturizing Cream are used externally for 4 weeks, with an efficiency of 82.1% (together with oral antihistamines). All of the above can promote the recovery of normal sebaceous film.
(2) Chinese medicine treatment
There are many methods combining traditional Chinese medicine and Chinese and Western medicine. The mechanism of identification is wind, heat, poison and evil blocking the face and infiltrating the blood vessels, so the treatment is based on draining wind, clearing heat, detoxifying poison, cooling blood and nourishing blood.
(3) Determination of therapeutic effect
There is no unified standard for determining the efficacy of hormone dependent dermatitis, two methods are available for reference.
①The evaluation of the patient’s conscious symptoms and the regression of the rash should be included. The assessment of patients’ conscious symptoms is based on a 10-point scale, and patients can determine the efficacy according to the improvement of symptoms.
②The facial rash can be rated according to the degree of itching, capillary dilatation, erythema, papules, dryness, and desquamation on a 4-point scale.
In summary, many reasons have caused a dramatic increase in cases of facial glucocorticoid-dependent dermatitis in recent years, which has become a common cosmetic disorder in dermatology outpatient clinics. While there is not yet a comprehensive and detailed description of the disease in authoritative reference books, the author provides a review of the concept, etiology, clinical features, diagnostic criteria and treatment methods for this disease for reference. Since the disease is difficult to treat and takes a long time to treat, doctors should do a good job in the ideological work of the patient while treating the disease to make them aware of the characteristics of the disease and instruct them on the methods of facial care and the correct use of skin care products to enhance their confidence in overcoming the disease.