Fig. 13.1
(a–d) Erythema due to topical steroid abuse
Fig. 13.2
(a, b) Papules due to topical steroid abuse
Fig. 13.3
(a–e) Pustules (secondary bacterial infections) due to topical steroid abuse
Fig. 13.4
(a–c) Acneiform eruptions due to topical steroid abuse
Fig. 13.5
(a–d) Hirsutism due to topical steroid abuse
Fig. 13.6
(a–c) Telangiectasia due to topical steroid abuse
Fig. 13.7
(a–d) Tinea incognito due to topical steroid abuse
Fig. 13.8
(a, b) Hypo- and hyperpigmentation due to topical steroid abuse
Fig. 13.9
(a–c) Perioral dermatitis due to topical steroid abuse
Fig. 13.10
(a–c) Rosacea-like features due to topical steroid abuse
Fig. 13.11
(a, b) Allergic contact dermatitis due to topical steroid abuse
Fig. 13.12
(a–c) Photosensitivity due to topical steroid abuse
Fig. 13.13
(a, b) Atrophy and striae due to topical steroid abuse
13.3 Ethical Use of TC on Face
Judicious use of TC on face depends on a number of factors such as indication, potency of the drug, age of the patient and duration, amount and frequency of application [12]. TCs have various therapeutic effects on the skin and hence are useful in hyperproliferative, inflammatory and immunologic disorders [11]. However, application of TC in diseases which are not steroid responsive or where TCs are contraindicated may lead to the catastrophic effects enumerated later [13]. The penetrability of the skin of the face is much higher than the skin of the other parts of the body because of its inherent thinness. Hence, TCs of higher potency should be avoided, and TCs of least potency should be applied on the skin of the face [12]. The age of the patient also determines the thickness of the skin of the face, e.g. children have even thinner skin than adults. Hence, TCs should preferably be avoided in this age group, and only TCs of least potency should be used if absolutely necessary [14, 15]. The duration of application is also important. It has been recommended that irrespective of the potency, TCs beyond a period of 2 weeks on the face should not be applied [11]. In fact most experts recommend once daily application of the proper amount of TC based on FTU [16] (Tables 13.1, 13.2, 13.3, 13.4 and 13.5).
Table 13.1
Major indications of topical corticosteroids
Eczematous diseases | Atopic dermatitis, seborrhoeic dermatitis, contact dermatitis |
Papulosquamous diseases | Psoriasis, lichen planus, erythroderma |
Bullous diseases | Pemphigus foliaceus, bullous and cicatricial pemphigoid |
Connective tissue disease | Discoid lupus erythematosus, morphoea |
Pigmentary disorders | Vitiligo, melasma (Kligman’s formula) |
Neutrophilic diseases | Behcet’s syndrome, Sweet’s syndrome |
Cutaneous malignancies | Cutaneous T cell lymphoma, lymphocytoma cutis, lymphomatoid papulosis |
Miscellaneous | Papular urticaria, alopecia areata, lichen sclerosus et atrophicus |
Table 13.2
Contraindications of topical corticosteroids
Absolute | Relative |
---|---|
Hypersensitivity to TC | Infections (fungal, bacterial, viral) |
Hypersensitivity to vehicle | Parasitic infestations |
Ulcerated skin |
Table 13.3
Side-effects of TC
Local | Systemic |
---|---|
Acneiform eruptions | Adrenal suppression |
Atrophy, striae | Hypopigmentation |
Hypopigmentation | Growth retardation in children |
Hypertrichosis | Glaucoma/Cataract |
Erythema (hallmark of TSDF) | |
Telangiectasia | |
Infections (fungal, bacterial and viral) | |
Purpura, bruising and ulcerations | |
Allergic contact dermatitis |
Table 13.4
Methods of abuse of topical corticosteroids
Sources of abuse | Methods |
---|---|
Bureaucratic red tape | Approval of multiple drug combinations containing TCs Inability to stop indiscriminate sale of TCs as OTC products at chemists |
Pharmaceuticals | Marketing scientifically unethical combinations Advertisement of TC containing products as fairness creams |
Pharma salesmen
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