A 5-year-old girl presented to us with an asymptomatic white
lesion on her cheek since the last four months. There was a
history of application of over-the-counter medications prior
to appearance of the lesion, due to insect bite. Cutaneous
examination revealed a hypopigmented circular patch of
diameter 6 cms (Fig. 1). It was surmounted by
fine scales and the center of the patch showed multiple
erythematous papules. Telangiectatic changes were not
appreciable. There was neither loss of sensation over the
patch nor any nerve enlargement. There was no similar lesion
elsewhere in the body. The patient did not give any history
of atopy. Scalp, nails and mucosae were normal. On the basis
of the clinical findings, a diagnosis of steroid abuse was
made. She was prescribed emollients and asked to stop
application of any other ointment. Gradual clearance of the
lesion in the follow-up visits re-inforced our diagnosis.
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Fig. 1 Hypopigmented scaly
patch surmounted by erythematous papules.
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Steroid is a crucial pharmacotherapy
offered by dermatologists in a wide array of diseases.
Topical and intralesional glucocorticosteroids can produce
local effects, including telangiectasias, atrophy and
hypopigmentation. The close clinical differentials in our
case were: pityriasis alba (ill defined hypopigmented patch
and features of atopic dermatitis), pityriasis versicolor (perifollicular
hypopigmented macules and patches, more prominent on
sweating) and leprosy (loss of sensation, reduced sweating,
nerve thickening).