Since hydrocortisone was first introduced in 1951 and modifications over subsequent years of the primary molecule led to birth of new molecules with different potencies, efficacy and safety profile, dermato-therapeutics has undergone a tremendous revolution [1]. It has never been easier to treat a variety of dermatoses in such an effective manner and bring quick relief to patients suffering with them for months or several years. With prudence over time, the ethical dermatologist used it mainly for non-infective inflammatory conditions and as per certain guidelines [2]. Sadly, TC started being used for improper indications like acne, tinea, urticaria, non-specific pruritus, etc. by general practitioners (GP), registered medical practitioners (RMP), practitioners of alternate medicine, quacks, chemists and homemade doctors (parents, siblings, neighbours) [3]. Due to the prolonged or improper use of TC in approved and non-approved indications, some well-defined adverse effects of TC came to be known [4]. Simultaneously, there came a time when the use of these wonder drugs spilled into the cosmetic realm where some of the pharmacological and adverse effects of TC, e.g. vasoconstrictive and melanopenic effects, were perceived as boom for people hungry to look fair. This was more apparent specially in those of brown and dark races. Here was a situation where people of ‘no skin disease’ preferred to use TC over safe cosmetic creams to look fair or hide their blemishes. With this, a new dermatosis emerged due to long and improper use and for obvious reasons was mainly confined to the face. This dermatosis was named variously by different workers: light-sensitive seborrheic dermatitis, perioral dermatitis, rosea-like dermatitis, steroid rosacea, steroid dermatitis resembling rosacea, steroid-induced rosacea-like dermatitis, topical corticosteroid-induced rosacea-like dermatitis (TCIRD) and topical steroid-dependent face (TSDF) [5–14].

Abuse of TC as a cosmetic probably must be as old as the discovery of TC itself. Almost all dermatologist encountered patients revealing inappropriate use of TC but very few documented it and brought it up to the level of published literature [9–12, 15, 16]. It is only in the last two decades when it has assumed epidemic proportion and unusual steroid induced difficult to treat dermatitis started appearing, that the community has been jolted to actively survey prevalence of the problem in the society resulting in many recent studies to this effect [8, 14, 17–20].

The phenomenon of TC abuse as a cosmetic is universal with reports appearing across the world [21–26]. Due to the society’s increased preference for fairness which is a commonplace in Caucasian American and European skin, the abuse appears to be more in races that have constitutive brown or black skin. Although generally not mentioned, one study found that frequency of patients with TC-related adverse effects amounted to 5.63% of all the dermatology patients seen during the period [26]. It is seen more often in the younger age group of 21–30 years, probably because they are socially more active [19, 24–27]. A strong female preponderance is seen in almost all studies. This may be because of their quest to look pretty and because in our society ‘a fair bride’ is always preferable. Most studies have found an urban preponderance though some reported it more in rural areas [24, 27]. Individuals are usually of poor socioeconomic background with surprisingly good educational level [25, 26, 28]. Majority of them were students or housewives [24–28]. The problem of TC abuse as a cosmetic is not limited to lay people alone. In a study, 31% of nursing students were using face creams containing steroid alone or in combination, of which 64% were of potent category [29].

Among the TC involved, betamethasone valerate appears to be the commonest followed variably by different steroid + antibacterial + antifungal combinations, clobetasol propionate, fluocinolone acetonide and mometasone furoate creams [8, 14, 19, 24–28]. It is a fact that there is hardly any household in India which has not heard of the brand name Betnovate cream (containing betamethasone valerate) by Glaxo. Duration of use of TC was usually for less than 12 months in most studies before patient presented with evidence of steroid dermatitis though TC applications up to 20 years have been documented [14]. Steroid dermatitis usually starts appearing within 6 months of continuous TC abuse [8].

Among the common cosmetic reasons for the use of TC are to look fair and beautiful; for acne, blemishes, suntan and dry skin; and as general skin care purpose [8, 14, 19, 24–28]. The suggestion to start TC as cosmetic cream comes from many quarters including friends, relatives, chemists and beauticians.

Among the factors responsible for the commonplace use of TC as a cosmetic cream by so many individuals are: