Topical steroid abuse and damaged face A presentation highlighting the problem of ‘Topical steroid abuse’ on face & other areas

Topical steroid abuse and damaged face

A presentation highlighting the problem of ‘Topical steroid abuse’ on face

& other areas

Prepared on behalf of IADVL egroup members

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From IADVL E-groupsA public awareness Initiative

30 Dec 2013

TOPICAL STEROID CREAM ABUSE

AND DAMAGED FACE


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Topical Steroid Damaged Face (TSDF)

• Topical Steroid Damaged Face (TSDF) is a condition triggered by abuse/ misuse of topical Corticosteroid skin creams on face.

(The shorter phrase ‘steroid’ is usually used in place of ‘corticosteroid’)

– Indiscriminate use of such creams have resulted in millions of people in India suffering facial damage, which is not fatal but can't be reversed completely, if patient is seen late.

• Can potentially cause permanent damage facial skin.30 Dec 2013


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Topical Corticosteroids

• Topical corticosteroids have been used extensively for over 50 years to treat various inflammatory skin conditions.

– They are the most commonly prescribed topical medications for the treatment of eczema and dermatitis.

• If used properly under medical supervision, they control

skin problems and restore patients’ quality of life.

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Topical steroid preparations

• Topical steroids creams are preparations of various potencies of Corticosteroids in ‘cream’, ‘ointment’ or ‘lotion’ form for easy application on skin.

• Corticosteroids (called ‘steroids’ in short) are powerful drugs which act by anti-inflammatory and vaso-constrictive properties.

– Due to this action they can temporarily mask the ‘inflammation’ of skin and cause temporary ‘fairness’ as side effect.

– But long term side effects can be disastrous.

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Indian obsession with ‘fairness’

• Asia is considered the biggest market for beauty products. And whitening creams are the products of choice.

– Thanks to our fixation with fairer skin rather than healthy flawless skin, both Indian men and women are going for lighter tones and fairness products.

» Times of india. Dec 22, 2013

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Typical abuse of topical steroids on face

• The typical (ab)user of topical steroid creams on the face is a young female or male who uses them mistakenly for ‘enhancing beauty, fairness or complexion or as a panacea for pimples’… for months together.

• In few cases, topical steroid cream on face are prescribed by unqualified medical practitioners.

– In most cases they are recommended either by a friend or a relative or a beautician

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Marketing of topical steroid creams for face as ‘fairness creams’

• The so called ‘fairness creams’ sold by beauty parlors many-a-time have a ‘mixture of high potent steroid creams with a commonly used moisturizing creams’, which may turn the skin thinner, so as to cause temporary ‘clear skin’.

– On using them for few weeks, the other side effects of topical

steroids start appearing on face, which can be quite devastating.

– These fairness creams are sold usually by ‘multi level’ marketing or ‘chain’ marketing.

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‘Fairness creams’ come in all shapes & sizes and in attractive packs


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Topical steroid creams & their availability

• Unfortunately, apart form these steroid containing fairness creams…

– wide variety of potent medicated steroid creams and ointments are freely available for any one to buy at Medical stores/Pharmacies as ‘over the counter products’ without prescription in India.

– which is not the case in other Countries of the world

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Some of the popular abused brands


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A study by members of IADVL

• A study was conducted in the year 2010 by members of Indian Association of Dermatologists, Venereologists and Leprologists ( IADVL) in 12 Indian cities to know the true extent of topical corticosteroid abuse on the face.

– It showed that most patients used topical steroid creams like Betnovate C and N, Tenovate, Lobate or Quadriderm which are available without a prescription.

– Saraswat A, Lahiri K, Chatterjee M, Barua S, Coondoo A, Mittal A, Panda S, Rajagopalan M, Sharma R, Abraham A, Verma SB, Srinivas C R. Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients. Indian J Dermatol Venereol Leprol 2011;77:160-6

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A Popular topical steroid cream ‘self purchased’ by many


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The side effects of steroid creams on face can be…

• Increase in pimples or rashes (for which a person must be using them in the first place!).

• Atrophy of skin• Telengectasia• Hirsutism • Perioral dermatitis and/or rosacea .• Fixed Redness of face

– There can be Systemic side effects due to long term abuse of topical steroid creams as well. (Eg. Cushing's syndrome, ACTH suppression etc.)

