Skin Atrophy

Hi Dr,

At the end of July last year I received one session of fraxel laser resurfacing along the orbital rim under both my eyes. I've always had dark circles and badly textured skin there but no puffiness, so this was supposed to be a relatively safe attempt at some form of remedy. I reacted quite badly to the fraxel and had some prolonged brusing and what the doctor told me was inflammation. he prescribed a topical steroid called Advantan for me to use once daily to bring down the inflammation. I used this for a week starting at the end of August, and after that period he told me to continue for another two weeks until my next appointment. However, on the 18th day of using the steroid i decided to stop because i believed i was seeing new blood vessels rise up in that area and the skin was taking on a thin and ill-textured appearance. It is now Mid February and my condition has not really improved. My dermatologist says that close to three week course of topical steroids could not have created this reaction, but all my research on the Internet says that this was a long period of time to be using steroids on the face. My skin has all the qualities of atrophic skin (lots of visible blood vessels, shiny, lax). I'm a 23 year old male, and I'd like to know if the Steroid could have caused this reaction, and if it has, is it irreversible. Is there anything i can do to help remedy the situation (i.e. use retin-a) or am i stuck like this forever?

Thanks for all your help

[Alan Rockoff, MD]

If the steroid was a mild one, the kind that should be used on the face, then it would not cause atrophy in 3 weeks or at all.  I don't know how to explain the blood vessels.  Perhaps because of your concern, you're looking at them more carefully than you might have done before.  Fraxel resurfacing wouldn't break blood vessels.  I'm afraid I'll have to refer you to face-to-face consultation for more detailed evaluation.  But again, the kinds of treatments you've had, Fraxel and steroids, would not be expected to cause long-lasting, much less permanent, skin damage.

Best.

Dr. Rockoff

[Nazcalines]

thank you for your evaluation Dr.

The steroid i had prescribed i've heard referred to as moderately potent. I know that the packaging says it is safe to use in adults for up to twelve weeks and children for 4 weeks, and that it may be used on the face, but the packaging recommends no longer than two weeks. If the steroid had theoretically been a strong steroid would any atrophy caused to the orbital rim be reversible, and if so over how long a period and by what means (natural or medical intervention)?

Thanks again