Topical Corticosteroids Impair Restoration of Skin Barrier

Corticosteroids OK for acute atopic dermatitis, but calcineurin inhibitors better for long-term treatment

WEDNESDAY, Feb. 15 (HealthDay News) -- Topical corticosteroids offer a more potent anti-inflammatory effect for the treatment of atopic dermatitis (AD), but they may impair the restoration of the skin barrier and can induce skin atrophy, making topical calcineurin inhibitors more suitable for long-term treatment of the disease, according to a study published in the March issue of Allergy.

Jens-Michael Jensen, M.D., of the University of Kiel in Germany, and colleagues performed gene expression profile analysis on lesional AD skin samples after topical treatment with either betamethasone valerate (BM) or pimecrolimus.

The researchers found that treatment with BM resulted in a significant reduction in mRNA levels of genes encoding markers of immune cells and inflammation, dendritic cells, T cells, cytokines, chemokines, and serine proteases, whereas pimecrolimus only had minor effects. Both BM and pimecrolimus normalized the expression of filaggrin and loricrin. Only BM significantly reduced the expression of rate-limiting enzymes for lipid synthesis and the expression of involucrin and small proline-rich proteins, which covalently bind ceramides. This may explain the lack of restoration of functional stratum corneum layers observed after BM treatment.

"The gene expression profiles are consistent with our previous findings that corticosteroids may exert a more potent anti-inflammatory effect but may impair the restoration of the skin barrier," the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Novartis, which funded the study.

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