Topical Steroid Damaged/Dependent Face (TSDF)



Fig. 13.1
(ad) Erythema due to topical steroid abuse



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Fig. 13.2
(a, b) Papules due to topical steroid abuse


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Fig. 13.3
(ae) Pustules (secondary bacterial infections) due to topical steroid abuse


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Fig. 13.4
(ac) Acneiform eruptions due to topical steroid abuse


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Fig. 13.5
(ad) Hirsutism due to topical steroid abuse


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Fig. 13.6
(ac) Telangiectasia due to topical steroid abuse


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Fig. 13.7
(ad) Tinea incognito due to topical steroid abuse


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Fig. 13.8
(a, b) Hypo- and hyperpigmentation due to topical steroid abuse


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Fig. 13.9
(ac) Perioral dermatitis due to topical steroid abuse


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Fig. 13.10
(ac) Rosacea-like features due to topical steroid abuse


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Fig. 13.11
(a, b) Allergic contact dermatitis due to topical steroid abuse


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Fig. 13.12
(ac) Photosensitivity due to topical steroid abuse


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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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Mar 5, 2018 | Posted by in Dermatology | Comments Off on Topical Steroid Damaged/Dependent Face (TSDF)

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