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부신피질 홀몬성 좌창에 관한 연구

Issue Date
1974
Description
의학과/석사
Abstract
[한글] A Study on the Steroid Acne Hong Sang Chin, M.D. Department of Medical Science, The Graduate School of Medicine (Directed by Prof. Tae Ha Woo, M.D., D.M.Sc.) Dermatologic treatment was greatly advanced when topical corticosteroids were introduced for the management of many inflammatory and pruritic dermatoses. Their use reduced or diminished most of the undireable side effects which often accompanied the systemic administration of these compounds. The good effects of topical application of hydrocortisone had been demonstrated in the treatment of various dermatoses e.g., atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. The halogenated derivatives followed and led to the trend to most of analogs now in use. Especially, fluocinolone acethonide cream greatly enhanced its therapeutic effectiveness in psoriasis, chronic discoid lupus erythematosus, pustular bacterid, granuloma, neurodermatitis circumscripta. But many side eddects of topical corticosteroids such as steroid acne, striae were develped and also fluorinated topical corticosteroids resulted in telangictasia, purpura, atrophy in skin(Chernosky and Schmidt, 1972). Weber(1972) reported that strong topical corticosteroids e.g., betamethasone valerate, fluocinolone acetonide, were resulted in rosacea-like dermatitis and it was steadily inceased. These adverse side effects of topical corticosteroids, especially steroid acne, were indisputable argument in dermatologic field, for the view that this topical corticosteroids is used for cosmetic and treatment of acne vulgaris in our country. Since the strong corticosteroid topical preparation, the peculiar form acne, so called steroid acne, was steadily increased in our clinic. Behrman and Goodman(1950) reported that acneform eruption induced by hormone was not associated with oiliness and there were but few comedon. Sullivan and Zeligman(1956) reported that the acneform eruption due to adrenal cortical hormone was uniform in size, small papule and few pustule, usually erythematous in color. There were also differencial histologic feature. The most important difference is the normal appearance of sebaceous glands in acneform eruption due to corticosteroids contrast with hyperplasia in acne vulgaris. Abscess formation was more frequent and more extensive in acne vulgaris. Sutton, Jr,(1950) and vanscott & MacCardle(1956) described that histologically, the major component in lesion of steroid acne was excessive Keratinization of follicle. Castor and Baker(1950) demonstrated that topical application of corticosteroid resulted in decrease of sebaceous glands, decresae of mitosis and increased cornification in epidermis. The present study investigated the steroid acne induced by topical corticosteroids such as betamethasone valerate, fluocinolone acetonide, fluocortolone etc, clinically and histopathologically. And also compared with steroid acne induced by systemic administration of corticosteroid and acne vulgaris, clinically and histopatholgically. And in order to appraise steroid acne induced by topical corticosteroids, strong topical corticosteroids e.g., betamethasone valerate, fluocinolone acetonide, fluocortolone were applied to back of 5 subjects under occlusive dressing for 20 days. Material and Method Subjects are 13 patients of steroid acne induced by strong topical corticosteroids e.g., fluocinolone acetonide, fluocortolone, dexamethasone betamethasone valerate and are 4 patients of steroid acne induced by systemic administration of corticosteroid eg, prednisolone and also 10 patients of acne vulgaris. We observed the clinical features of steroid acne induced by topical corticosterids and compare them with steroid acne induced by systemic administration of corticosteroid and also with acne vulgaris. Biopsy is performed from 13 patients of steroid acne induced by topical corticosteroids, 3 patients of steroid acne induced by systemic administration of corticosteroid and one patients of acne vulgaris. The tissue is fixed in 10% buffered fromalin, sectioned vertically and stain with hematoxylin-eosin. In order to induce steroid acne, experimentally, the strong topical coticosteroid such as betamethason valerate, fluocinolone acetonide, fluocortolone were applied every day to 4 x 5 cm square area outlined by black brush pen. On one side of back, daily occlusive dressing therapy was performed with polyethylene film and overlapping strips of micropore plaster, and on another side of back applied 3 times daily. Biopsy was performed from papule of acneform eruption Tissue was fixed in 10% buffered formalin, serially sectioned and stained with hematoxylin eosin. Comment and Conclusion In 13 patients of steroid acne induced by topical corticosteroids 4 patients of steroid acne induced by systemic administration of corticosteroid, 10 patients of acne vulgaris and also 5 subjects of experimentally induced acne by topical application of corticosteroids were obserbed clinically and histopathologically. A. Clinical feature The steroid acne induced by topical application and systemic administration of corticosteroid and experimental induced acne by topical application had absolutely unique clinical features, that showed absence of comedone and uniform sized papules few pustules which located deep seated, usually scaly erythematous base. The eruption of the steroid acne induced by topical application of corticosteroid was distributed to face, neck where were applied. But the eruption of the steroid acne induced by systemic administration of corticosteroid was distributed to face, neck, chest, back, and scalp. Above findings are quite different from acne vulgaris. B. Histologic finding Histologically, the steroid acne induced by topical application and systemic administration of corticosteroids showed hypoplasia of sebaceous glands and excessive follicular keratinization. Occlusion of pilosebaceous opening by keratotic plug in severe case by long term application showed atrophy of the epidermis and sparsity of sebaceous glands and sweat glands with hypokeratosis and parakeratosis. C. Experimentally induced steroid acne and the steroid acne After 4 weeks of continuous application of corticosteroid, acneform eruption was developed. And it was definitly specific features which were absolutely-identical with above clinical steroid acne, clinically and histopathologically.