• Finally a ‘Topical Steroid dependence’ develops in the user (Topical steroid dependent/damaged face).

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In the following slides, you would find photographic evidence of ill effects occurring due to abuse of topical steroid creams on face and other body areas

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AGGRAVATION OF ACNE

Side effects of misuse of topical steroid containing creams on face:

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SEVERE COMPLICATED ACNE Topical steroid abuse on face .. can turn simple acne in to…

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MISUSE FOR FACIAL PIGMENTATIONTopical steroid abuse on face

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Some medical brands prescribed for treatment of pigmentation (Which are to be used under medical supervision only)


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One such example of misuse of potent topical steroid cream for simple facial pigmentation


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Result of misuse


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INCREASED FACIAL HAIR - HIRSUITISM

Topical steroid abuse on face

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Increased facial hair due to topical steroid abuse


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FACIAL ERYTHEMA & TELAGECTASIATopical steroid abuse on face

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Fixed facial erythema


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Rosacea like changes


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Telangectasia


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PERIORAL DERMATITISTopical steroid abuse on face

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TINEA INCOGNITO Topical steroid abuse on face - Other side effects

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Steroid + antifungal /antibiotic combinations are available in pharmacies


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Abuse of topical steroid on face, masking and increasing underlying

fungal infection


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STRIAE FAR AWAY FROM THE SITE OF TOPICAL STEROID MISUSE

Topical steroid abuse

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Although striae can occur normally, severe striae can be due to topical steroid abuse


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Normal striae in adolescent during period of linear growth


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Abnormal (wide) striae


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TOPICAL STEROID ABUSE ON OTHER AREAS OF BODY

Note that misuse of topical steroid creams is not limited to face

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Signs of steroid abuse

in infants


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In children


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In adolescents


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In young adults


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In adults


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In elderly


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ILL-EFFECTS OF USE OF TOPICAL STEROIDS AS PANACEA FOR ‘ALL SKIN PROBLEMS’!


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Topical steroid is a medicine to be used only on the advise of ‘qualified medical practitioner’

• Number of un-qualified medical practitioners and quacks prescribe topical

steroid creams to many skin problems carelessly &

illogically, causing damage to skin

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How to manage these ill effects?

• Fortunately most of the problems arising out of abuse of topical steroids are reversible and manageable, if recognized early.

• However, if very delayed, they can be irreversible!

– How to manage?

• Stop the abuse immediately• Consult ‘qualified’ Dermatologist

– Please note that it may take few months for the side effects to be controlled

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How to address this nation-wide problem?


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Recommendations of IADVL study* on topical steroid misuse on face

• All healthcare providers need to be sensitized about the dangers of topical corticosteroid misuse, especially on the face.

• This can be enhanced through

– Public awareness initiatives – Focused presentations to

• College students, • Nursing staff, • Pharmacy personnel

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What more can be done?

• Legislation/stronger implementation of existing laws is required to limit public access to topical steroid creams and ointments.

• There is a need to advertise, through audio visual media, the ill effects of overuse /abuse of potent Topical steroid creams.

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A sincere request!

Please spread the message of ‘avoidance of topical steroid abuse’ to all concerned.

Also there is need to educate general public about the myth of considering ‘fairness’ as a measure of beauty.

(Most of the topical steroid abuse on face is to done to enhance ‘fairness’).

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Nina Davuluri, a young women of Indian origin was crowned Miss America in the year 2013

She has dark skin!


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Interesting responses on social network


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Many famous personalities are addressing this myth of equating ‘fairness’ with ‘beauty’.


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Spread the message!!


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About this presentation• This presentation was made possible with the clinical photographs contributed by

members to the IADVL e groups, as well many photographs generously given by Dr Koushik Lahiri, the owner of the TSDF Facebook page*, apart those taken from my own collection.

• Any member of IADVL or medical fraternity can use this presentation to further awareness about this menace of topical steroid abuse to lay public as well as to medical students / practitioners / others.

• Any one who would like to use the photographs or contents are requested to to acknowledge the source.

P Narasimha Rao Hon Gen Secretary,

IADVL 2012-13

• *Topical Steroid damaged face(TSDF) https://www.facebook.com/media/set/?set=a.246365175434624.58786.246358225435319&type=1

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Documents

Topical steroid abuse and damaged face A presentation highlighting the problem of ‘Topical steroid abuse’ on face & other areas