Background: Abuse of topical corticosteroids (TCS) and “fairness creams” on the face has become a significant dermatological problem in India, leading to a spectrum of adverse effects known as topical steroid-damaged/dependent face (TSDF). This study aims to assess the demographic profile of patients with facial TCS misuse, evaluate their perceptions and awareness regarding steroid use, and document the clinical adverse effects associated with misuse. Methods: A prospective, questionnaire-based, observational cross-sectional study was conducted over two months (July-August 2025) in the Department of Dermatology, Government Institute of Medical Sciences (GIMS), Western Uttar Pradesh. Ninety-six consecutive patients with a clinical diagnosis of TSDF were enrolled. Data regarding demographics, indications for use, source of recommendation, type and potency of steroids, duration of use, and cutaneous adverse effects were recorded in a preformed questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA). Results: Out of the 96 patients, 66 (68.8%) were females, and 30 (31.3%) were males, with a mean age of 29.42 years. Rural residents constituted 51 (53.1%) participants. The majority of the patients belonged to lower socioeconomic groups (59.4%). Non-prescription use was reported by 62 (64.6%) patients, most commonly recommended by pharmacists (32, 51.6%). Clobetasol propionate was the most frequently used steroid by 43 (44.8%) patients, and 45 (46.9%) patients had used other superpotent corticosteroids. The mean duration of use of topical agents was 13.65 months. Common indications for usage included melasma (39, 40.6%), tinea (29, 30.2%), and acne (24, 25%). The most frequent adverse effects were hypopigmentation (84, 87.5%), cutaneous atrophy (84, 87.5%), hypertrichosis (69, 71.9%), acneiform eruptions (61, 63.5%), and telangiectasia (61, 63.5%). A large proportion of patients (92, 95.8%) were unaware of the contents of the creams, and 94 participants (97.9%) did not read product leaflets. The overall total economic burden was INR 1,72,659 (USD 1885), with marked individual financial expenditure. Conclusion: Facial misuse of TCS is highly prevalent in Western Uttar Pradesh, largely driven by over-the-counter (OTC) availability, pharmacist recommendation, prescription by non-registered practitioners, and poor awareness. There is an urgent need for stricter regulation of potent steroids, banning irrational fixed-dose combinations, and large-scale public and pharmacist education to prevent further morbidity.
Sethi et al. (Mon,) studied this question.