Rebounding triad (severe itching, dryness and burning) after facial corticosteroid discontinuation defines a specific class of corticosteroid-dependent dermatitis

摘要

In patients with dermatitis, the sudden discontinuation of topical corticosteroid (TC) use after long-term treatment could cause flaring symptoms (named rebounding responses). Diagnostic criteria for facial corticosteroid-dependent dermatitis (FCDD) are vague and uncertain. We aim to define a category of patients with clinical rebounding triad including severe itching, dryness and burning. Patients with FCDD (n=268) were evaluated to determine distinctive rebounding triad manifestations after TC cessation. Data on history of facial TC use and rebounding presentations were collected. A group of chronic dermatitis patients (n=83) with rebounding triad after TC discontinuation were enrolled and added to patients with FCDD presenting triad symptoms. Patients without triad were compared with triad-positive patients. Eighty-five patients who displayed triad manifestations after TC cessation showed longer (93.1 +/- 53.6 vs 9.6 +/- 5.5weeks, P<0.001) and more frequent (7.7 +/- 4.5 vs 2.3 +/- 1.6 times/week, P<0.001) use of TC. Similar results were observed after adding 83 dermatitis patients who experienced triad after TC cessation. Multivariate analysis showed that mean duration of TC use (odds ratio [OR]=1.83, 95% confidence interval (95% CI)=1.042-3.218, P=0.035) and mean frequency of TC use (OR=2.802, 95% CI=1.135-6.918, P=0.025) were independent predictors of rebounding triad after TC cessation. Duration and frequency of TC use were the main factors predicting rebounding triad.