Background:
Glucocorticoids have been shown to downregulate collagen synthesis in human skin in vivo, thereby contributing to skin atrophy.
Objectives:
To compare the effects of continuous and intermittent use of topical hydrocortisone on skin collagen synthesis and, furthermore, to elucidate the mechanism of collagen synthesis reduction induced by hydrocortisone.
Methods:
Collagen propeptides reflecting the synthesis rate of type i and iii collagens were studied from suction blister fluids in nine healthy subjects after 3 weeks of continuous (twice daily) or intermittent (on three consecutive days weekly) topical hydrocortisone treatment and 2 weeks after the termination of treatment. type i collagen mrna was studied in the same subjects from skin biopsies by using in situ hybridization (ish) after 3 weeks of treatment.
Results:
Three weeks of continuous treatment decreased the types i and iii collagen propeptides in suction blister fluid by 89% and 82%, respectively, while intermittent treatment resulted in a corresponding decrease of 53% and 50%. ish studies from skin biopsies showed type i collagen mrna to be markedly reduced in fibroblasts after continuous and intermittent steroid treatment. after a 2-week drug-free interval, the synthesis rate was completely restored in both areas, and some subjects even showed upregulation of synthesis in previously steroid-treated skin.
Conclusions:
Continuous hydrocortisone for 3 weeks markedly decreases collagen propeptides and corresponding mrna in human skin. intermittent hydrocortisone has a less marked effect on the collagen synthesis rate.