Topical steroid abuse and damaged face

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

2. Topical steroid cream abuse and damaged face A public awareness Initiative From IADVL E-groups Prepared on behalf of IADVL egroup members

3. 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. Prepared on behalf of IADVL egroup members

4. 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. Prepared on behalf of IADVL egroup members

5. 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. Prepared on behalf of IADVL egroup members

6. 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.Dec22, 2013 Prepared on behalf of IADVL egroup members

7. 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 faceare prescribed by unqualified medical practitioners. • In most cases they are recommended either by a friend or a relative or a beautician Prepared on behalf of IADVL egroup members

8. 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. Prepared on behalf of IADVL egroup members

9. ‘Fairness creams’ come in all shapes & sizes and in attractive packs Prepared on behalf of IADVL egroup members

10. 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 Prepared on behalf of IADVL egroup members

11. Some of the popular abused brands Prepared on behalf of IADVL egroup members

12. A study by members of IADVL • A study was conducted in the year 2010 by members of Indian Association of Dermatologists, Venereologistsand 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, Lobateor 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 DermatolVenereolLeprol 2011;77:160-6 Prepared on behalf of IADVL egroup members

13. A Popular topical steroid cream ‘self purchased’ by many Prepared on behalf of IADVL egroup members

14. 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 dermatitisand/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). Prepared on behalf of IADVL egroup members

15. 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 Prepared on behalf of IADVL egroup members

16. Side effects of misuse of topical steroid containing creams on face: Aggravation of acne Prepared on behalf of IADVL egroup members

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20. Topical steroid abuse on face .. can turn simple acne in to… Severe Complicated acne Prepared on behalf of IADVL egroup members

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27. Topical steroid abuse on face misuse for facial pigmentation Prepared on behalf of IADVL egroup members

28. Some medical brands prescribed for treatment of pigmentation (Which are to be used under medical supervision only) Prepared on behalf of IADVL egroup members

29. One such example of misuse of potent topical steroid cream for simple facial pigmentation Prepared on behalf of IADVL egroup members

30. Result of misuse Prepared on behalf of IADVL egroup members

31. Topical steroid abuse on face Increased facial hair - hirsuitism Prepared on behalf of IADVL egroup members

32. Increased facial hair due to topical steroid abuse Prepared on behalf of IADVL egroup members

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38. Topical steroid abuse on face Facial erythema & Telagectasia Prepared on behalf of IADVL egroup members

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40. Fixed facial erythema Prepared on behalf of IADVL egroup members

41. Rosacea like changes Prepared on behalf of IADVL egroup members

42. Telangectasia Prepared on behalf of IADVL egroup members

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44. Topical steroid abuse on face Perioral dermatitis Prepared on behalf of IADVL egroup members

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48. Topical steroid abuse on face - Other side effects Tinea incognito Prepared on behalf of IADVL egroup members

49. Steroid + antifungal /antibiotic combinations are available in pharmacies Prepared on behalf of IADVL egroup members

50. Abuse of topical steroid on face, masking and increasing underlying fungal infection Prepared on behalf of IADVL egroup members