Topical Steroid Abuse Research Articles

Iatrogenic Cushing’s syndrome, cataract, and metabolic syndrome in an adult following topical steroid abuse for dermatophytosis

A much is known about the cutaneous side effects of topical corticosteroids (TCs) often neglecting their potential systemic adverse events, including Cushing’s syndrome (CS). Although cases of CS following TCs abuse are a well-documented entity in the pediatric population, similar instances in adults are less common and less discussed. Here, we describe a case of dermatophytosis where the patient developed multiple systemic adverse effects, including significant weight gain, numerous skin striations, and blurred vision, as a result of TCs misuse complicating the otherwise non-significant disease. Hence, it is crucial to emphasize the importance of consulting a dermatologist instead of relying on easily accessible over-the-counter medications from pharmacies, which many people in the general population often resort to.

Beyond the surface: confronting the impact of topical steroids on facial skin

Background: Topical steroids have become the primary therapeutic approach among dermatologists. The clinical outcomes are attributed to their anti-inflammatory, antiproliferative, and immunosuppressive effects. However, this miraculous remedy can lead to significant trouble when used improperly, especially on the face where it can lead to topical steroid damaged faces (TSDF). Methods: study was conducted for 9 months among 30 patients presenting with chief complaints due to topical steroid abuse over face and data was collected and analysed after using self-designed open ended questionnaire. Results: Out of 30 patients, preponderance were seen in females (M:F=1:2.3) The most common age group was 18-28 years (50%). Majority of them (36.6%) used class-3 of highly potent steroid which is betamethasone valerate 0.1%. Most common indication for application was as fairness cream (46.7%). In majority of the patients (70%), suggestion for application was given by pharmacist. 73.3% of patients, purchase medication over the counter (OTC) without prescription. Duration of usage was more than 6 months in 10% patients. Dyspigmentation (32.1%) followed by erythema (28.6%) were the most common adverse effects. Conclusions: Using too many topical corticosteroids may benefit manufacturers and sellers, but it harms unsuspecting people. It's crucial to evaluate and advise patients, as well as inform doctors about avoiding excessive use of these products on the face. This is an important step that needs attention now.

CLINICO-EPIDEMIOLOGICAL STUDY OF TOPICAL STEROID DAMAGED FACE IN A TERTIARY CARE HOSPITAL

Objectives- The aim of the study was to determine the clinical features, extent, and dermographics of topical corticosteroid usage on the face in patients who were seen in the dermatology outpatient department. Materials and Methods: Between August 2022 and August 2023, a questionnaire-based analysis of patients attending the dermatology outpatient department of a tertiary care hospital was conducted. The study was comprised of 200 subjects who applied topical steroid on their face for more than 6 weeks and they were enquired regarding their history. Clinical assessment, and lesion photography was also done. Results: 200 patients with topical steroid damaged face were examined in the study. The most prevalent age range for topical steroid use was between 18 and 30 years which comprised 42% of total patients in the study. Out of 200 patients 149 were women [74.5%]. The average time between commencing the topical steroid regimen and the appearance of symptoms was six months. 74 [39.5%] used topical steroids to treat dermatophyte infections and the remaining subjects used them for miscellaneous reasons. In this study population, cream-based betamethasone valerate was the most frequently misused steroid. The most frequent adverse effect was hyperpigmentation (27%) followed by acneiform eruptions (25%) facial erythema (18%), hypertrichosis (12%), perioral dermatitis (4%) and skin atrophy (5%), hypopigmentation(9%). Conclusion: Topical steroid damaged face is a dermatological concern. The public must be made aware of the possible danger of topical steroid abuse to stop its indiscriminate use.

