Infiltrative Erythemas and Nodules on a Unilateral Cheek Following Inappropriate Use of a Topical Steroid

Background: Topical steroid-modified tinea corporis and tinea cruris is on the rise due to the ease of availability of over-the-counter potent topical corticosteroid preparations and their inappropriate use, alters the true morphology of lesion. As there is paucity of literature about increasing prevalence and varied presentation of this condition, we aimed to study the clinical profile and dermoscopic features of Tinea pseudoimbricata due to topical steroid abuse. We present a case-series of 77 cases of a distinct morphological pattern with central erythematous, scaly, pruritic concentrically spreading plaques with raised and scaly borders known as Tinea pseudoimbricata.Methods: We evaluated 77 clinically diagnosed patients of Tinea pseudoimbricata with positive 10% potassium hydroxide examination and culture. Dermoscopy was performed in all patients. The demographic, clinical, and mycological features of each patient were recorded on a predesigned proforma.Results: There were 52 male and 25 female patients with a mean age of 28.66 and a mean disease duration of 7.6 months. There was a history of application of potent or super-potent topical steroid for varying durations. Culture isolates were Trichophyton rubrum species. Dermoscopic analysis showed features of steroid abuse.Conclusions: Injudicious and inappropriate use of topical steroid causes Tinea pseudoimbricata; a special subset of tinea incognito, which is very common now a days. This should alert the dermatologist about the steroid abuse and requires systemic anti-fungal treatment for prolong time.

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Tinea incognito with unjustified use of potent Topical Corticosteroids: a case series

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20173301 ◽

2017 ◽

Vol 6 (8) ◽

pp. 2087

Author(s):

Haiya J. Sheth ◽

Santosh P. Rathod ◽

Raju G. Chaudhary ◽

Supriya D. Malhotra ◽

Pankaj R. Patel

Keyword(s):

Symptomatic Relief ◽

Topical Steroid ◽

Case Series ◽

Superficial Infection ◽

Steroid Abuse ◽

Inappropriate Use ◽

Monitoring Centre ◽

Topical Corticosteroids ◽

Chief Complaints ◽

Tinea Incognito

Topical corticosteroids prescribed for various dermatological conditions, if used haphazardly have their adverse effects too, like aggravation of underlying infections - tinea, herpes etc. Tinea incognito is a fungal infection of skin masked and often exacerbated by application of topical immunosuppressive or steroid agent. Tinea incognito results because local physicians/chemists might mistake tinea with a simple rash. Availability of a topical steroid cream as an over the counter (OTC) drug is also one of the causes. Once it is diagnosed (clinically with or without KOH mount preparation), it should be thoroughly treated with oral and topical antifungal agents. Four cases presenting to Dermatology OPD VSGH with chief complaints of itching and aggravation of existing lesions due to application of potent topical corticosteroids like Clobetasol and Beclomethasone have been discussed here. They were diagnosed as cases of Topical Corticosteroids induced Tinea Incognito. The patients were recovering with oral and topical antifungals prescribed by dermatologist. These were also reported to nearest ADR Monitoring Centre under PvPI with Probable causality according to WHO UMC Criteria for Causality Assessment. The wide use of topical corticosteroids is due to its immediate symptomatic relief. However, the normal presentation of superficial infection gets altered with their inappropriate use. Lack of awareness among population, steroid abuse by local physicians or no strict regulations for local chemist shops have led to its inappropriate use. Its incidence ranges from 5-15%. These figures point towards the fact that implementation of appropriate regulations for the safe use of topical corticosteroids is essential.

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Misuse of topical corticosteroids and attitude towards self-medication: a rising alarm

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20175370 ◽

2017 ◽

Vol 3 (4) ◽

pp. 485

Author(s):

Savita Chaudhary

Keyword(s):

Indian Population ◽

Topical Steroid ◽

Medical Practitioner ◽

Topical Steroids ◽

Self Medication ◽

Topical Medication ◽

Inappropriate Use ◽

Topical Corticosteroids ◽

Number Of Patients ◽

History Of

Background:Topical corticosteroids (TC) are among the most commonly used medications for treatment of skin disorders. They give immediate relief from symptoms in many inflammatory dermatoses. Even inappropriate use in infectious dermatoses relieves the symptoms. This study was done to analyze the misuse of topical corticosteroids in Indian population and to analyze the attitude of patients towards self-medication.Methods:All patients presenting with various dermatoses to the investigator were asked about history of usage of any topical medication on the lesion. In case of a positive answer, the investigator ascertained whether the topical medication in question contained a corticosteroid. The total number of patients seen during the recruitment period (January 2012 – December 2012) was noted on a separate list. Full questionnaires were only filled for patients with history of using topical corticosteroids.Results:5256 patients were screened out of which 4100 (78%) were already using topical medications. 3154 (60%) patients were using topical steroid in various forms. About 80% of the patients using topical steroids confessed that they have not consulted qualified medical practitioner. They were advised these medications by chemists, friends or quacks, neighbours, barbers, beauticians etc.Conclusions:Misuse of topical corticosteroids is common in Indian population and results in various complications. Educating public, chemists, general practitioners along with strict vigil by law enforcing agencies is needed for optimal and safe use of corticosteroids.

