Topical Corticosteroid Abuse: Southeast Asia Perspective

Fig. 21.1

Striae on the legs of a psoriasis teenage Filipino patient from prolonged application of clobetasol (Dermovate) cream (Courtesy of Dr. Ana Lucia Dela Paz, Philippines)

Fig. 21.2

Multiple striae on the thighs of an Indonesian male patient after daily application of clobetasol cream for over a month (Courtesy of Prof. Indropo Agusni, MD-DV, Indonesia)

Fig. 21.3

Steroid-induced striae on the abdomen of a psoriatic Singaporean patient (Courtesy of National Skin Centre, Singapore)

Fig. 21.4

Deep abdominal striae in a psoriatic Indonesian patient after application of many kinds of TCS (Courtesy of Prof. Indropo Agusni, MD-DV, Indonesia)

Fig. 21.5

Striae on the inner arms (a) and thigh areas (b) in a 13-year-old Filipina patient with psoriasis after 2 months of self-administered topical halobetasol propionate in petroleum jelly (Courtesy of the Department of Dermatology, Research Institute for Tropical Medicine, Philippines)

Fig. 21.6

Deep striae of the axillary regions in a 23-year-old Filipina female from a 1-month continuous application of topical clobetasol intended for “whitening” purposes, as prescribed by a medical doctor (Courtesy of Dr. Christene Pearl Arandia, Philippines)

Fig. 21.7

Deep axillary striae in a 45-year-old Filipina female after prolonged application of betamethasone valerate cream 2× daily for 6 months on contact dermatitis lesions from herbal medications (Courtesy of Dr. Noemie Ramos, Philippines)

Fig. 21.8

Very deep striae on the axillae from prolonged topical steroid use in a Filipino male (Courtesy of the Department of Dermatology Jose R Reyes Memorial Medical Center, Philippines)

Fig. 21.9

Steroid-induced striae on the axillae in a Singaporean patient (Courtesy of National Skin Centre, Singapore)

Fig. 21.10

Striae on both inguinal and thigh areas in a 21-year-old Filipino male with psoriasis who self-medicated with halobetasol propionate ointment and clobetasol propionate ointment for 6 months (Courtesy of the Department of Dermatology, Research Institute for Tropical Medicine, Philippines)

Fig. 21.11

Striae in the inguinal areas and atrophy of the scrotal skin from topical steroid application for diaper rash in a child (Courtesy of Dr. Rataporn Ungpakorn, Institute of Dermatology, Thailand)

Telangiectasia

Mostly on the face (Fig. 21.12) but on other areas of application as well (Fig. 21.13)

Fig. 21.12

Steroid-induced facial telangiectasia (Courtesy of National Skin Centre, Singapore)

Fig. 21.13

Multiple telangiectatic atrophic lesions on the chest of a 46-year-old Filipina with folliculitis who self-medicated with clobetasol propionate cream 2× daily for 3 months (Courtesy of the Department of Dermatology, Research Institute for Tropical Medicine, Philippines)

Skin atrophy (Figs. 21.11, 21.14, and 21.15)

Though commonly seen in patients using superpotent TCS, prolonged use and excessive amounts of lower-potency TCS like triamcinolone can lead to atrophy [4, 5] (Fig. 21.16).
As TCS suppresses proliferation of cells in the epidermis and later in the dermis, collagen synthesis is likewise inhibited [4]. Thinning becomes evident as loose crinkled skin, along with striae of various depths and hypopigmentation.

Fig. 21.14

Atrophic skin-colored patches with telangiectasia on the labia majora in a 69-year-old Filipina with mucosal lichen planus, noted with application of prescribed halobetasol propionate and betamethasone dipropionate ointment for 1 year (Note that resorption of labia minora has occurred prior to starting topical corticosteroid) (Courtesy of the Department of Dermatology, Research Institute for Tropical Medicine, Philippines)

Fig. 21.15

Upper lip atrophy from potent topical steroid in a Thai patient (Courtesy of Dr. Rataporn Ungpakorn, Institute of Dermatology, Thailand)

Fig. 21.16

Deep skin atrophy seen on this post-CS scar due to excessive use of triamcinolone creams (Courtesy of Prof. Indropo Agusni, MD-DV, Indonesia)

Acneiform eruptions

Known to exist as a common side-effect of oral intake of corticosteroid but commonly seen with application of TCS (Figs. 21.17, 21.18, 21.19, 21.20, and 21.21) and even with inhaled steroid forms (Fig. 21.22).
Though prolonged use of TCS may be a factor, there are some cases when only after a week’s use of low-potency TCS like dexamethasone cream, acneiform lesions erupt.
Appearance is the same for all and although improvement comes with stopping the steroid use, treatment is difficult in many patients and quality of life is much affected.
The positive anti-inflammatory effect of the steroids may take its toll by leading to the undesirable increase in the cutaneous free fatty acids and pilosebaceous duct bacteria that may lead to comedogenesis [5, 12].

Fig. 21.17

Acneiform dermatitis on the (a) chest and (b) back in a 16-year-old Filipino male who applied a 2-week-prescribed desonide lotion 2× daily for 16 weeks for his pityriasis rosea (Courtesy of Dr. Roberto Pascual, Philippines)

Fig. 21.18

Acneiform dermatitis on the chest of an Indonesian female (Courtesy of Prof. Indropo Agusni, MD-DV, Indonesia)

Fig. 21.19

Acneiform dermatitis, truncal (a) and extremities (b), in an Indonesian male (Courtesy of Prof. Indropo Agusni, MD-DV, Indonesia)

Fig. 21.20

Acne lesions in a Thai male treated with topical steroids for pityriasis versicolor (Courtesy of Dr. Rataporn Ungpakorn, Institute of Dermatology, Thailand)

Fig. 21.21

Aggravation of acne lesions and eruption of acneiform papules due to application of BL cream (OTC clobetasol-ketoconazole combination cream) for 3 months in a 20-year-old Filipina patient (Courtesy of the Department of Dermatology, Research Institute for Tropical Medicine, Philippines)

Fig. 21.22

Steroid acne developing in a Filipino patient after prolonged use of asthma inhaler (Courtesy of Dr. Ma. Flordeliz Abad-Casintahan, Philippines)

Aggravation of existing acne (Fig. 21.23)

Occurs when acne cases are mistaken for a dermatitis treatable by TCS and when consumers are misled by misinformation on some OTC drugs (i.e., “BL” cream with clobetasol propionate and ketoconazole as ingredients, with indications as fungal infections and eczema and with price range of USD 30 cents—USD 1)

Only gold members can continue reading. Log In or Register to continue