Topical steroid menace: A case series of severe debilitating infections during the COVID-19 pandemic

ABSTRACT Background: Topical corticosteroids is a boon and also a bane in treating chronic skin conditions. The risk of cutaneous infections due to topical steroids increases with their potency, dose, and duration of treatment. Herein, we present a case series of severe debilitating infections secondary to topical steroid abuse. Materials and Methods: We came across five cases of severe skin infection following the prolonged application of topical steroids. These cases gave a history of the use of steroid creams for persistent skin conditions and the inability to visit the hospital due to the prevailing COVID-19 pandemic. Observations: We came across two cases of crusted scabies, two cases of Fournier’s gangrene, and a case of erosio interdigitalis blastomycetica. These cases had been using topical steroids for a prolonged period for other dermatological conditions. Conclusion: We propose that, as crusted scabies and erosio interdigitalis blastomycetica mimic various other papulosquamous disorders, a KOH examination is a diagnostic tool. Topical steroid abuse is one of the predisposing factors for Fournier’s gangrene. Key words: Topical Steroids; Crusted Scabies; Fournier’s Gangrene; COVID-19

A Clinical-Mycological Study of Dermatophytosis in Western India with Focus on Antifungal Drug Resistance as a Factor in Recalcitrance.

Dermatophytosis have assumed epidemic proportions in India. Antifungal drug resistance solely cannot explain disease magnitude and changing epidemiology. Aim of this study was to analyse clinical-mycological aspects of dermatophytosis, and estimate contribution of drug resistance in clinical recalcitrance. This single-centre observational, cross-sectional, descriptive study was done in tertiary centre of western India after ethical approval, enrolling dermatophytosis patients of all ages and sex. After history and examination, KOH mount and culture in modified SDA medium was done. Culture positive isolates were subjected to E-strip antifungal susceptibility method to test MIC for Terbinafine, Itraconazole, Fluconazole and Griseofulvin. Total 300 patients were included, with mean age of 33.83±27.5 years and male-to-female ratio of 1.22:1; tinea corporis et cruris being commonest, 39.33% (n=118). Only 11.67% (n=35) were treatment naïve, having classical annular morphology. History of topical steroid abuse was found in 81.67% (n=245), with pseudoimbricate lesions in 70.61% (n=173). 86.67% (n=260) had KOH positivity while 83.33% (n=250) had culture positivity: Trichophyton mentagrophytes 45.6% (n=114), followed by Trichophyton rubrum in 34.4% (n=86). A total of 265 patients fit into definition of recalcitrance, from which 12.45%, i.e., 33 isolates showed in-vitro fluconazole resistance. 14.33% (n=43) cases were chronic, 37% (n=111) persistent, 46% (n=138) recurrent while 17% (n=51) had relapse in their disease course. Steroid abuse was the commonest denominator. Role of antifungal resistance in recalcitrant dermatophytosis remains debatable. Stopping steroid abuse, which is often the commonest culprit, with adherence to standard antifungal therapy remains the paradigm in management.

Comparative evaluation of host immune response and cytokine signature pertaining to Th1 and Th2 immune arms in serum and tissue among patients of acute localised vs. chronic disseminated dermatophytosis.

India is witnessing an epidemic of dermatophytosis. The role of host immune response against fungi in chronicity and dissemination is topic of ongoing research. We conducted cross-sectional comparative study to determine the difference in Th1 (IFN-γ) and Th2 (IL4) response in serum and tissue between acute and localised vs. chronic and disseminated cases. Patients (18-60 years) were divided in two groups-group A (n=114, BSA <5%, single anatomic site, duration <6 months, n=118) and group B (n=107 BSA >10%, > one anatomic site, duration >12months, n=118). Clinical parameters along with serum levels of IgE, IL-4 and IFN-γ and expression of IL4 and IFN-γ in dermal infiltrate were compared between group. Trichophyton mentagrophytes complex was commonest causative fungi. Serum levels of IgE were significantly higher (median A-539.2, B-2901.0, p < .001) whereas levels IL-4(median A-21.3, B-20.4, p < .001) and IFN-γ(median A-9.6, B-5.1, p < .001) were significantly lower in chronic cases. Expression of IL-4 was observed in most biopsy specimens in both groups without any difference in intensity of staining. Expression of IFN-γ was not detected in all but one specimen across both the groups. Severe itching (OR:0.050, CI:0.018, 0.139, p < .001), sign of topical steroid abuse (OR:0.203,CI:0.077, 0.537; p=.001), ↓IFN-γ (OR:4.683, CI:1.634, 13.418; p=.004) correlated significantly and independently with chronic dermatophytosis. Our study shows chronic and disseminated cases of dermatophytosis differ immunologically in terms of higher IgE, and lower IL4 and IFN-γ. Expression of IL4 is present in tissue of both acute, localised and chronic disseminated cases. Expression of IFN-γ cannot be established in our study.

