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Indian Pediatr 2014;51: 162

Topical Corticosteroid Abuse


Anupam Das, Dipti Das and Nilay Kanti Das

Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India.
Email: [email protected]
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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.

Fig. 1 Hypopigmented scaly patch surmounted by erythematous papules.

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).

 

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