Topical steroid damaged skin: A clinico-epidemiological and dermatological study

Authors

  • Surya Ravindran Consultant Dermatologist, Artes Skin Clinic, Palakkad, Kerala, India
  • Smitha S Prabhu Associate Professor Dept. of Dermatology & Venereology, Manipal Academy of Higher Education Kasturba Medical College Manipal. Karnataka, India http://orcid.org/0000-0002-2410-5208
  • Sudhir UK Nayak Associate Professor, Dept. of Dermatology & Venereology, Manipal Academy of Higher Education Kasturba Medical College Manipal. Karnataka, India

Keywords:

topical steroid, adverse effect, dermoscopy, Potency, abuse, erythema, white hair

Abstract

Objective To evaluate patients clinically diagnosed as having topical steroid damaged skin clinically as well as by dermoscopy. To tabulate the common side effects observed, source and potency of the steroid used.  Methods A thorough history, clinical evaluation, photography and dermoscopy of lesions performed. Details entered in a structured 14 point questionnaire.  Results 189 patients were studied. Common diagnoses which led to steroid abuse were dermatophytosis (40.2%), pigmentary abnormalities, (30.1%) and acne scars (12.1%). Dermatologists (51.2%) and pharmacists (21.2%) were the foremost prescribers; The average duration of use was 2 weeks to 2 years. The common steroids abused were betamethasone (34%), mometasone (28%), clobetasol and halobetasol derivatives. Common side effects included erythema, hypopigmentation, tinea incognito, striae, atrophy and visible veins. White to translucent hairs admixed with the normal pigmented vellus facial hair   was a novel dermatoscopic observation. Early changes of TSDS in users of less than four weeks were found to be erythema and hypopigmentation which on dermatoscopy showed loss of rete pigmentary network, tortuous dilated vessels with brown clods and white to pink structureless zones.  Conclusion Topical steroid damaged skin is a common dermatological concern. Dermoscopy can be used to detect early steroid induced changes to prevent its further unmonitored use and side effects along with creating awareness in general population about potential harm of indiscriminate use.  

Author Biography

Smitha S Prabhu, Associate Professor Dept. of Dermatology & Venereology, Manipal Academy of Higher Education Kasturba Medical College Manipal. Karnataka, India

Associate ProfessorDermatology & Venereology, Kasturba Medical College, Manipal Academy of Higher Education

References

Sulzberger MB, Witten VH. The effect of topically applied compound F in selected dermatoses. J Invest Dermatol 1952;19:101-2

Mahe A, Ly F, Aymard G, Dangou JM. Skin diseases associated with the cosmetic use of bleaching products in women from Dakar, Senegal. Br J Dermatol 2003;148:493-500

Becker DE. Basic and clinical phar macolog y of glucocorticosteroids. Anesth Prog. 2013;60:25–31

Abraham A, Roga G. Topical steroid-damaged skin. Indian J Dermatol 2014;59:456-9

Gómez Moyano E, Crespo Erchiga V, Martínez Pilar L, Martinez García S. Correlation between dermoscopy and direct microscopy of morse code hairs in tinea incognito. J Am Acad Dermatol. 2016 Jan;74(1):e7-8. doi: 10.1016/j.jaad.2015.09.019.

Lallas A, Argenziano G, Longo C, Moscarella E, Apalla Z, Koteli C, et al. Polygonal vessels of rosacea are highlighted by dermoscopy. Int J Dermatol. 2014;53:e325–7.

Kittler H, Marghoob AA, Argenziano G, Carrera C, Curiel-Lewandrowski C, Hofmann-Wellenhof R, Malvehy J, Menzies S, Puig S, Rabinovitz H, Stolz W. Standardization of terminology in dermoscopy/dermatoscopy: Results of the third consensus conference of the International Society of Dermoscopy. Journal of the American Academy of Dermatology. 2016 Jun 1;74(6):1093-106.

Lu H, Xiao T, Lu B, Dong D, Yu D, Wei H, et al. Facial corticosteroid addictive dermatitis in Guiyang city, China. Clin Exp Dermatol 2009;35:618-21.

Al-Dhalimi MA, Aljawahiri N. Misuse of topical corticosteroids: A clinical study from an Iraqi hospital. East Mediterr Health J 2006;12:847-52

Nagesh T S, Akhilesh A. Topical steroid awareness and abuse: A prospective study among dermatology outpatients. Indian J Dermatol [serial online] 2016 [cited 2017 Nov 27];61:618-21. Available from: http://www.eijd.org/text.asp?2016/61/6/618/193666

Saraswat A, Lahiri K, Chatterjee M, Barua S, Coondoo A, Mittal A, et al. Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients. Ind J Dermatol Venereol Leprol 2011;77:160-6

Rapaport MJ, Rapaport V. The Red Skin Syndromes: Corticosteroid addiction and withdrawal. Expert Rev Dermatol. 2006;1:547–61

10. Friedman P, Sabban EC, Cabo H. Usefulness of dermoscopy in the diagnosis and monitoring treatment of demodicidosis. Dermatol Practical & Conceptual. 2017;7(1):35-38. doi:10.5826/dpc.0701a06.

Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54:1–15

Jakhar D and Kaur I. Dermoscopy of topical steroid damaged/dependent skin. Ind Dermatol Online J 2018;9:286-7.

Kaliyadan F, Jha AK, Sonthalia S. Dermoscopy of striae rubrae. Indian Dermatology Online Journal. 2018 Nov;9(6):477.

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Published

2022-04-10

How to Cite

1.
Ravindran S, Prabhu SS, Nayak SU. Topical steroid damaged skin: A clinico-epidemiological and dermatological study. J Pak Assoc Dermatol [Internet]. 2022Apr.10 [cited 2024Jun.17];31(3):407-14. Available from: http://www.jpad.com.pk/index.php/jpad/article/view/1621

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Original Articles