Complications
Although corticosteroid-associated atrophy can be reversible, corticosteroid-associated striae and pigmentation abnormalities are usually permanent.
Prevention involves restricting the use of potent topical corticosteroids to no longer than 2 to 3 weeks at a time, with avoidance of the face and intertriginous areas whenever possible. If prolonged topical treatment is required, the addition of a corticosteroid-sparing agent such as a topical calcineurin inhibitor may be required. Limiting the use of topical corticosteroid occlusion to several hours per day for 1 to 2 weeks is another important preventive measure.
Using the lowest effective concentration of intra-lesional corticosteroid, appropriate injection technique and selection of injection sites, and limiting corticosteroid injections to every 6 weeks can reduce the risk of intra-lesional corticosteroid adverse effects. These adverse effects include adrenal suppression in prolonged use, epidermal and dermal atrophy, and depigmentation if injected too superficially or used too often and for prolonged periods, fat atrophy if injected too deeply into the underlying subcutis, abscess formation if injected into an infected lesion, and weakening or rupture of tendons if injections are given over these structures.[12][34]
Pigmentation is lost at sites where scratching has led to necrosis or mechanical removal of melanocytes and is often permanent.[2]
If the skin surface is chronically and repeatedly traumatised and breached, with time, permanent scarring results.
Also known as postinflammatory hyperpigmentation, transient hyperpigmentation occurs due to chronic mechanical damage to keratinocytes containing melanin pigment (melanocytes) associated with pruritus.[2] This results in the release of melanin into the dermis. Although it can occur with any skin tone, it is most common in dark-skinned people.
Cryosurgery is associated with several adverse effects including blister formation; haemorrhage; infection; excessive granulation tissue formation; pigmentation abnormalities, especially in darker-skinned people; and altered sensation.
Avoiding freeze cycles of >30 seconds and deep freezing over nerve bundles can reduce many of the complications of cryosurgery.
As pigmentation abnormalities are very common with the use of cryosurgery in dark-skinned people, consideration of an alternative form of treatment in these patients is warranted.
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