Evaluation of Adverse Drug Reactions caused by Topical Steroids in Patients Presenting in Dermatology Department of Teaching Institute of Tertiary Health Care Centre of Central India

Introduction : Topical steroids are most commonly being used today. Mostly these are being misused due to lack of awareness of their adverse effects. Malpractice and easy availability of these agents also responsible for their abuse. Aim : To Evaluate Topical Steroid abuse in various parameters according to CDSCO ADR forms. Objectives : This study was conducted to know the extent of abuse of topical steroid ,along with clinical profile and mode of accessibility in dermatology department of a teaching institute of tertiary health care centre of central India. Material and Method: First 200 patients of adverse drug reaction attending dermatology department were screened according to ICSR form of CDSCO in a period of December 2015 to November 2016 and 181 patients of them who gave history of topical steroid application were further analyzed. Result: Most commonly affected people belong to age of 21 to 30 years (41.98%),Tinea incognito (58%) was the commonest manifestation of steroid abuse, Tinea (58%)was the most common indication of steroid application, self medication (46.40%) was most common mode of steroid accessibility, betamethasone (61.87%) was most commonly applied topical steroid. Conclusion :Self medication and over the counter drug use were most common mode of steroid accessibility both can be controlled by making strict health regulatory policies . Simultaneously health education program must be targeted to young population who are more vulnerable to steroid abuse to make them aware regarding harmful effects of unguided or misguided use of topical steroid.

Immunopathogenesis of Dermatophytoses and Factors Leading to Recalcitrant Infections.

The pathogenesis of dermatophytic infections involves the interplay of three major factors: the dermatophyte, the inherent host defense, and the adaptive host immune response. The fungal virulence factors determine the adhesion and invasion of the skin while the immune response depends on an interaction of the pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMP) with pattern recognition receptors (PRRs) of the host, which lead to a differential Th (T helper) 1, Th2, Th17, and Treg response. While anthropophilic dermatophytes Trichophyton rubrum and now increasingly by T. interdigitale subvert the immune response via mannans, zoophilic species are eliminated due to a brisk immune response. Notably, delayed-type hypersensitivity (Th1) response of T lymphocytes causes the elimination of fungal infection, while chronic disease caused by anthropophilic species corresponds to toll-like receptor 2 mediated IL (interleukin)-10 release and generation of T-regulatory cells with immunosuppressive potential. Major steps that determine the ultimate clinical course and chronicity include genetic susceptibility factors, impaired epidermal and immunological barriers, variations in the composition of sebum and sweat, carbon dioxide tension, skin pH, and topical steroid abuse. It is important to understand these multifarious aspects to surmount the problem of recalcitrant dermatophytosis when the disorder fails conventional therapeutic agents.

Management of Ocular Surface Squamous Neoplasia in Association with Fungal Keratitis in a HIV Positive Individual

Ocular Surface Squamous Neoplasia (OSSN) co-existent with fungal keratitis in an immunodeficient individual has rarely been talked about in literature. Risk factors for fungal keratitis are trauma with vegetative matter, topical steroid abuse, poor ocular surface, corneal anaesthesia, systemic immunosuppression, etc., and for OSSN a major risk factor is immunodeficiency. In current report, patient had multiple risk factors. This report highlights the management of HIV positive 42-year-old male with OSSN and fungal keratitis. A comprehensive evaluation helps clinician decide on treatment priority and achieve good clinical outcome.

