Topical steroid damaged face : All you need to know

 

Just type TSDF (topical steroid damaged face) or TSDRF (topical steroid damaged red face) on Google and you will see a lot of posts out there. If you click pictures tab you will see horrible photos of patients throughout the world. This is not a disease that someone gets. This is something that someone unknowingly or knowingly incurs to himself/herself.

Now the most pertinent question in your mind would be, what am I here for?

   I'm here to stop you from damaging your face and end up losing lots of money on undoing what you have done to yourself.

Why do people do this to themselves?

There are endless reasons why someone can indulge in using a cream that can have such a terrifying effect on the facial skin. But the most common reason is having some disease which causes hyperpigmentation of facial skin like melasma, etc. or just using it as a fairness product. For which he/she sometimes uses some OTC (over the counter) product from local shop without consulting a dermatologist. People go to a quack or a dermatologists with fake degrees who don't understand what the disease is and prescribe a cream which is a cocktail of steroid, antifungal, and antibiotics. Obviously it will not cure the disease at all. So the next most obvious question is-

Why do people keep on using those cocktail creams?

When someone starts using those creams on face initially there is a skin lightening or whitening effect which is of course a side effect of the steroid content of that cream. The mechanism of which is not the topic to discuss here. This itself can induce continuous use due to a false belief that it will lighten the skin tone and incur fairness.

 Another fact is that sometimes doctors give topical steroids for some disease or rash on face. And the patient may not come back for a follow up visit and continue applying the cream for long duration. When the patient gets satisfied that the disease is cured and stops applying the cream after sometime there is erythema that appears over the face due to vasodilation. Few patients falsely think of it as a glowing skin which compels them to use the offending cream again.

And that’s how the fire starts.

Now follows the addiction

After the happy hour is over, the victim realizes that he/she has done something horrendous with their face. Then they try to stop using the cream further. After a certain period more drastic side effects appear. Which can be pus filled acne, thinning and dryness of the skin, itching and burning sensation which gets aggravated on exposure to sun, uneven skin tone, white and black spots on skin, visible blood vessels through the skin, increased facial hair in females and the list is a never ending nightmare.

 After a certain period there is severe redness of the face which may last for few weeks and then disappear and again reappear after few weeks. This will go on if the patient does not start reusing the cream again. As the face is most visible part of the body there is no hiding and due to social pressure the patient again starts reusing the cream. This may give him/her relief for some time which further aggravates the side effects of steroid. And the cycle continues.

 Whenever such patient comes to me most of them refuse to stop applying the cream. Instead they ask for something that can allow him/her to continue applying the cream without any problem. Then I usually come up with an answer. “what you are basically saying is, Doctor I want to consume poison everyday, you just suggest me something so that the poison doesn’t harm me at all”. And believe me it works most of the time. 

Here comes the withdrawal episode

In spite of various treatment methods patients usually follow up with a complaint that the treatment is not working. Instead it is worsening my skin and is unable to show his/her face in public. And they applied the xyz cream again for few days and got some relief. Few people really break down while saying this. Of course it’s the curse of human society that face-value is something no one can ignore. At this point I usually say “suppose you consumed alcohol daily for years and suddenly stop taking it. If you do so you may end up in a hospital because of withdrawal symptoms. And the solution is never to start consuming alcohol again”. 50-60% patients get the point and ultimately get rid of the ordeal after few visits. The rest of the patients either decide to try consulting another doctor or just simply ignore and continue poisoning themselves.

  This post is not only for those who damage themselves beyond any treatment, rather it is meant to create a world without TSDF.

The solution

I’m not a bureaucrat or a politician or a sociologist. So I’m not touching the economic and social agendas of this problem. And it’s not a proper platform to discuss treatment options either. Rather I’ll only try to create awareness among patients which is most important./

1.     😊 Firstly, stop using these creams as a fairness product. Because I believe there is no such cream which can be termed as “fairness cream”.

2.     😊 If you really think you have some skin disease or even if you are just not happy with your complexion just consult a genuine dermatologist. Do not apply anything on your precious skin which is being advised by a relative or a pharmacist. Now deciding the genuineness of a doctor is something that I can’t help you with. Because in my 11 years of experience as a doctor and 7 years of experience in the field of Dermatology I found lots of patients who actually went to a quack or a fake dermatologist deliberately. They either went there because of fake publicity or they charge less than a qualified doctor. Or just don’t want to stand behind a long queue in public hospital OPDs. I’m sharing what I have understood so that you can decide wisely.

3.     😊 Now this is for the highest percentage of patients who in spite of visiting a genuine doctor got caught up in the line of fire. See whenever you visit a doctor, after each prescribed medicine the doctor writes the duration for which you should use it. And at the end of the prescription he/she mentions when you should come for a follow up visit. And many people believe that a doctor is asking for a follow up visit just to earn more money. I’ll try to explain the reality both as a doctor and a patient. Suppose a doctor gave me antibiotics for 10 days. And after 5 days I’m completely symptom free. As a patient I might think that the extra 5 days of medication is just to increase the bill. This belief is one of the reasons for something called drug resistance. Similarly, when a doctor prescribes you a cream containing steroid for a disease and asks you to come after 3 weeks there is a strong reason behind that. Steroid is such a drug which needs to be stopped or withdrawn gradually to prevent rebound or withdrawal. If a disease can be cured in 3-6 weeks the doctor will certainly give you a prescription specifying proper withdrawal procedure. But there are numerous skin diseases which need long duration treatment. For which it's essential for the doctor to decide the next best course of action after re-evaluating the patient, after a specific period. To conclude the long story short, try not to miss the follow up visit. If you do miss, do not change, stop or continue (more than the specified duration mentioned in the prescription) any medication without consulting your doctor. Call him, WhatsApp him or in extreme cases if your doctor is not available consult another equally qualified doctor to decide what to do next.

4.     😊 Do not hesitate to waste your doctor’s precious time during consultation, if you didn’t properly understand how the medications to be used precisely. Because not all pharmacists are qualified enough that you can rely on them blindly. I myself is very particular about explaining everything and 24x7 available over phone. But on several occasions I’ve seen my patients doing mistakes on taking medications precisely. Many patients think that the pharmacist will write down everything in local language and explain everything properly, which if goes wrong in anyway may lead to mishaps. 

5.     😊 Deciding which doctor to consult – Let me tell you a true story. In a rural area once I met a quack. I casually asked him whether he sees skin patients or not. And he very confidently conveys that treating a skin disease is very easy. When he understands the diagnosis he treats it accordingly. But most of the time he can't diagnose the problem. Then he just gives a combination cream. Because he believes that one of the drugs in that combination will definitely work on that disease. See don’t confuse a quack with a general physician with an MBBS or equivalent degree. I’ve seen very good and accurate diagnosis and treatment done by many general physicians, when many patients bring their previous prescriptions. There are so many places where finding a specialist doctor is impossible. MBBS doctors are doing a great job by providing the best possible treatment there. All I’m saying is whenever a dermatologist is available seek his/her advice for skin related issues. When you can’t find a dermatologist you should go to a qualified doctor for help.  But never surrender your life to a quack or a fake doctor.

If I have enlightened you in any way please share the post or if you have any suggestions/queries you can comment in the below section.