Topical Steroid Abuse- Its Use as Topical Depigmenting Agent
Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose...
Transcript of Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose...
![Page 1: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/1.jpg)
Topical Steroid AbuseA presentation for Family Physician by IADVL.
IADVL THEME FOR YEAR 2019-
“FIGHT TOPICAL STEROID MISUSE”
![Page 2: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/2.jpg)
Typical Tineacruris
Also called GAJA KARNA- Elephant’s Ear
![Page 3: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/3.jpg)
Typical Tinea cruris
![Page 4: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/4.jpg)
Typical Tineacruris
Pruritic Annular plaque with scaling – A Ring or An Arc
![Page 5: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/5.jpg)
Typical TineaFaciei
![Page 6: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/6.jpg)
Such type of “ BLANKET” treatment is commonly given
![Page 7: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/7.jpg)
Few commonly prescribed creams
• Candid-B Sofradex• Zole-F Tenovate M• Lobate GM Candid Total• Panderm+ Clobet GM• Quadriderm Clodem M• Surfaz SN Cloben G• Betnovate C Fourderm• Betamil GM O2 derm• Dermi 5 Clobikem GM• Cosvate GM Lupiderm GM
Market is flooded with such irrational FDCs
![Page 8: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/8.jpg)
Irrational Fixed dose combination creams are often sold OTC by chemists and also prescribed by GPs
![Page 9: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/9.jpg)
Patient applies it on Ringworm
What happens NEXT ?
![Page 10: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/10.jpg)
Patient applies cream
He feels better
He stops applying cream
Relapse
And the vicious cycle continues…
![Page 11: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/11.jpg)
This is Topical Steroid modified Tinea
Multiple rings and arcs, pustular lesions, wide area involved
![Page 12: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/12.jpg)
This is Topocal Steroid modified Tinea
Ill defined map, multiple arcs
![Page 13: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/13.jpg)
This is Topical Steroid modified Tinea
Ill defined map, multiple arcs
![Page 14: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/14.jpg)
This is Topical Steroid modified Tinea
No
No ring, only multiple arcs, activity even in the center of plaques
![Page 15: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/15.jpg)
Such extensive tinea is common scinariosince last few years
![Page 16: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/16.jpg)
Sincere appeal from IADVL
Do not prescribe steroid containing cream to treat fungal infection.
![Page 17: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/17.jpg)
No steroid cream for Ringworm( Fungal Infection)
Use plain antifungal cream like
Clotrimazole Eberconazole
Bifonazole Amrolfine
Miconazole Terbinafine
Luliconazole Sertaconazole
Ciclopirox Olamin Ketoconazole
![Page 18: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/18.jpg)
Steroids• Potent Anti-inflammatory
• Anti-proliferative ( Anti-mitotic)
• Immunosuppressant
![Page 19: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/19.jpg)
Indications for Topical steroids
• Dermatitis- Atopic , seborrhoeic, Nummular eczema, Varicose eczema, allergic contact
• Psoriasis, lichen planus
• Drug induced allergic rash
• Vitiligo
• Lichen simplex chronicus
• Discoid Lupus erythematosus
• Insect bite allergy
It is very useful drug in treating steroid responsive skin diseases.
![Page 20: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/20.jpg)
Side Effects of Topical Steroid
o Thinning of skin
oBurning of face , face becomes sensitive
oAcneiform eruption
oExacerbation of existing acne
![Page 21: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/21.jpg)
Side Effects of Topical Steroid(contd.)
oFacial hairs in females
oFacial skin becomes erythematous
oTelangiectasia on face
oPerioral dermatitis, Rosacea
![Page 22: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/22.jpg)
Side Effects of Topical Steroid(contd.)
oStriae
oPurpura,Ecchymosis
oCushing’s syndrome-Hypertension, Hyperglycemia, Osteoporosis,
oGlaucoma
![Page 23: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/23.jpg)
Thinning of Skin
And hence prominent veins
![Page 24: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/24.jpg)
She applied steroid cream on upper extremities to make them fair
No fairness but skin became thin with prominent veins
![Page 25: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/25.jpg)
Development of striae (stretch marks)
This is irreversibleside effect
![Page 26: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/26.jpg)
Sever Ugly Striae
![Page 27: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/27.jpg)
Striae ( Stretch Marks) on Skin
Ulcers develop in stretch marks but fungus prevails.
![Page 28: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/28.jpg)
Thinning of skin with stretch marks( striae)
![Page 29: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/29.jpg)
Ecchymosis, Purpura ( along with striae)
![Page 30: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/30.jpg)
Purpura
![Page 31: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/31.jpg)
Skin lightening-Three in One Creams contain
• Fluocinolone/ Mometasone
• Hydroquinone
• Tretinoin
![Page 32: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/32.jpg)
Skinlite, Cosmelite, Melalite XL, Melacare, Melacare forte, Lomela, Getlite, lookbrite, Eveglow, Metacortillite, Melamet White, Pearl ,Grazia, Metaskin, Liteskin, Melacut, MosolPlus, Motesol Plus, Acnezac MS, Melanorm MS ,D-Masi, Depig-TM ,M-lite, HQN Plus, Multi HTM, Tinacare, Melabest, No-scar , UB Fair
And many more….
