Topical steroid-dependent face: Response to xylometazoline topical

Kakkar, Sonia; Sharma, Prafulla Kumar

doi:10.4103/ijdd.ijdd_6_16

Cited by 8 publications

(8 citation statements)

References 1 publication

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“…History of potent topical steroid application steroids prior to appearance of lesions was present in all our patients. Our findings of this demographic data is similar to the finding by Singal et al, Verma et al, Verma et al, Jakhar et al and Kakkar et al [4][5][6][7][8] This suggests that many women are seeking treatments in order to have fair skin. Lack of resources, wrong notion among the general population and especially the pharmacists that steroid application helps in brightening of skin, supply of drugs by pharmacists without prescription has lead to steroid misuse.…”

Section: Discussionsupporting

confidence: 91%

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

et al. 2020

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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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Section: Discussionsupporting

confidence: 91%

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

et al. 2020

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“…7 TSDF presents as a stumbling block for the patient as well as the treating dermatologist. 8 At first, patients may initiate using TCS for some minor dermatosis such as acne or melasma upon suggestion by friends and relatives. 9 Ab initio, the anti-inflammatory and vasoconstrictive effects of steroids result in what appears to be clearing of primary dermatitis, but their incessant use culminates in atrophy of epidermis, degeneration of dermal structure, and collagen deterioration over several months.…”

Section: Discussionmentioning

confidence: 99%

“…9 Ab initio, the anti-inflammatory and vasoconstrictive effects of steroids result in what appears to be clearing of primary dermatitis, but their incessant use culminates in atrophy of epidermis, degeneration of dermal structure, and collagen deterioration over several months. 8 Various studies have stressed upon the diverse clinical manifestations of TSDF. Female predominance has been reported by most investigators, which was the finding in this study as well.…”

Section: Discussionmentioning

confidence: 99%

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

Sethi¹,

Chauhan²,

Jindal³

et al. 2021

IJDVL

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Background: Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. Aims: This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher’s exact test, and one-tailed Z-test. Results: Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Limitations: Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

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“…Transient tingling and prickling sensations were reported adverse reactions. [9] Xylometazoline, which is an alpha-adrenergic receptor agonist, is an effective new treatment option for patients with redness and erythema resulting from long-term topical steroid use on the face. Similar to the aforementioned cases, the property of imidazole derivatives is being attempted in the treatment of rosacea, telangiectasias and port-wine stains [10].…”

Section: New Applications -A Reviewmentioning

confidence: 99%

“…Recent reports also suggest new uses for xylometazoline and oxymetazoline. In combination with lidocaine, an intranasal solution of xylometazoline has shown efficacy in the anesthesia of maxillary teeth in patients with minor carious lesions [9], and a beneficial therapeutic combination of oxymetazoline and dye laser (PDL) has also been reported for the treatment of rosacea, among others [10].…”

mentioning

confidence: 99%

Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review)

Klas

Kluz

Piwowar

2021

J Educ Health Sport

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The aim of the study is to systematize the knowledge about xylometazoline and oxymetazoline - commonly used nasal sprays with sympathicomimetic effect, mainly directly on α-adrenergic receptors [1]. A review of recent reports on possible side effects and new therapeutic options will be presented. Results: Over several years, reports have been published regarding descriptions of unusual cases of side effects, such as angina attack [4], a case of respiratory failure in a newborn [5], ischemic stroke [6], or anaphylactic reaction during routine surgery. In experiments using rats, on the other hand, it has been shown that these substances can also cause increased inflammation of the lower respiratory tract [7], as well as numerous ophthalmic problems [8]. Recent reports also suggest new uses for xylometazoline and oxymetazoline. In combination with lidocaine, an intranasal solution of xylometazoline has shown efficacy in the anesthesia of maxillary teeth in patients with minor carious lesions [9], and a beneficial therapeutic combination of oxymetazoline and dye laser (PDL) has also been reported for the treatment of rosacea, among others [10]. Conclusions: Although imidazoline derivatives were admitted to the drug list decades ago, still their pharmacological potential has not been fully exploited. Finding applications of these drugs in dermatology and dentistry may not only improve the efficacy and comfort of treatment, but also significantly reduce the costs of the whole therapy. The aforementioned reports on the side effects of xylometazoline and oxymetazoline should not be forgotten. It is possible that the presented examples will increase awareness to use these drugs with more respect, according to the recommendations on the leaflet.

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Topical steroid-dependent face: Response to xylometazoline topical

Cited by 8 publications

References 1 publication

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

Clinical profile of Tinea pseudoimbricata: an observational study from a tertiary care institution in western Maharashtra, India

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

Xylometazoline and oxymetazoline - unusual effects of everyday drugs (literature review)

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