Abuse of Topical Corticosteroids and its Consequences: A Prospective Study

Background: Misuse of topical corticosteroids is a widespread among young people in India, especially women. The inadvertent use of topical corticosteroids for various common dermatological conditions is associated with significant adverse effects Aim: To assess the steroid abuse for various common dermatological conditions and its adverse effects. Materials & Methods: Sixty patients who attended OPD dermatology were taken in to study. A detailed clinical history with regard to age, gender, education status, duration and frequency of use of topical steroids, type and formulation of the drug (lotion, cream, ointment), cause for using the drug and the source of the drug (by dermatologist, doctor- physician/Ayurvedic/homeopathic, over the counter (OTC) were taken. Results: Majority of patients were between the age group of 15-30 years and females were in predominance. The common indications were facial pigmentation, dermatophytosis and acne. The source of drug were mostly from pharmacist, friends and family members. Most commonly used steroid were betamethasone valerate, clobetasol propionate and mometasone furoate. The common side effects observed were acneiform eruptions, tinea incognito, and erythema with telangiectasia, cutaneous atrophy and striae. Conclusion: Topical steroids should be used cautiously and judiciously. Awareness should be given regarding the indications and its consequences. Avoidance of self-medication by over the counter purchase should be stressed upon. While treating children extreme care should be given regarding the selection of potency of topical steroids.

A Comparative Study on Clinical and Therapeutic Features Between Malassezia Folliculitis and Steroid Acne / 대한의진균학회지

BACKGROUND: Steroid acne have similar clinical manifestations with Malassezia folliculitis, so it is not easy to distinguish between these disease entities clinically. And there have been few reports about them and the therapeutic efficacy of antifungal agent for steroid acne. OBJECTIVE: We aimed to find out different points clinically between steroid-using acneiform eruption group and the group without use, and describe the results of direct-microscopic examinations and establish the relationships between therapeutic responses to oral antifungal agent and some variables like use of corticosteroids, grade of direct-microscopically positive score. METHODS: With 91 patients according to the protocol prepared, we described characteristics of the lesions, sites, and distributions, use of corticosteroids, then examined Malassezia spores with 10% KOH/Parker blue black ink mount from patient's skin lesions. And finally we compared the reponses to antifungal agent. For objective evaluation we used direct microscopic grading method to count spores introduced by Jacinto-Jamora et al. RESULTS: In both groups with and without use of corticosteroids, most had characteristics of papules and pustules, symmetric distributions except the patients using topical corticosteroids. In all positive groups, there was no significant difference in therapeutic responses regardless of the previous use of corticosteroids. Interestingly therapeutic response rate of (1+) group to itraconazole are similar with that of higher scoring groups. CONCLUSION: We suggest that not in a tropical area like Korea, direct-microscopically low score ((1+) or (2+)) and even negatives with typical manifestations of Malassezia folliculitis has a clinical significance and both steroid acne and Malassezia folliculitis may be one spectrum of the same disease.

The Incidences of Malassezia in Steroid Acne and Other Acneiform Eruptions / 대한의진균학회지

BACKGROUND: Steroid acne is a folliculitis that can result from a systemic or topical administration of steroid and has been described as showing similar clinical pictures to Malassezia folliculitis, but there have been few reports about the incidence of Malassezia in steroid acne and other acneiform eruptions. OBJECTIVE: Our purpose was to describe the incidences of Malassezia in acneiform eruptions and to discuss about the relationship between clinical steroid acne and Malassezia folliculitis. METHODS: The history, clinical features, direct microscopy, histopathological analysis, and therapeutic results of 125 cases with steroid acne or other acneiform eruptions were described and compared. RESULTS: Over 80% of patients with acneiform eruption receiving systemic steroid revealed significant numbers of Malassezia in the lesional follicle. CONCLUSION: Steroid acne and other acneiform eruptions showing discrete follicular papules and/or pustules localized to the upper trunk or acneiform facial skin lesions associated with multiple acneiform lesions on the body in the summer period should be suspected as Malassezia folliculitis.