Topical steroids have wide use in dermatology in many dermatoses and dermatitis. Major use of topical steroids are in pruritus, psoriasis vulgaris, asteatotic eczema, nummular dermatitis, seborrheic dermatitis, lichen planus, lichen simplex, lichen simplex chronicus, atopic dermatitis, discoid lupus, lichen sclerosus et atrophicus, and alopecia areata.

Longtime uses of topical steroid may cause tachyphylaxis; to prevent such problem, we usually ask patient to apply such drugs with thin film and low quantity. Some patients are advised to stop the topical steroid after a week and re-start on alternate days. This process helps to prevent tachyphylaxis.

All types of topical steroids that are in use almost always have magical results, but side effects also are very noticeable. It depends on potency and type of topical steroid.

Local side effects or adverse effects of topically applied steroids are as follows:

Also glaucoma or cataract may develop due to topical use of eye ointments or drops.

Systemic side effects of potent topical steroids are also noticed due to percutaneous absorption which is common in infant and young children.

Topical corticosteroids are widely used and also misused and even abused. In our country these medications are sometimes unsupervised and even used without prescription, just like OTC medicine. These sorts of condition cause unnoticed bad effects, side effects, and adverse effects which are undesirable. These sorts of problems are commonly seen in the use of corticosteroid on the facial skin.

Use of steroid over the face is mainly done by females, which is common in Bangladesh. The commonest misused drug in Bangladesh is betamethasone valerate. The most common side effect observed is acneiform eruptions followed by steroid dependency and steroidal dermatitis resembling rosacea or red face.

This type of misuse is done by quacks and patients themselves mostly due to unknown knowledge of consequence or ignorance.

Repeated use of topical corticosteroids in various skin problems in Bangladesh is common, which is detrimental for facial skin. For magic symptomatic relief in many skin diseases, our patients use steroid topically without knowing its side effects.

In Bangladesh, so many dark complexion women and even men use steroid as a fairness cream solely or with the combination of known fairness cream.

In close observation for 30 years, I have noticed most of the abusers are young people who come from poor socioeconomic families and uneducated background. They usually get this information from the neighbors, relatives, friends, colleagues, and even from advertisement in electronic media.

Other than steroid so many persons in Bangladesh use different types of whitening and lightening fairness cream which is common in dark complexion girls or women. Those creams sometimes contain hydroquinone and inorganic mercury and even mixed with steroid also. Bleaching effects of these creams usually have severe side effects. Sometimes these products are phototoxic and cause photodermatitis resulting in hyper- or hypopigmentation of skin surface.

These sorts of mixed formulation have multidimensional mechanisms of action which lightened dark skin in pursuit of fair complexion. So many persons, boys and girls, adults and adolescents, and even elderly women, are victims of these circumstances. They need no prescription as topical steroids are sold in local pharmacies even cosmetics or grocery shops in Bangladesh.

As discussed, the side effects of topical steroids with or without other agents cause more serious side effects instead of fairness. These sorts of creams may cause contact dermatitis and exogenous ochronosis with irreversible whitening of the skin, and also severe hyperpigmentation is not uncommon which usually happened due to phototoxicity.

So many students and young female garment workers are victims of the circumstances of skin lightening creams. Misguided by advertisements of steroid containing lightening cream, they are attracted to use those creams and continue to use them until it causes serious burning and hyper- and hypopigmentation of their facial skin. These gullible individuals are erroneously advised to use these creams by their relatives, friends and neighbors. Abuse of topical steroid is a big problem in Bangladesh.

Sometimes users became habituated or addicted with the use of steroid, so it is difficult for them to leave it suddenly.