Glucocorticoid withdrawal dermatitis

  Due to the long-term use of glucocorticoid-containing preparations, once the drug is discontinued, the original skin disease relapses, aggravates, or new skin damage occurs, forcing the patient to use glucocorticoids again. The disease is due to the abuse of glucocorticoids or drug addiction caused by physical dependence, withdrawal symptoms, is a kind of adverse drug reactions, so the name glucocorticoid withdrawal dermatitis, rather than hormone dependent dermatitis.  There are four clinical types: 1. facial dermatitis type; 2. rosacea-like type; 3. pigmentation type; 4. skin aging and increased fine hair type.  Self-perceived symptoms: pruritus, tingling, tightness.  Pathogenesis 1, impaired skin barrier function; 2, inflammatory reaction caused by hormones; 3, vascular nerve hyperreactivity; 4, microbial infection.  Treatment 1. General treatment 1. Decisively stop using all suspected topical hormone preparations; 2. Establish confidence and patience; 3. Pay attention to communicating with patients about dependence; 4. Adjust diet and avoid spicy and irritating diet; 5. Adhere to sufficient treatment course: 4 months-2 years.  Second, restore the skin barrier function-medical skin care products Shu Min Extra Care Cream, Cymbopogon Fruit Oil-promote ceramide synthesis, Horsetail-anti-inflammatory and anti-allergic. Also, pay attention to skin cleansing, hydration, moisturizing, sunscreen after inflammation control, apply sunscreen 20-30 minutes before going out, outdoor, choose SPF > 30, PA+++, indoor SPF > 20, PA++, 3-4 times daily, 2mg per cm2. III. Anti-inflammatory treatment Topical tacrolimus ointment, pimecrolimus ointment, Bute ointment, etc. can be used.  Systemic medication:compound glycopyrrolate, hydroxychloroquine, rehmannia polysaccharide, etc.  IV. Reduce vascular and neural hyperreactivity Dextran; first generation antihistamines; cold spray; IPL. V. Anti-microbial therapy Minocycline, etc.  Summary: Glucocorticoid withdrawal dermatitis can definitely be cured as long as doctors and patients build up confidence, cooperate closely and adhere to adequate treatment courses, and at the same time, strengthen the protection and repair of skin barrier function and the proper use of modern cosmetic laser technology.