By Gary M. White, MD
An older woman applying fluocinonide daily to the chest for months because she had "itchy" spots. The purpura was much too widespread to just be solar/senile purpura.
Chronic use of steroids, either topical or oral, can thin the skin, weakening the blood vessels, and predisposing to purpura (blood leaking into the dermis). This is called steroid purpura.
Purple macules and patches along with atrophic skin are seen. The purpura may be at the site of topical steroid application or distant to it. Sometimes patients mistakenly apply the steroid (given for some other condition) to the purpura, thinking it will treat it! Inquire about all sources of steroids, e.g., topical, oral, and even intralesional. One patient of mine developed significant purpura after 9 months of IL Kenalog to both knees for osteoarthritis.
Stop all steroids if possible. If there is a dermatitis that needs to be treated, see if pimecrolimus or tacrolimus will suffice. Time should improve the condition. Topical tretinoin has been shown to thicken collagen and prevent steroid-induced thinning of the skin, so it may be tried in select situations.
Months of applications of a strong topical steroid to the face.
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