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Tinea incognito: Report of two cases

Journal of College of Medical Sciences-Nepal ◽

10.3126/jcmsn.v6i3.4076 ◽

1970 ◽

Vol 6 (3) ◽

pp. 46-49

Author(s):

SK Kedia ◽

M Mathur

Keyword(s):

Case Report ◽

Fungal Infection ◽

Clinical Presentation ◽

Topical Steroid ◽

Medical Sciences ◽

Diagnostic Challenge ◽

Over The Counter ◽

Inappropriate Use ◽

General Physicians ◽

Tinea Incognito

Tinea incognito remains diagnostic challenge even to expert specialist because of modified clinical presentation caused by of inappropriate use of topical steroid. Topical steroid are being prescribed frequently for vary many dermatosis including fungal infection of skin and being used by patient as "over the counter drug" leading to varied clinical presentation of common dermatosis. This case report is of iatrogenic dermatosis that was invariably misdiagnosed by general physicians. Key words: Tinea incognito; dermatosis; fungal infection. DOI: 10.3126/jcmsn.v6i3.4076Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.46-49

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Topical steroids - fairness fervour to fallout

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20172203 ◽

2017 ◽

Vol 3 (2) ◽

pp. 234

Author(s):

Ashok S. Hogade ◽

Ismat Fatima

Keyword(s):

Symptomatic Relief ◽

Topical Steroid ◽

Pharmaceutical Companies ◽

Topical Steroids ◽

Short Term ◽

Inappropriate Use ◽

Inflammatory Dermatoses ◽

Household Workers ◽

History Of ◽

Almost All

Background: Topical Steroids (TS) are one of the most widely used therapeutic formulations in practice. Treatment was revolutionized with the advent of these anti-inflammatory corticosteroids .They provide rapid symptomatic relief in almost all inflammatory dermatoses , in short term. In India topical steroids are marketed by many pharmaceutical companies and few of these formulations are available at every medical store even without a prescription.Methods: Patients with relevant facial dermatoses (clinical features suggestive of TS abuse) with history of current TS inappropriate use were included. Diagnosis was established on clinical basis and consent was sought. Proper skin examination was performed to detect the condition related to abuse of TS.Results: Out of 100 patients studied 54 were females and 46 males. Majority were of 15-35 years age group and unmarried. 72% patients belonged to lower and 25% to middle socioeconomic class. Majority of the patients were students (42%) followed by household workers (38%). Conclusions: Unnecessary cosmetic use of TCs with or without fairness creams is quite common in facial dermatoses resulting in steroidal dermatitis resembling rosacea. Topical steroid misuse is increasing because of easy availability, Lack of awareness, Obsession for fair skin.

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Letter: Penetration of topical steroid preparations

Archives of Dermatology ◽

10.1001/archderm.112.2.261b ◽

1976 ◽

Vol 112 (2) ◽

pp. 261b-261

Author(s):

S. S. Lee

Keyword(s):

Topical Steroid

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Health Informatics: Handle with Caution

Methods of Information in Medicine ◽

10.1055/s-0038-1634701 ◽

1997 ◽

Vol 36 (02) ◽

pp. 79-81

Author(s):

V. Leroy ◽

S. Maurice-Tison ◽

B. Le Blanc ◽

R. Salamon

Keyword(s):

Health Care ◽

Data Management ◽

Medical Informatics ◽

Health Care Professionals ◽

Data Security ◽

Health Informatics ◽

The Other ◽

Inappropriate Use

Abstract:The increased use of computers is a response to the considerable growth in information in all fields of activities. Related to this, in the field of medicine a new component appeared about 40 years ago: Medical Informatics. Its goals are to assist health care professionals in the choice of data to manage and in the choice of applications of such data. These possibilities for data management must be well understood and, related to this, two major dangers must be emphasized. One concerns data security, and the other concerns the processing of these data. This paper discusses these items and warns of the inappropriate use of medical informatics.

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