![Page 33: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/33.jpg)
Fairness craze
Young boys and girls, men and women apply such creams on face by recommendation of friends, chemists, relatives or parlor and land up in various side effects on face. This is called Topical Steroid Damaged/ Dependent Face (TSDF)
![Page 34: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/34.jpg)
Telangiectasia ( Permanent dilatation of blood vessels)
It is irreversible damage to the skin , responds only to LASERs
![Page 35: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/35.jpg)
Telangiectasia
![Page 36: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/36.jpg)
Perioral Dermatitis
Erythematous papules around lips
Erythematous, scaly papules around lips
![Page 37: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/37.jpg)
Same patient , close-up view
![Page 38: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/38.jpg)
Rosacea
![Page 39: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/39.jpg)
Persistent Erythema
![Page 40: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/40.jpg)
Persistent Erythema
![Page 41: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/41.jpg)
Hypertrichosis
![Page 42: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/42.jpg)
30 Dec 2013 Prepared by IADVL egroup members 43
Hypertrichosis
![Page 43: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/43.jpg)
Acneiform eruption
Monomorphicinflammatory papules
![Page 44: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/44.jpg)
He was given a “Specially made” cream by a parlor for fairness
![Page 45: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/45.jpg)
They are not “acne vulgaris”
![Page 46: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/46.jpg)
![Page 47: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/47.jpg)
Exacerbation of existing Acne
![Page 48: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/48.jpg)
She applied steroid cream for melasma
Melasma was unaffected but severe acne developed
![Page 49: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/49.jpg)
Even very low potency steroid cream can cause side effects
Skin becomes thin, sensitive with burning& stinging.
She had applied Clobetasone butyrate-low potency steroid
![Page 50: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/50.jpg)
![Page 51: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/51.jpg)
Other side effects of topical steroids
![Page 52: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/52.jpg)
Hypopigmentation
This is side effect of topical steroid. If somebody uses it as fairness cream , he will also get other side effects of steroids. The fairness doesn’t last longer. In fact face becomes more dark.
![Page 53: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/53.jpg)
Masking of Infections
Tinea incognito ( Steroid modified Tinea)
![Page 54: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/54.jpg)
Glaucoma
Steroid ( Clobetasol ) cream was applied around left eye for fungal infection.
![Page 55: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/55.jpg)
Cushing's syndrome
Clobetasol propionate 1 tube applied per day led to systemic absorption
![Page 56: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/56.jpg)
Boy developed obesity, Hypertension and bone resorption
![Page 57: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/57.jpg)
![Page 58: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/58.jpg)
10 yr old girl; developed cushingoid features with obesity, striae and hypertichosis. Used Clobetasol FDC for tineafor 6 months.
![Page 59: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/59.jpg)
Systemic side effects of topical steroids
Cushing’s Syndrome
Hypertension
Hyperglysemia
DUB
Bone resorption
![Page 60: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/60.jpg)
Classification of topical steroid according to potency
![Page 61: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/61.jpg)
![Page 62: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/62.jpg)
Avoid Potent Steroids on
• Infant
• Eyelids
• Axillae
• Groins
• Extensive body surface area
![Page 63: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/63.jpg)
No steroid cream for Ringworm( Fungal Infection)
Use plain antifungal cream like
Clotrimazole Eberconazole
Bifonazole Amrolfine
Miconazole Terbinafine
Luliconazole Sertaconazole
![Page 64: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/64.jpg)
This is how Dermatophyte presentsPruruti annular lesions with tiny papules, vesicles and scales
at the border, also called ringworm or tinea
![Page 65: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/65.jpg)
Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin.
![Page 66: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/66.jpg)
ITATSA
Iadvl’s Taskforce Against Topical Steroid Abuse
It is for awareness of the issue oftopical steroid abuse amongstchemists, doctors and public.
![Page 67: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/67.jpg)
Poster by IADVL
![Page 68: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/68.jpg)
![Page 69: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/69.jpg)
Tall claims by makers of irrational FDCs
![Page 70: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/70.jpg)
Kindly do not get carried away by such claims
![Page 71: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/71.jpg)
OATHHenceforth I will use
steroid cream Judiciously and only when indicated.
![Page 72: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/72.jpg)
Take home message
• Use steroid cream judiciously only for proper indication and in correct potency.
• No steroid cream for any infection - bacterial or fungal ( ringworm )
• Not to prescribe any steroid cream as fairness cream.
• If any doubt about diagnosis kindly refer the patient to a dermatologist.
![Page 73: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/73.jpg)
![Page 74: Topical Steroid Abuse - Amazon S3 · Topical Steroid Abuse ... Kindly do not use fixed dose combination cream for any skin disease. It may ruin patient’s skin. ITATSA Iadvl’sTaskforce](https://reader033.fdocuments.in/reader033/viewer/2022053001/5f0558dc7e708231d41283e2/html5/thumbnails/74.jpg)
THANKS