Steroid atrophy spider veins

[kira_pelletier]

Hi, I am 35, and 2 1/2 years ago had a sudden worsening of my previously mild atopic eczema. I had a skin infection - my leg and airm hair fell off etc. I had infected eczema on 100% of my skin. I was treated in a hospital with wet wraps and triamicinolone cream. Triamcinolone was used daily on most of the body for 2 months. I still have signs of atrophy (in the beginning all my veins were visible in my legs etc). My hands are very thin and wrinkled (on my hands they also used a stronger steroid for a week because of pomphylox that was out of control - I noticed the thinning after the week). I previously had a very young looking, healthy skin. Now I am depressed because it is 1 1/2 years from the hospitalization (I have used nothing but hydrocortizone since and tried going long streches steroid-free) and my skin still looks "aged" (My skin tone looks uneven because you can see veins through, there are some spider veins and one spot (around an old scar) where the skin is completely white. I also have lax skin, some of it from scractching - most of that has reversed - but some from steroids).Is there any hope still that the damage would completely reverse? The thinning has made my skin super sensitive - I can't wear a bra or any restricting clothing, and I get hives when I handle food etc. I am really sad and upset with my Dr. that he did this to me, even though I was really worried about and was assured that it couldn't happen.

[Alan Rockoff, MD]

The only part about steroid atrophy (thinning) that's irreversible without treatment is superficial blood vessels.  Irregulairty of pigment and more prominent veins are not signs of steroid thinning, but rather those of either aging or (more likely in your case) ongoing eczema itself.  I think you ought to see a different dermatologist to get personal confirmation of this, as well as suggestions for controlling any eczema that remains and using other measures to even out skin tone.

Again stroid use, even intense like what you had, does not itself cause permanent sensitivity or hives.  

Best.

Dr. Rockoff

[kira_pelletier]

I've had bursts of improvement every 2-3 months, most recently a month ago. THe skin seems to smooth and get thicker very quickly  and then it tapers off. IN the beginning I could see veins through, now not so much. So there is hope still, after 1 1/2 years?

Could some of the damage be because of intense scratching? When I was sick, I scratched hard. I am not scratching so much any more, and try not to. IN your experience, at what point does one reach maximum improvement? Could it be up to 2-5 years?

I was diagnosed with mild steroid atrophy. THe doctors had never seen anybody react so strongly to steroids before. My skin became transparent with the strong steroid (hands) in a week, with the triamcinolone in 2 months.

[Alan Rockoff, MD]

Yes, perhaps scratching did play a role.  Best to stop.

Most steroid atrophy lasts under a year.  What persists beyond that often needs other explanation.

Dr. Rockoff