Download Topical Steroid Abuse and Damaged Face

Topical steroid abuse
and damaged face
A presentation highlighting
the problem of ‘Topical
steroid abuse’ on face
& other areas
TOPICAL STEROID CREAM
ABUSE
AND DAMAGED FACE
A public awareness Initiative
From IADVL E-groups
30 Dec 2013
Prepared on behalf of IADVL egroup
members
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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.
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Prepared on behalf of IADVL egroup
members
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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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Prepared on behalf of IADVL egroup
members
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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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Prepared on behalf of IADVL egroup
members
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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;77:1606
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members
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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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Side effects of misuse of
topical steroid containing creams on face:
AGGRAVATION OF ACNE
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Topical steroid abuse on face .. can turn simple acne in to…
SEVERE COMPLICATED ACNE
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Topical steroid abuse on face
MISUSE FOR FACIAL PIGMENTATION
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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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Topical steroid abuse on face
INCREASED FACIAL HAIR - HIRSUITISM
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Increased facial hair due to
topical steroid abuse
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Topical steroid abuse on face
FACIAL ERYTHEMA & TELAGECTASIA
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Fixed facial erythema
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Rosacea like changes
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Telangectasia
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Topical steroid abuse on face
PERIORAL DERMATITIS
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Topical steroid abuse on face - Other side effects
TINEA INCOGNITO
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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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Topical steroid abuse
STRIAE FAR AWAY FROM THE SITE OF
TOPICAL STEROID MISUSE
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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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Note that misuse of topical steroid creams is not limited to face
TOPICAL STEROID ABUSE ON OTHER
AREAS OF BODY
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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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Topical steroid abuse
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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Topical steroid abuse
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
•
30 Dec 2013
*Topical Steroid damaged face(TSDF)
https://www.facebook.com/media/set/?set=a.246365175434624.58786.246358225435319&type=1
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