The introduction of topical corticosteroids (TCs) in the form of hydrocortisone in 1952 completely revolutionised dermatologic therapy [1]. Later from the same decade onwards, more potent TCs were introduced making the treatment of dermatological disorders easier and simpler. However, more than 10 years after the introduction of TC, the first reports of cutaneous adverse effects of TC misuse started appearing in the literature [2]. Moreover, the addictive potential of TC came to light when Burry reported cases of addiction to TC in 1973 [3]. The term “steroid addiction” was coined by Kligman and Frosch in 1979 when they first described in detail the parameters of the condition [4]. TC addiction has also been later reported under various names such as light-sensitive seborrheic dermatitis [5], red skin syndrome [6], steroid-induced rosacea-like dermatitis [7] and topical corticosteroid damaged face [8], each of which describes a particular manifestation of TC addiction. “Topical corticosteroid addiction/dependence” implies the cutaneous and psychological dependence of the patient on the drug (TC), which results in rebound phenomenon and psychological distress on stoppage of its application. The psychological aspect differentiates this condition from the other TC-induced adverse effects.

The term addiction implies an excessive liking or fondness for any substance. Addiction, therefore, leads to repeated use of the substance resulting in overuse, misuse and finally a dependence on that item. Dependence on a psychoactive substance is characterised by certain distinctive features. Once the person starts using the substance, e.g. a drug, he might lose control of amount and duration of intake. This further leads to an intense craving for the drug. Withdrawal of the drug leads to a set of withdrawal symptoms. The patient may experience a tolerance to the substance—progressive increase in the amount of the substance may be required to produce the desired physiological and psychological effect. Dependence is also characterised by a continuous use of a substance in spite of being aware of its harmful physical, social or legal consequences. A person is officially diagnosed with dependence on a substance if three or more of these features are present together at a particular period of time [9]. Dependence, addiction, abuse or harmful use all imply that the person is harmfully and helplessly attached to the substance for a substantial period and hence are essentially synonymous [10].

TCA is a condition which results from chronic misuse of TC causing intense psychological and physical (cutaneous) dependence on the drug. Stoppage of the TC results in a rebound or flare in the symptoms which causes physical and psychological distress to the patient and a craving for the culprit TC. The quality of life of the patient is affected in such a manner that the individual starts using the TC again to maintain normal or near-normal social functioning. Further attempts to withdraw it are resisted by the patient. Most of the studies on TC misuse are hospital based and have assessed the incidence of side effects and the magnitude of TC misuse among dermatology OPD patients. However, no population-based study to assess the prevalence of TC misuse in the society at large is as yet available. Hence, it is difficult to assess the number of patients of chronic TC misuse who develop the rebound phenomenon [9]. The largest multicentric study on TC misuse on the face conducted in India found that 15% of such patients were addicted to it [8]. A hospital-based study in Iraq found 94% of patients with steroid-induced rosacea to experience a rebound [11]. The face is the commonest site of TCA [12]. TC addiction is also manifested at other sites of the body such as the flexures, perianal area and genital area in both males and females [6]. However, irrespective of the site, the basic clinical features of TCA remain the same, though the clinical features may vary depending on the site.