In general, strong hormonal creams used on the face for more than 1.5 months and weak or offending cosmetics containing trace amounts of hormones used for a long time (1-2 years) can induce hormone-dependent dermatitis locally.
Definition.
Due to long-term topical application of glucocorticoid-containing preparations, once the medication is discontinued leading to recurrence and aggravation of the original skin disease with polymorphic skin damage, it is called hormone-dependent dermatitis.
Causes.
1, improper use of hormones: failure to correctly and reasonably select appropriate topical glucocorticoids for patients.
2.Improper selection of indications: Long-term abuse of medium- and strong-acting glucocorticoids for some skin diseases for which hormones are prudent, such as acne, rosacea, facial unidentifiable ringworm, chloasma, etc.
3.Improper selection of medication sites: It is better not to choose such hormones for sites that are not suitable for medium- and strong-acting hormones and fluorinated hormones, such as the face, under the breasts, external genitalia, armpits, groin and infant skin.
4.Too long topical application time: long-term use of glucocorticoids, high-efficiency hormones more than 20 days, low- and medium-effect hormones more than 2 months.
5, the use of hormones as cosmetics: hormones mixed into cosmetics, long-term application of the so-called “special effects of skin rejuvenation, whitening” cosmetics have become dependent.
Clinical manifestations: 1.
1, skin lesions.
(1) Skin thinning, flushing with capillary dilation.
(2) acne-like dermatitis: acne, papules, pustules.
(3) hyperpigmentation.
(4) Skin aging: dry, flaky, rough, or even atrophic skin.
(5) Thickening and elongation of fine hair.
2.Self-perceived symptoms.
Self-conscious burning, itching, pain, tightness.
Treatment.
(a) General treatment
1.Health education
2.Daily care:
Long-term topical glucocorticoids tend to lead to thinning of the skin, inflammatory reactions, destruction of the skin barrier function, increased sensitivity of the skin to various external physical and chemical stimuli, and increased symptoms whenever exposed to sun, wind, heat and after eating irritating food. Therefore, anti-allergy and moisturizing medical skin care products that can restore the skin barrier function should be used to reduce skin sensitivity. In the acute stage, cold spray and cold film treatment is feasible; avoid facial massage.
3. Diet.
Try to avoid spicy and stimulating food and alcohol. Eat more vegetables, fruits and other foods rich in vitamins.
(II) Drug treatment
1.Topical medication.
(1) hormone regressive therapy.
For the short duration of the disease and the use of medication, the rebound is lighter after stopping the drug, can stop using hormone preparations.
(2) hormone replacement therapy.
Calmodulin inhibitor: e.g., tacrolimus ointment, 1-2 times a day
(3) Non-steroidal ointments.
(i) Butalbital hydroxy acid cream.
(ii) Ethoxybenzamine cream.
(3) Butyl flufenamic acid ointment; 1-2 times a day.
(4) With acne-like dermatitis.
After the skin barrier function is restored, add peroxybenzoyl gel, etc.
(5) With hyperpigmentation.
After the skin barrier function is restored, add 3% hydroquinone, arbutin, azelaic acid and other depigmentation agents.
2.Systematic treatment
(1) Anti-sensitivity drugs: can reduce the inflammatory reaction and pruritus symptoms.
(2) Anti-inflammatory treatment
(3) Other treatment: with pigmentation, supplementation of vitamin C, vitamin E, glutathione, etc.
(3) Physical therapy.
(1) Intense pulse light and red light.
The use of lower energy, longer wavelength of intense pulsed light (590-1200nm) and red light (635nm), non-ablative, non-invasive treatment of sensitive skin can be achieved to repair the skin, reduce inflammation, reduce skin sensitivity or restore the role of normal.
2.Laser hair removal.
For patients with Cui hair hyperplasia, laser hair removal treatment can be carried out after their skin barrier function is restored.
VII. Treatment of primary disease.
After the symptoms of hormone-dependent dermatitis are eliminated, the treatment of primary skin diseases, such as acne, melasma and facial dermatitis, should be standardized.
Eight, prevention
1. Rational selection of glucocorticoids
(1) It is best not to use medium- or strong-acting hormones and fluorinated hormones on the face and infant skin. If you need to use them, you should try to use weak-acting, fluorine-free hormones and not to use them for more than one month.
(2) Acne, rosacea, superficial fungal disease, melasma and other skin diseases should not use glucocorticoids externally as much as possible, and if they are used, they should use non-fluorinated hormones as much as possible, and the use time should not exceed 1 week.
(2) Educate patients not to use cosmetics containing glucocorticoids.