Scalp atrophy from steroid injections

Cancer chemotherapy affects rapidly dividing cells and, at any given time, 90% of human hair follicles are in the actively dividing phase. Hair loss frequently occurs due to partial or total atrophy of the hair root bulb, causing constriction of the hair shaft, which then breaks off easily. Cell division is metabolism-driven - this process is decelerated by cooling. Also, a decrease in the metabolic activity of the cells in the hair follicle could cause a more general reduction in the cytotoxicity of chemotherapy drugs localised to the scalp.

The following local adverse reactions are reported infrequently when topical corticosteroids are used as recommended. These reactions are listed in an approximately decreasing order of occurrence: burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis , maceration of the skin , secondary infection , skin atrophy , striae, and miliaria. Systemic absorption of topical corticosteroids has produced reversible HPA axis suppression, manifestations of Cushing's syndrome , hyperglycemia , and glucosuria in some patients. In rare instances, treatment (or withdrawal of treatment) of psoriasis with corticosteroids is thought to have exacerbated the disease or provoked the pustular form of the disease, so careful patient supervision is recommended.

Oh lawsonia inermis, how do I love thee? Let me count the ways… Back in January, I began a quest to strengthen and thicken my hair and discovered henna . My hair was thinner than normal, and weak/brittle from frequent manipulation due to psoriasis. At the time, I wasn’t thinking about relief from psoriasis – but rather a solution to make my hair more resilient. I sauntered down to Whole Foods and purchased my first of many boxes of Light Mountain Red Henna (I know it’s not the fancy online herbal mystic brand, but it IS 100% lawsonia inermis and that is good enough for me).  I did a four hour treatment of henna , water, and coconut oil, and was in for the surprise of my life. After washing out the henna with the Shea Moisture African Black Soap Shampoo , I discovered my scalp was completely clear. Like, I could part my hair clear. I figured it was an anomaly, and that the shampoo was just working really well that day. Weeks later, my scalp was still clear. After about a month, I experienced some slight itching towards the nape, and felt a few small flakes. So I henna’d again, and it went away. Twice is nice, but the 3 rd time is the charm. After my March henna treatment, I realized that this plant was providing something I hadn’t had in YEARS – a clean scalp. There isn’t a lot of research on henna , nor a solid explanation for why (beyond it carrying anti-bacterial/anti-fungal properties, and that is irrelevant for psoriasis) – but for me, the proof is in the pudding. Henna smells awful (although creating a henna mix with a yummy smelling conditioner does help), and is incredibly messy, but I am committed to monthly treatments at the beginning of every month. I am on month 7 of henna treatments, and I will continue them until it becomes ineffective.

Parameters No. treated 40 Females 23 Males 17 No. with Atopic Dermatitis 15 No. with Psoriasis vulgaris 25 Mean age (years) 43 (range 22-57) Mean duration of treatment with Group III or IV topical steroids (years) 16 (range 6-25) Localization of skin atrophy:   Extremities 40 Face 28 Trunk 12 Concomitant Diseases:   Arthritis 7 Hypertonia 6 Rhinitis allergica 4 Concomitant medication:   Antiflogistica 6 Antihistamines 2 Antihypertensive drugs 5 Table 2.
Clinical evaluation of severity of symptoms and signs of skin atrophy at baseline and at end of treatment.

Clinical parameters Mean severity at baseline Mean severity at end of treatment Decreased thickness of skin (range 2-3) Laxity (range 2-3) Purpura/Echymoses (range 1-3) Dryness Teleangiectasia (range 2-3) (range 1-2) Table 3.
Mean epidermal and dermal thickness, skin elasticity, erythemal and moisture indexes at baseline and after 8 months of treatment with Vivida of 40 patients with corticosteroid induced skin atrophy.
Parameters Baseline 8 months Epidermal thickness (mm) (-) (-) Dermal thickness (mm) (-) (-) Elasticity Index 44 (39-53) 74 (65-78) Erythemal Index (-) (-) Moisture Index (11-37) (75-97)

Scalp atrophy from steroid injections

scalp atrophy from steroid injections

Parameters No. treated 40 Females 23 Males 17 No. with Atopic Dermatitis 15 No. with Psoriasis vulgaris 25 Mean age (years) 43 (range 22-57) Mean duration of treatment with Group III or IV topical steroids (years) 16 (range 6-25) Localization of skin atrophy:   Extremities 40 Face 28 Trunk 12 Concomitant Diseases:   Arthritis 7 Hypertonia 6 Rhinitis allergica 4 Concomitant medication:   Antiflogistica 6 Antihistamines 2 Antihypertensive drugs 5 Table 2.
Clinical evaluation of severity of symptoms and signs of skin atrophy at baseline and at end of treatment.

Clinical parameters Mean severity at baseline Mean severity at end of treatment Decreased thickness of skin (range 2-3) Laxity (range 2-3) Purpura/Echymoses (range 1-3) Dryness Teleangiectasia (range 2-3) (range 1-2) Table 3.
Mean epidermal and dermal thickness, skin elasticity, erythemal and moisture indexes at baseline and after 8 months of treatment with Vivida of 40 patients with corticosteroid induced skin atrophy.
Parameters Baseline 8 months Epidermal thickness (mm) (-) (-) Dermal thickness (mm) (-) (-) Elasticity Index 44 (39-53) 74 (65-78) Erythemal Index (-) (-) Moisture Index (11-37) (75-97)

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