Recently, the dermatology clinic of Jiangsu Provincial Hospital of Integrative Medicine has received a number of patients who have been suffering from redness and itching of the face for a long time, and they all have a history of long-term application of glucocorticoid (hereinafter referred to as hormone) creams such as dermatoprene and paregoric pine. The effect was obvious at the beginning of topical application, but after using them for a long time, once the hormones were stopped, the original disease recurred or worsened, and could only be alleviated or temporarily relieved after using similar hormone preparations or more potent hormone preparations again. It was only after the dermatologist at the hospital consulted and treated the patient that it was the dermatitis treatment cream —- hormones that caused the problem.
Hormones have powerful anti-inflammatory, immunosuppressive and anti-proliferative effects. At present, most of the topical creams sold in the market belong to the hormone category. Correct topical hormones can effectively treat a variety of skin diseases, but if used improperly, they can easily cause or aggravate skin damage, the most common being “hormone-dependent dermatitis”.
”Hormone-dependent dermatitis is caused by patients or doctors’ inaccurate grasp of the indications for topical hormones, or the dependence of the primary skin lesions on hormones due to excessive topical hormone use, as well as the inflammatory skin damage caused by this dependence forcing patients to use topical hormones for a long time. It is most commonly seen in young and middle-aged women and is most likely to occur on the face.
The clinical diagnosis is mainly determined from four aspects: the duration of hormone use, the phenomenon of dependence of primary lesions on hormones, subjective symptoms and objective symptoms.
1. History of long-term topical hormone use: topical hormone use for about 1 month or more.
2, 2-10 days after stopping the use of hormones, the original disease or lesions recurred or aggravated, and the lesions can be reduced or temporarily relieved after re-using the same type of hormone preparation or stronger hormone preparation; the result of patch test using this type of hormone preparation is negative.
3.Subjective symptoms: burning itching, burning pain, dryness, flaking or tightness, aggravated by heat (sunlight, etc.) or irritating drugs or detergents.
4. Objective symptoms: Dilated capillaries, erythema or skin flushing, edema, papules or pustules or acne, rosacea-like changes, hyperpigmentation or skin atrophy, bookishness, etc. may appear at the site of topical hormone application.
Hormone-dependent dermatitis can be diagnosed if the patient has both 1 and 2, and 1 of 3 and 4.
The causes of “hormone dependent dermatitis” are.
1, the long-term use of strong hormone preparations for common skin diseases such as acne, seborrheic dermatitis, eczema, neurodermatitis, psoriasis, etc.
2, improper selection of drug varieties: Most of them are caused by patients’ own successive or simultaneous topical application of multiple hormone creams. Common hormone varieties include dermatoprene, Paregoric, Pikang Wang, Skin Easy, Clofloxacin Cream, Enbrel Cream, etc., which are mainly strong or super strong hormone preparations.
3. Abuse of hormone-containing cosmetics: hormone-containing preparations are mistakenly used for beauty, whitening and skin rejuvenation, and some patients even use them as cosmetics for years.
4.Improper choice of medication site: The skin thickness of various parts of the human body varies, and thin parts such as the face are easier to absorb hormones and more prone to adverse reactions, so when using creams for the face, weak or medium-acting soft hormones such as Youzol and Eloson should be chosen, and the medication time should be short.
For treatment, including.
1. Discontinuation of hormone preparations: Discontinuation of hormone preparations is the basic principle for the treatment of the disease. There are 2 general methods of discontinuation.
① Immediate discontinuation: oral placebo or antihistamine, local cold compress, available emollient or trial of calcium-regulated neurophosphatase inhibitor, such as tacrolimus. The advantages of this method are that it is highly targeted and timely discontinuation. The disadvantage is that it is more difficult to control rebound symptoms quickly. It is suitable for patients who have used hormonal agents for a short period of time, generally those who have used hormones continuously for <3 months or those who have used hormonal drugs intermittently for 3 - 6 months.
② Slow withdrawal: the decreasing method, subtraction method or substitution method can be chosen. Such as choosing weak hormone instead of strong hormone; using fluorine-free instead of fluorine-containing hormone; adding drug-free cream to the hormone preparation, gradually decreasing the hormone dosage according to the ratio of 1/2, 2/3, 3/4, 4/5 until it can be replaced by emollient; decreasing the number of doses, or extending the interval until stopping the drug. The advantage of this method is that it can reduce the number of rebound and the severity of symptoms, but the disadvantage is that the patient’s compliance is poor. This method is suitable for patients who have been using hormone preparations for a long time, such as those who have been using hormone drugs continuously for more than 3 months or those who have been using hormone drugs intermittently for more than half a year.
2. Psychotherapy: The patient’s compliance and confidence are very important for the treatment of this disease. In addition, because the skin barrier function of hormone dependent dermatitis patients is damaged, it is very sensitive to the stimulation of various external physical and chemical factors, such as sunlight, chemical substances, heat and cold and other physical factors can cause lesions to appear on the lesion site, and even redness, swelling, exudation, eczema-like changes. Therefore, in the process of discontinuation or withdrawal of drugs should try to avoid physical stimulation (especially to avoid thermal stimulation), chemical stimulation and light stimulation.
3, Chinese medicine evidence-based treatment: Chinese medicine has advantages in the treatment of this disease. In the past 10 years, the clinical reports on the treatment of hormone dependent dermatitis in China, Chinese medicine and the combination of Chinese and Western medicine have the most methods.
4.Perfect pulse laser technology is a new method for the treatment of this disease, which has been widely used in clinical practice.