Background/Purpose: The katabolic effects of a systemic treatment with glucocorticoids can lead to a progressive atrophy of the skin. Clinical observation suggests a more pronounced effect of methylprednisolone compared with prednisolone. Therefore, a study was undertaken to correlate the cumulative doses of the respective steroids with the skin thickness measured by high-resolution sonography, comparing patients with rheumatic disorders receiving long-term prednisolone and patients with renal transplants taking methylprednisolone.

Methods: The study included 92 patients, 47 of them after renal transplantation and immunosuppressive therapy with methylprednisolone, 45 with rheumatic diseases and prednisolone treatment, including 29 cases with rheumatoid arthritis. The cumulative steroid doses were recorded by chart review. Patients were included, if they had at least two years of glucocorticoid treatment, had a complete documentation of their steroid intake at least every three months and were free of relevant dermal diseases. The measurement of dermal thickness was performed by high-resolution ultrasound, using an 18 MHz probe, at three standardized locations at volar and dorsal forearm.

Results: There were no differences in the cumulative steroid doses between both groups,  after adjusting for  equivalent doses. However, patients receiving methylprednisolone revealed a significantly more pronounced dermal atrophy, compared with patients taking prednisolone. (mean dermal thickness 0,77 mm, standard error 0,023 in group with prednisolone treatment; 0,65 mm, standard error 0,018 in methylprednisolone group)(t-test; p=5*10^-4). By Pearsonxs correlation we identified a statistical interaction between the mean dermal thickness and type of glucocorticoid used (Pearsonxs r = -0,41; p=2*10^-5). Multiple regression analysis revealed, that methylprednisolone had a more pronounced negative influence on skin atrophy than prednisolone (regression coefficient β= -0,15; p= 2,3*10^-7). The association between cumulative dose of the last two years and degree of atrophy was significantly represented by β= -0,011; p=0,035, however only significant for cumulative steroids of last or last half year in methylprednisolone.

Conclusion: In our study, the long-term use of methylprednisolone was associated with a more pronounced dermal atrophy compared with prednisolone, particularly prominent in the last half year before data collection by measurement . The katabolic effects of methylprednisolone may be more pronounced that those of prednisolone, even after the adjustment for equivalent doses.