Transepidermal Elimination Following the Use of a Topical Adrenal Steroid

Abstract

The concept of transepidermal elimination was described by Mehregan 1 as a mechanism by which the skin may rid itself of a material. In the primary perforating disorders of the skin, the foreign material that is spontaneously extruded through the epidermis represents altered dermal substances. 2 Goette 3 recently reported a case of transepidermal elimination of altered collagen that developed in a psoriatic plaque following intralesional adrenal steroid injections. Herein, we describe a patient with psoriasis who developed a clinically and histologically similar lesion following the use of a new potent topical adrenal steroid preparation, betamethasone dipropionate ointment (Diprolene). Report of a Case A 67-year-old woman had a six-month history of a skin eruption on her lower back and elbows. She had been an insulin-dependent diabetic for many years and was taking a diuretic for hypertension. Physical examination revealed classic thick psoriatic plaques on the skin over the elbows