Sir,
A 35-year-old male presented to the Dermatology OPD with a history of multiple, depressed, red, linear skin lesions over bilateral axillae. On detailed history taking, he was found to be using clobetasol propionate (0.05%) cream for the past 3 months (purchased directly from a chemist) in order to get relief in itchy, red, scaly lesions over the affected skin. He had applied nearly 200 g of the cream in this period. On examination, multiple, atrophic, erythematous, linear skin lesions with surrounding hypopigmentation were noted bilaterally. Fine scaling was also evident towards the periphery [Figure 1]. A potassium hydroxide mount from the scaly lesions revealed multiple septate hyphae. The patient was thus diagnosed as a case of dermatophytosis and was treated with oral and topical antifungals after which the itching and scaly lesions subsided, but the striae remained unchanged.
Figure 1.
Multiple striae with surrounding hypopigmentation and fine scaling towards the periphery (black circle)
Unsupervised use of topical corticosteroids (TCS) inevitably results in several cutaneous adverse effects.[1] These are often difficult to manage and can be irreversible too. Besides, the use of TCS also leads to modification or masking of the primary dermatosis which makes the diagnosis difficult. In our country, we are already facing an epidemic of corticosteroid-induced cutaneous adverse effects as well as difficult-to-treat cases of dermatophytosis.[2,3]
We are reporting this case to highlight the potential of TCS to cause irreversible cutaneous changes. Topical products are generally regarded as free from side-effects, hence self-application is frequent. It is therefore essential to regulate the sale of TCS and be vigilant while prescribing any TCS, even in case of steroid-responsive dermatoses. Appropriate regulatory laws and their strict implementation to curb over-the-counter sale of TCS is the need of the hour. Education of patients, chemists and prescribers is necessary to prevent such adverse effects.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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