부신피질 홀몬성 좌창에 관한 연구

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.