PREVALENCE AND RISK FACTORS OF STEROID-INDUCED SKIN ATROPHY IN PATIENTS WITH CHRONIC DERMATOLOGIC DISORDERS: A MULTICENTER STUDY
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Keywords
Topical corticosteroids; Skin atrophy; Dermatology; Steroid misuse; Chronic dermatoses; Cutaneous adverse effects
Abstract
Background: Topical corticosteroids have been extensively used in dermatology due to their anti-inflammatory and immunosuppressive properties. Although they have therapeutic advantages, a long-term or an inappropriate usage can lead to local adverse effects, especially to steroid-induced skin atrophy. The use of powerful corticosteroids without the appropriate medical control has become widespread particularly in patients with chronic skin diseases.
Objective: To determine the prevalence and associated risk factors of steroid-induced skin atrophy among chronic dermatologic patients attending multiple tertiary care centers.
Methods: This multi-center cross-sectional study was carried out at Pak International Medical College Peshawar and Wah Medical College, POF Hospital, Wah Cantt, Pakistan, from January 2024 to January 2025. Non-probability consecutive sampling was used to enroll a total of 72 patients with chronic dermatologic conditions who used topical corticosteroids. A structured proforma was used to capture demographic information, clinical presentation, and steroid-use history. Clinical examination was performed to identify steroid-induced skin atrophy and related cutaneous findings. IBM SPSS Statistics version 26 were used to analyze the data. The Chi-square test and logistic regression were used to assess the associations.
Results: Among 72 participants, 33 (45.8%) developed steroid-induced skin atrophy. Mild atrophy was the most frequent presentation. Chronic eczema was the leading dermatologic diagnosis, followed by psoriasis and atopic dermatitis. Potent corticosteroids were the most commonly used preparations, while prolonged steroid use beyond three months was reported in 55.5% of patients. Significant associations were observed between skin atrophy and prolonged steroid use (p=0.001), potent or super-potent steroid application (p=0.021), facial application (p<0.001), and self-medication (p=0.028). Regression analysis identified prolonged use, facial application, and higher steroid potency as independent predictors of skin atrophy.
Conclusion: Steroid-induced skin atrophy is a common complication among chronic dermatologic patients using topical corticosteroids. Inappropriate duration of therapy, stronger steroid potency, and unsupervised use significantly increase the risk of cutaneous damage. Proper prescribing practices and patient education are necessary to reduce preventable steroid-related complications.
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Sikandar Hayat
Consultant Dermatologist, Department of Dermatology, Dr. Sikandar Skin Laser & Hair Clinic, Ghouri Town, Islamabad, Pakistan
, Salma Noreen
SPR, Department of Dermatology, Pak International Medical College, Peshawar, Pakistan
Hanniya Marwat
Consultant Dermatologist, Department of Dermatology, Hayatabad Medical Complex, Peshawar, Pakistan
Armish Kainat
Registrar Dermatology, Department of Dermatology, S Clinic, Kuwait
Shanze Khan
Senior Registrar, Department of Dermatology, Rawal Institute of Health Sciences, Islamabad, Pakistan
Hafiza Maham Amin
Senior Registrar, Department of Dermatology, Wah Medical College, POF Hospital, Wah Cantt, Pakistan
