Topical Steroid-Induced Perioral Dermatitis (TOP STRIPED): Case Report of a Man Who Developed Topical Steroid-Induced Rosacea-Like Dermatitis (TOP SIDE RED).

Kyra L Diehl,Philip R Cohen

doi:10.7759/cureus.14443

Abstract

The long-term use of topical corticosteroids can result in rosacea-like dermatitis or facial perioral dermatitis. The case of a 54-year-old man is described who developed topical corticosteroid-induced perioral dermatitis (TOP STRIPED), and the features of topical corticosteroid-induced rosacea-like dermatitis are reviewed. The man presented with a painful erythematous facial eruption. Additional history revealed that he had been applying a high-potency topical corticosteroid twice daily to the affected area. Correlation of the clinical history and cutaneous examination established a diagnosis of topical corticosteroid-induced rosacea-like dermatitis (TOP SIDE RED). Treatment of the patient’s TOP SIDE RED included not only discontinuing the high-potency corticosteroid but also initiating topical and oral antibiotics. In addition, a low-potency topical corticosteroid and metronidazole gel were also applied to the affected area. His facial rash resolved within three months and has not recurred. TOP STRIPED, also referred to as TOP SIDE RED, is an adverse side effect associated with the use of high-potency topical corticosteroids to the face. Management includes discontinuing the corticosteroid. Additional treatment may include a low-potency topical corticosteroid, antibiotics (systemic or topical or both), and/or topical calcineurin inhibitors, such as tacrolimus or pimecrolimus.

Highlights

Corticosteroids are used for the treatment of multiple systemic and cutaneous conditions
The case of a 54-year-old man is described who developed topical corticosteroid-induced perioral dermatitis (TOP STRIPED), and the features of topical corticosteroid-induced rosacea-like dermatitis are reviewed
There are several postulated mechanisms for the development of perioral dermatitis and rosacea; prolonged duration of application of high-potency topical corticosteroids can result in the appearance of a dermatitis that has been referred to as either topical steroid-induced perioral dermatitis (TOP STRIPED) or topical steroid-induced rosacea-like dermatitis (TOP SIDE RED) [3-5]

Summary

Introduction

Corticosteroids are used for the treatment of multiple systemic and cutaneous conditions. A man with TOP SIDE RED is described His facial condition occurred after he applied a high-potency corticosteroid cream, which had been prescribed for his hand dermatitis, to his face daily for nearly two months. His dermatosis eventually resolved after he was treated with oral and topical antibiotics, and a lower-potency topical corticosteroid cream. Two months later, the dermatitis on his face had persisted He concurred with starting an oral antibiotic, and doxycycline monohydrate, 100 mg twice daily, was begun. The previously affected red areas (shown within black ovals) are flesh-colored At his visit, again after four weeks, his perioral dermatitis remained resolved. At the subsequent follow-up, two months later, his hands still remained clear and there was no recurrence of the facial dermatitis

Discussion

Conclusions

Disclosures

Goa KL

Weber G