A cross sectional observational study of pediatric dermatophytosis: Changing clinico mycological patterns in Western India

Introduction: The last few years have seen a significant rise in the incidence of dermatophytosis across India. Vulnerability of children to this disease is more than adults due to multiple factors. However, limited data are available regarding clinical and mycological variants of dermatophytosis in children. Materials and Methods: A cross-sectional observational study was designed at the dermatology outpatient department in Mumbai. The aim of the study was to assess the clinical profile and identify the causative fungal species in pediatric dermatophytosis. Sixty-seven children below 14 years of age with a clinical diagnosis of dermatophytosis were included by the simple random sampling method. A detailed history (duration of lesions, topical creams used, similar lesions in contacts, contact with pets, and other comorbidities/comedications) was taken and clinical examination (sites of involvement, number of lesions, associated erythema/scaling, morphology, and extent of lesions) was done followed by fungal mount preparation (potassium hydroxide (KOH) and KOH with Chicago Sky Blue stain) and culture of the scrapings on Sabouraud's agar medium containing chloramphenicol and cycloheximide. Microsoft Excel and SPSS-20 software were used to analyze the data. Results: A total of 42 male and 25 female children (mean age – 6.2 years) were included in the study. Prior topical applications of steroids±antifungal combinations were used in 57 cases (85%) before presenting to the dermatologist. About 76.12% (n = 51) of cases had positive family/contact history. Thirty-five children (52.2 %) had extensive disease. Multiple atypical clinical patterns were observed: tinea incognito, irregular geographic plaque, tinea recidivans, tinea pseudo-imbricata, penile tinea, and annular plaques on scalp. Trichophyton mentagrophytes complex was the most common isolate from cultures grown from scrapings, in 14/19 cases (73.7%). Conclusion: This clinico-mycological study highlights the changing clinical patterns (including Tinea pseudoimbricata, geographically patterned plaques) and shift in the etiological agent in childhood dermatophytosis. The study brings into focus the increasing proportion of T. mentagrophytes, high percentages of topical steroid abuse by parents in children, and positive family/close-contact history in children.

Clinico-epidemiological study of topical steroid dependent face in a tertiary care hospital at Mysore

Background: Topical steroids are the most commonly prescribed drugs in dermatology. The adverse effects of steroid misuse are noticeable 3 to 4 weeks after application. Steroid rosacea, hypertrichosis and acneiform eruptions are few of them. A new entity known as topical steroid dependent face, topical steroid dependent face (TSDF) has been recently coined to encompass symptoms such as erythema, burning sensation on attempted cessation of topical steroid application.Methods: A questionnaire-based analysis was done among patients attending dermatology outpatient department of government medical college hospital, Mysore between November 2018 to May 2019. Prior approval of the institutional ethics committee, and consent of patients were obtained. A total of 200 outpatients with facial dermatosis using topical steroids on face for a period greater than one month were taken up for study.Results: The results included population across different age groups, between 16 to 60 years. 56% belonged to the age group of 16 to 30 years. Most common steroid abused was mometasone cream 0.1% (50%), betamethasone valerate cream 0.1% (24.5%) followed by clobetasol ointment 0.05% (21.5%). The major adverse effect with steroid abuse, were acne 72% facial redness 67%. Hyperpigmentation 51%, hypertrichosis 32.5% and skin atrophy 21%.Conclusions: The present study highlights and creates awareness on the burden of facial topical steroid abuse and the poor attitude towards them.

