Site-Specific Characterization and Quantification of Facial Corticosteroid Addiction Dermatitis: A Multimodal Nomogram Integrating High-Frequency Ultrasonography and Transepidermal Water Loss.

BACKGROUND

The evaluation of facial corticosteroid addiction dermatitis (FCAD) lacks objective criteria, and existing clinical evaluation methods largely ignore regional facial heterogeneity. This study aimed to develop a site-adjusted multimodal nomogram integrating 22-MHz high-frequency ultrasonography (HFUS) and transepidermal water loss (TEWL) to serve as an adjunctive quantitative assessment tool to quantify the FCAD pathological state objectively.

MATERIALS AND

METHODS

In this prospective case-control study, 279 facial sites (119 lesional, 160 healthy) from 40 patients with FCAD and 40 healthy controls (HCs) were evaluated. Generalized estimating equations (GEE) were employed to adjust for the intra-subject clustering effect of multisite data.

RESULTS

Multivariable GEE identified four independent predictors for FCAD: marked blood flow on power Doppler imaging (PDI) (adjusted odds ratio [aOR] = 19.46, p < 0.001), subepidermal low-echogenic band (SLEB) thickness (aOR = 1.76 per 0.01 mm increase, p = 0.005), TEWL (aOR = 1.11, p = 0.002), and the chin site (vs. forehead, aOR = 0.35, p = 0.009). The resulting nomogram achieved an area under the curve (AUC) of 0.905, significantly outperforming a single-parameter vascular model (AUC = 0.821, p < 0.05). At the optimal probability cutoff, sensitivity was 85.7% and specificity was 86.9%.

CONCLUSION

Integrating vascular, structural, and functional dimensions with anatomical site adjustments establishes a robust baseline for characterizing FCAD. This multimodal nomogram is intended for use as an adjunctive tool for quantitative assessment and disease monitoring, facilitating a critical shift from subjective clinical evaluation to precise, quantitative imaging.