Lehmann P, Zheng P, Lavker R M, Kligman A M
J Invest Dermatol. 1983 Aug;81(2):169-76. doi: 10.1111/1523-1747.ep12543603.
Steroid atrophy was induced in 3 volunteers by the continuous, occlusive application of clobetasol propionate to the forearms for 6 weeks. The changes were followed sequentially by light, scanning, and transmission electron microscopy. a 59% decrease in viable epidermal thickness was noted after the sixth week of treatment, as well as a flattening of the dermal-epidermal junction. The 3-dimensional architecture of the dermis was strikingly reorganized. This was largely brought about by resorption of the ground substance as revealed by a progressive diminution of Hale's stain for acid mucopolysaccharides. Loss of ground substance resulted in decreased spaces between collagen and elastic fibers as shown by scanning and transmission electron microscopy. The fibrous network consequently collapsed, yielding a more compact papillary and reticular dermis. This compression caused the reorientation of both collagen and elastic fibers. However, no differences in collagen and elastin fine structure were noted. Fibroblasts were shrunken but not reduced in density. A marked decrease in number of mast cells was noted in 3-week specimens and virtually no mast cells were observed after 6 weeks. We found that the primary effect of short-term steroid use was a rearrangement of the geometry of the dermal fibrous network. This was not due to alterations in the fibers themselves but a secondary consequence of the loss of ground substance.
通过在3名志愿者的前臂连续封闭涂抹丙酸氯倍他索6周来诱导类固醇性萎缩。随后依次通过光学显微镜、扫描电子显微镜和透射电子显微镜观察变化情况。治疗6周后，可见存活的表皮厚度下降了59%，同时真皮-表皮连接变平。真皮的三维结构发生了显著重组。这主要是由于基质的吸收，酸性粘多糖的 Hale 染色逐渐减少表明了这一点。如扫描电子显微镜和透射电子显微镜所示，基质的丧失导致胶原纤维和弹性纤维之间的间隙减小。纤维网络因此塌陷，产生了更致密的乳头层和网状真皮。这种压缩导致胶原纤维和弹性纤维重新定向。然而，胶原和弹性蛋白的精细结构没有差异。成纤维细胞萎缩但密度未降低。在3周的标本中观察到肥大细胞数量显著减少，6周后几乎未观察到肥大细胞。我们发现短期使用类固醇的主要作用是真皮纤维网络几何结构的重新排列。这不是由于纤维本身的改变，而是基质丧失的次要结果。