Topical steroid abuse in commercial workers: a cross-sectional analytical study in a tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Abuse of topical corticosteroids (TCs), especially over the face, is prevalent worldwide with India as no exception. Lack of adequate specialist services, the practice of self-medication and easy access over the counter (OTC) has resulted in widespread abuse. Aim of this study was to assess the magnitude of topical steroid abuse and its diverse cutaneous side effects in commercial sex workers.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional analytical study was conducted among commercial sex workers (both females and transgender) attending the STI clinic in the study institution for 6 months. A semi-structured questionnaire was given and type of steroid cream used, frequency, duration, the reason for application and source of information for its use were recorded. Clinical patterns of side-effects were noted. Clinical photographs were taken. Descriptive statistical analysis was done, (SPSS 21.0).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of the total 180 commercial sex workers (CSWs), 80 were transgender and 100 were females. The most common steroid used was betamethasone valerate followed by the triple regimen containing mometasone. The reasons for TCs use were fairness (72%) followed by melasma (18%) and acne (10%). Side effects were seen in 77.5% of transgender and 66% of female CSWs. Common side effects noted were erythema (40%), acne (26%) and, pigmentation (18%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The main reason for TCs abuse in our country as a fairness agent is obsessiveness with fair skin colour. Various studies on TCs abuse were done in the general population but none of the studies focuses on a particular group as in this study.&lt;/p&gt;

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt; due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt;.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We evaluated 77 clinically diagnosed patients of &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt; with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were &lt;em&gt;Trichophyton rubrum&lt;/em&gt; species. Dermoscopic analysis showed features of steroid abuse.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Injudicious and inappropriate use of topical steroid causes &lt;em&gt;Tinea pseudoimbricata&lt;/em&gt;; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.&lt;/p&gt;

Cross-sectional study on assessing quality of life of patients diagnosed with superficial dermatophytosis in South-West India

BACKGROUND: Dermatophytosis is a common skin infection, having recurrent and persisting course because of topical steroid abuse, irregular treatment, and poor hygiene. The aim of this study was to assess the quality of life (QoL) of patients diagnosed with superficial dermatophytosis. MATERIALS AND METHODS: Patients (n = 100) diagnosed with superficial dermatophytosis were recruited in the study. A pretested, structured questionnaire was used for recording patient's details. The observing dermatologist simultaneously assessed the clinical severity of the disease. Data were collected by a single examiner and recorded in a case record pro forma. Clinically doubtful cases were included after examining samples with 10% KOH. Correlation analysis was performed between the Dermatology Life Quality Index (DLQI) score and the study variables. RESULTS: Out of 100 patients, 42 had DLQI scores with moderate effect (score 6–10). A total of 19 patients had a very large effect on QoL and four patients had DLQI scores bearing an extremely large effect on QoL. Both males and females had similar mean DLQI values. A moderate correlation was found between DLQI scores and the use of topical steroids (r = 0.0002), and a slight correlation was found between duration of the disease and DLQI scores (r = 0.006). CONCLUSION: A high prevalence of the disease was found in males, and prolonged disease duration with use of topical steroids was observed. A significant impact was found in the QoL of the patients. Hence, proper counseling and treatment, along with early detection, is needed.

Topical corticosteroid abuse over face: A clinical study

Topical corticosteroid abuse over face: A clinical study - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/j.ijced.2019.063, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Dermatology life quality index in patients with persisting and recurrent dermatophytoses

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Dermatophytosis is the most common fungal infection, which has recurrent and persisting course because of topical steroid abuse, irregular treatment and poor hygiene. Dermatology life quality index (DLQI) is a questionnaire based survey method to assess the impact and severity of many dermatology specific diseases and infections. There is paucity in the literature on the impact of dermatophytosis on the quality of life (Qol). The aim of the study was to assess the impact of dermatophytosis and its sequelae on quality of life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 186 patients with recurrent and persistent dermatophytosis were selected for Qol questionnaire for a period of six months and statistical analysis was performed using t test to determine the impact of dermatophytosis on Qol.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Male to female ratio was 2.7:1, most cases were between 25 to 45 years age group. Thigh fold and gluteal region were the most common sites involved. Mean DLQI score was 12.7. The DLQI scores were statistically influenced by age of the patient, duration of the infection and site of involvement.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study revealed significant impairment of Qol in dermatophytosis patients. Assurance and counselling along with early and prompt treatment plays a significant role in reducing disease related psychosocial sequelae and increase the efficacy of treatment.&lt;/p&gt;

Knowledge, Attitudes and Behavior Regarding Topical Corticosteroids in a Sample of Pharmacy Students: A Cross Sectional Survey.