[영문] Dermatologic treatment was greatly advanced when topical corticosteroids were introduced for the management of many inflammatory and pruritic dermatoses. Their use reduced or diminished most of the undireable side effects which often accompanied the systemic administration of these compounds. The good effects of topical application of hydrocortisone had been demonstrated in the treatment of various dermatoses e.g., atopic dermatitis, seborrheic dermatitis, contact dermatitis etc. The halogenated derivatives followed and led to the trend to most of analogs now in use. Especially, fluocinolone acethonide cream greatly enhanced its therapeutic effectiveness in psoriasis, chronic discoid lupus erythematosus, pustular bacterid, granuloma, neurodermatitis circumscripta. But many side eddects of topical corticosteroids such as steroid acne, striae were develped and also fluorinated topical corticosteroids resulted in telangictasia, purpura, atrophy in skin(Chernosky and Schmidt, 1972). Weber(1972) reported that strong topical corticosteroids e.g., betamethasone valerate, fluocinolone acetonide, were resulted in rosacea-like dermatitis and it was steadily inceased. These adverse side effects of topical corticosteroids, especially steroid acne, were indisputable argument in dermatologic field, for the view that this topical corticosteroids is used for cosmetic and treatment of acne vulgaris in our country. Since the strong corticosteroid topical preparation, the peculiar form acne, so called steroid acne, was steadily increased in our clinic. Behrman and Goodman(1950) reported that acneform eruption induced by hormone was not associated with oiliness and there were but few comedon. Sullivan and Zeligman(1956) reported that the acneform eruption due to adrenal cortical hormone was uniform in size, small papule and few pustule, usually erythematous in color. There were also differencial histologic feature. The most important difference is the normal appearance of sebaceous glands in acneform eruption due to corticosteroids contrast with hyperplasia in acne vulgaris. Abscess formation was more frequent and more extensive in acne vulgaris. Sutton, Jr,(1950) and vanscott & MacCardle(1956) described that histologically, the major component in lesion of steroid acne was excessive Keratinization of follicle. Castor and Baker(1950) demonstrated that topical application of corticosteroid resulted in decrease of sebaceous glands, decresae of mitosis and increased cornification in epidermis. The present study investigated the steroid acne induced by topical corticosteroids such as betamethasone valerate, fluocinolone acetonide, fluocortolone etc, clinically and histopathologically. And also compared with steroid acne induced by systemic administration of corticosteroid and acne vulgaris, clinically and histopatholgically. And in order to appraise steroid acne induced by topical corticosteroids, strong topical corticosteroids e.g., betamethasone valerate, fluocinolone acetonide, fluocortolone were applied to back of 5 subjects under occlusive dressing for 20 days. Material and Method Subjects are 13 patients of steroid acne induced by strong topical corticosteroids e.g., fluocinolone acetonide, fluocortolone, dexamethasone betamethasone valerate and are 4 patients of steroid acne induced by systemic administration of corticosteroid eg, prednisolone and also 10 patients of acne vulgaris. We observed the clinical features of steroid acne induced by topical corticosterids and compare them with steroid acne induced by systemic administration of corticosteroid and also with acne vulgaris. Biopsy is performed from 13 patients of steroid acne induced by topical corticosteroids, 3 patients of steroid acne induced by systemic administration of corticosteroid and one patients of acne vulgaris. The tissue is fixed in 10% buffered fromalin, sectioned vertically and stain with hematoxylin-eosin. In order to induce steroid acne, experimentally, the strong topical coticosteroid such as betamethason valerate, fluocinolone acetonide, fluocortolone were applied every day to 4 x 5 cm square area outlined by black brush pen. On one side of back, daily occlusive dressing therapy was performed with polyethylene film and overlapping strips of micropore plaster, and on another side of back applied 3 times daily. Biopsy was performed from papule of acneform eruption Tissue was fixed in 10% buffered formalin, serially sectioned and stained with hematoxylin eosin. Comment and Conclusion In 13 patients of steroid acne induced by topical corticosteroids 4 patients of steroid acne induced by systemic administration of corticosteroid, 10 patients of acne vulgaris and also 5 subjects of experimentally induced acne by topical application of corticosteroids were obserbed clinically and histopathologically. A. Clinical feature The steroid acne induced by topical application and systemic administration of corticosteroid and experimental induced acne by topical application had absolutely unique clinical features, that showed absence of comedone and uniform sized papules few pustules which located deep seated, usually scaly erythematous base. The eruption of the steroid acne induced by topical application of corticosteroid was distributed to face, neck where were applied. But the eruption of the steroid acne induced by systemic administration of corticosteroid was distributed to face, neck, chest, back, and scalp. Above findings are quite different from acne vulgaris. B. Histologic finding Histologically, the steroid acne induced by topical application and systemic administration of corticosteroids showed hypoplasia of sebaceous glands and excessive follicular keratinization. Occlusion of pilosebaceous opening by keratotic plug in severe case by long term application showed atrophy of the epidermis and sparsity of sebaceous glands and sweat glands with hypokeratosis and parakeratosis. C. Experimentally induced steroid acne and the steroid acne After 4 weeks of continuous application of corticosteroid, acneform eruption was developed. And it was definitly specific features which were absolutely-identical with above clinical steroid acne, clinically and histopathologically.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117110
Appears in Collections:
2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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