Clinical and Dermoscopic Evaluation of Patients With Topical Steroid Damaged Faces (TSDF)

Background Topical steroid-dependent or damaged face (TSDF) is a common condition where the widespread availability of over-the-counter topical corticosteroid (TCS)-containing products leads to their misuse and addiction. Prolonged use of these steroids on the face can result in significant side effects. Early diagnosis and cessation of steroid use are important. Dermoscopy can serve as an easy-to-use and non-invasive tool for the early diagnosis and for assessing the exact extent of damage caused by steroid misuse. Aims and objectives To observe the various clinical and demographic features of patients with TSDF, the dermoscopic features of these patients, and to find their association with the potency and duration of application of TCS. Material and methods In this observational, cross-sectional study of 250 patients (aged 12-60 years, both genders) presenting with facial dermatosis and clinical signs of TSDF, having a history of at least one month of TCS use, were enrolled using consecutive sampling. Demographic data, clinical features, and dermoscopic findings were recorded. Dermoscopic results were compared with clinical examination, TCS potency, and duration of application. Results The majority (208; 83.2%) of the patients were females, and most of them belonged to the age group of 26-35 years (87; 34.8%). Hyperpigmentation (101; 40.4%) was the most prevalent indication for TCS use in the study. The most common clinical findings included erythema, hypertrichosis, and telangiectasia. Dermoscopic findings such as linear, serpentine, polygonal, and Y-shaped vessels, along with breaking of the pseudo reticular network, red diffuse areas, Demodex tails, and comedones were significantly associated with the duration of TCS use. Linear vessels, Demodex tails, and comedones also correlated significantly with TCS potency, while most other findings did not. Conclusion Dermoscopy is a novel, non-invasive diagnostic technique for the early identification of TCS abuse. In TSDF, it confirms the diagnosis and predicts disease severity earlier than examination by the naked eye alone.