[ZKKL] Academic Sharing | Recent Advances in the Study of Hormone-Dependent Dermatitis

It manifests as erythema, papules, flushing, telangiectasia, dryness and scaling, swelling, pigmentary changes, acne‑like or rosacea‑like lesions, hirsutism, and other polymorphic skin manifestations, accompanied by subjective symptoms such as pruritus, burning, and discomfort.

Ljubojeviae et al. classified facial corticosteroid-induced dermatitis into three types based on the affected area:

① mouth Week Type. A well-defined area approximately 35 mm in diameter around the mouth, extending from the lower lip, exhibits moderately dispersed erythema, papules, and pustules.

② Central facial type. The bilateral cheeks, lower eyelids, nose, and forehead are involved; the perioral area typically remains unaffected.

③ Diffuse type. The entire face, forehead, and neck are affected [11]. What Lei Based on the characteristics of its skin lesions, it is classified into five types:

① Facial dermatitis type. Facial erythema, papules accompanied by diffuse skin flushing, and telangiectasia;

② Acneiform type: densely distributed comedones, papules, and pustules; ③ Skin‑aging type: skin aging, dryness with scaling, and an increase in wrinkles.

④ Pigmentary type: The facial skin appears dull and grayish, often accompanied by patchy or diffusely distributed light brown to dark brown pigmented macules.

⑤ Coarse and elongated vellus hair type: The vellus hairs on the facial skin become thicker and longer, often accompanied by telangiectasias. Expansion, pigmentation [12].

The histopathological findings vary according to the stage and severity of the disease. The epidermis shows eczematous changes, mild acanthosis, intercellular edema, and parakeratosis; small venous dilatation, perivascular lymphocytic infiltration, and perifollicular edema with inflammatory cell infiltrate are also observed. Occasionally, follicular pustules with ulceration may be seen, and the lumina contain abundant polymorphonuclear leukocytes. Elastin fibers exhibit degeneration, and Demodex mites may be encountered in occasional cases. Diffuse thickened connective tissue is present, accompanied by sebaceous gland hyperplasia.

6.1 General Treatment

Patients who discontinue topical corticosteroids should be cautious of irritant cosmetics containing steroids, practice sun protection, wash their face with lukewarm or cool water, limit spicy and irritating foods, and minimize exposure to external physical or chemical irritants. For those with pruritus, antihistamines may be used to alleviate inflammatory responses; in cases of photosensitivity, short-term hydroxychloroquine therapy is recommended [14]; and for patients with follicular microbial infections, treatment with appropriate antibiotics is indicated.

6.2 Gradual withdrawal of hormone replacement therapy by substituting or reducing the intensity and/or frequency of corticosteroid use: Topical tacrolimus ointment is applied once daily for the first 3 days, then twice daily for the next 3 days, continued for 1 week, followed by once daily for 20 days, and finally every other day for 30 days. Tacrolimus ointment is a novel immunosuppressive agent that can help prevent steroid rebound [15]. Weak‑potency corticosteroids are substituted for high‑potency ones, fluorinated preparations are replaced with non‑fluorinated formulations, and tapering is performed gradually and slowly; thereafter, emollients may be used as an alternative. Clinical studies have shown that this approach is suitable for patients who have been using topical corticosteroids for extended periods, such as those who have used these agents continuously for more than 3 months or intermittently for over 6 months [16].

6.3 Improving Skin Barrier Function: Promoting the synthesis and assembly of the epidermal lipid barrier, topical formulations containing a mixture of palmitic acid, cholesterol, and ceramides, along with vitamin C, can significantly restore impaired barrier function and enhance the integrity of the stratum corneum [17]. Emollients and moisturizers are indispensable; Liang Jianping et al. reported that the use of moisturizing agents can markedly alleviate patient symptoms and improve treatment adherence [18].

6.4 Laser Therapy

Wang Weizhen et al. treated 104 cases of facial sensitive skin disorders with dual-wavelength, low-energy intense pulsed laser therapy, achieving a cure rate of 75.3% (58/77) [19]. Zhou Dong et al. conducted intense pulsed light therapy on 46 patients with facial corticosteroid‑dependent dermatitis following the resolution of acute inflammation, attaining an overall effective rate of 93.5% [20]. Intense pulsed light (500–1200 nm) exerts photothermal effects on cutaneous tissues, enabling capillary closure, reduction of pigmented lesions, minimization of enlarged pores, and enhancement of skin elasticity, thereby exerting beneficial effects on multiple aspects of skin recovery. Both domestic and international studies have reported that intense pulsed light increases the expression of heat shock protein 70 in dermal papillae and dermal dendritic cells, suppresses cutaneous inflammatory responses, and attenuates inflammatory cell infiltration in the dermis [21].

Restore the skin’s normal barrier function, Photonic‑electrical synchronization technology (intense pulsed light plus radiofrequency) can be employed; the combination of lower light energy with radiofrequency results in more robust dermal heating and stimulation, while minimizing adverse effects and enhancing therapeutic efficacy [22].

6.5 Traditional Chinese Medicine Treatment

Hormone-dependent dermatitis falls under the category of “heat-toxin” in traditional Chinese medicine. All its clinical manifestations are associated with external pathogenic factors—wind, heat, dampness, and toxin—thus the primary therapeutic principle is to cool the blood and resolve toxicity, supplemented by clearing heat, drying (draining) dampness, dispelling wind, and relieving pruritus [23]. In addition, psychological therapy can help patients overcome their psychological dependence on topical corticosteroids and enhance treatment adherence. Hu Weibin [21] reported that combining pharmacological treatment with psychological counseling yielded superior clinical outcomes; when psychological intervention was added to drug therapy, both clinical efficacy and patients’ mental health status and quality of life improved significantly.

6.6 Prognosis

The prognosis of this condition is influenced by multiple factors, including age, sex, skin thickness, site of application, duration of treatment, potency of the corticosteroid, type of skin lesion, and individual response [25]. Clinical experience has shown that follicular papules, follicular pustules, comedonal lesions, and edema tend to resolve more readily, typically within about three months; in contrast, diffuse erythema, telangiectasia, skin atrophy, dryness, and pigmentary changes are more difficult to treat and require a longer course—usually at least six months, with some cases persisting for several years. Severe striae, moreover, represent permanent damage and, particularly in elderly patients, are essentially incurable. In summary, over the past decade or so, corticosteroid‑induced dermatitis has become extremely common in China; however, its pathogenesis remains incompletely understood, and basic research in this area is limited. To date, no unified nomenclature, conceptual framework, diagnostic criteria, efficacy assessment standards, or clinical classification have been established. Treatment generally relies on an integrative approach combining traditional Chinese and Western medicine.

It is hoped that, in the future, further research and exploration will be conducted across the aforementioned areas to refine and expand the existing body of knowledge on hormone-dependent dermatitis.