Introduction and Background:The abuse and misuse of topical corticosteroids, especially over the face, is an increasing problem encountered by dermatologists in India. Lack of patient awareness and the ease of obtaining topical corticosteroids without a prescription are important underlying factors. As the first point of contact, the pharmacist has an important role in controlling topical corticosteroid abuse.Aims:This study aimed to evaluate the knowledge, attitudes, and behavior regarding topical corticosteroids in a sample of pharmacy students.Methods:A cross-sectional survey was carried out among pharmacy students using convenience sampling method. A total of 110 questionnaires were distributed, and 103 valid responses were obtained.Results:Majority of the students were conversant of the fact that different classes of topical corticosteroids effectuate different effects. Majority of the students concurred on points such as topical corticosteroids can have significant cutaneous adverse effects, the important role pharmacist plays in preventing topical steroid abuse, and the need to hold fast dispensing of topical corticosteroids on a prescription-only basis. However, a significant gap in knowledge related to specific side effects and awareness of different classes of topical corticosteroids was noted. Moreover, there was no statistical significant difference in terms of knowledge and awareness regarding topical corticosteroid use between postgraduate and undergraduate students.Conclusion:In our study, although several students were aware of the potential adverse effects of topical corticosteroids, there were gaps in the awareness about specific classes and adverse effects. Knowledge regarding the ethical and rational use of topical corticosteroids should be disseminated among pharmacy students, and the dermatologists should play a key role in this.

A Study on Topical Steroid Abuse and Its Consequences in Dermatology

A Study on Topical Steroid Abuse and Its Consequences in Dermatology

Topical steroid abuse on face: a prospective study from a tertiary care centre of north India

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Topical corticosteroids (TCS) are widely misused on face which is associated with significant adverse effects and poor awareness of these effects. The aim of this study was to assess the frequency of misuse of topical corticosteroids, the causes behind it and the most common adverse events resulting from it and to make aware the people about it&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was conducted at Dermatology Department of Govt. Medical College, Kota during period of one year from July 2015 to June 2016. A total of 670 patients using topical steroids over face were enrolled in the study. Details about the usage of topical corticosteroids and their side effects were recorded.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of the patients were females (72.68%). The most common reason for misuse was melasma (57. 91%) followed by use as a fairness cream (22.38%). Most of the patient used topical steroid cream for duration of 3-6 months (33.13%). Most common age group was 21-30 years (48.20%). Acne form eruption (38.05%) and rebound erythema (28.20%) were the most common adverse effects noted. Patients were ignorant of the ingredients and their side effects.&lt;/p&gt;&lt;p class="Default"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Steroids have been misused by patients on their own or by pharmacist and non-dermatologist physicians for various reasons. Topical steroid should not be used on the face unless it is under strict dermatological supervision. &lt;/p&gt;

Topical steroid-dependent face: Response to xylometazoline topical

Unsupervised and long-term use of fluorinated/potent topical steroids on the face can lead to side effects such as acne, skin thinning, photosensitivity, and a typical clinical presentation of a topical steroid-dependent face (TSDF) with rebound flushing, burning, dryness, and scaling on attempted withdrawal of the potent topical steroid cream. To evaluate the response of a commercially available nasal decongested solution of xylometazoline 0.05% in patients of long-term potent topical steroid abuse on the face. Two patients with a history of long-term, indiscriminate, and unsupervised topical steroid use on the face were asked to use a commercially available nasal decongestant solution, on face. Patients were asked to use the decongestant solution on face, once daily for 2 weeks. Follow-up after 2 weeks demonstrated excellent improvement in flushing and erythema. Side effects reported were transient tingling and stinging sensation. Xylometazoline, being an alpha-adrenergic agonist, presents an effective new option for treatment in patients of flushing and erythema, resulting from long-term topical steroid use on face.