Dermatology: Practical and Conceptual


166 Letter  |  Dermatol Pract Concept 2018;8(3):2

DERMATOLOGY PRACTICAL & CONCEPTUAL
www.derm101.com

The role of dermoscopy in a topical  
steroid-damaged face

Sidharth Sonthalia1, Abhijeet K. Jha2, Reena Sharma3

1 SKINNOCENCE: The Skin Clinic, Guragaon, India

2 Patna Medical College and Hospital, Patna, Bihar, India

3 Department of Dermatology, Derma Essence Clinic, Noida, India

Key words: dermoscopy, steroid abuse, topical steroid-damaged face

Citation: Sonthalia S, Jha AK, Sharma R. The role of dermoscopy in a topical steroid-damaged face. Dermatol Pract Concept. 2018;8(3):166-
167. DOI: https://doi.org/10.5826/dpc.0803a02

Received: February 8, 2018; Accepted: April 21, 2018; Published: July 31, 2018

Copyright: ©2018 Sonthalia et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, 
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

All authors have contributed significantly to this publication.

Corresponding author: Sidharth Sonthalia, SKINNOCENCE: The Skin Clinic, C-2246, Sushant Lok-1, Block C, Gurgaon, 122009, India. 
Email: sidharth.sonthalia@gmail.com

A 29-year old male presented with pinkish-red erythema 

over the cheeks with patchy brown discoloration and grossly 

visible telangiectasias of 6 months’ duration (Figure 1). He 

also complained about his facial skin being very sensitive, 

especially to sun exposure. The patient was aware that he had 

melasma and gave a history of occasional use of sunscreen 

in the past. Despite repeated and persuasive questioning, he 

staunchly denied applying any topical steroid-containing 

formulations or depigmenting creams. Polarized dermoscopic 

examination (EScope; Nakoda, ×20) of the cheeks revealed 

a reddish-brown background, brown dots, globules and 

clods, multiple tortuous and branching linear vessels and 

telangiectasias, and ivory white-to-strawberry ice cream 

colored patches in addition to conspicuous hypertrichosis 

(Figure 2A-2B). Suspecting topical steroid abuse, he was 

shown the dermoscopic features on the computer screen and 

cautioned about the complications of “topical steroid-dam-

aged face.” He finally admitted to having used a mometasone-

containing triple combination cream over the cheeks twice a 

day for the previous 4 months, at the suggestion of a friend. 

Since his last examination, the patient has been using a broad-

spectrum sunscreen on a daily basis, topical vitamin 20% 

serum and has been scheduled for intense pulsed light therapy 

for facial rejuvenation.

Prominent telangiectasias, ivory white-to-strawberry-

colored patches (suggestive of skin atrophy) and lesional 

hypertrichosis constitute dermoscopic features which are 

Figure  1. Clinical picture of the patient showing pinkish-red ery-

thema over the cheeks with patchy brown discoloration and grossly 

visible telangiectasias. [Copyright: ©2018 Sonthalia et al.]



Letter  |  Dermatol Pract Concept 2018;8(3):2 167

indicative of “topical steroid-damaged face,” while the brown 

pigmented structures suggest a background of melasma. The 

abuse of topical steroid-containing formulations over the face 

has now been well established as a dermatological nuisance 

in India [1].

Conclusions

Through this report, we wish to highlight that many of these 

patients are in a denial about their steroid abuse. Importantly, 

dermoscopy not only noninvasively confirms the suspicion, 

but also aids in the patient’s understanding of the seriousness 

Figure 2. (A, B) Dermoscopy of the cheek revealing reddish-brown background, brown dots, globules and clods (black arrows) suggestive 

of a background of melasma, multiple tortuous and branching linear vessels (white arrows), telangiectasias and ivory white-to-strawberry-

colored patches (blue arrow) suggestive of skin atrophy, in addition to conspicuous hypertrichosis (Escope, videodermoscope, polarizing 

mode, 20×). [Copyright: ©2018 Sonthalia et al.]

of topical steroid abuse through the demonstration of pic-

tures explained in patient-friendly language. In the majority 

of cases it also ensures further steroid abuse and improves 

treatment compliance [2].

References

1. Coondoo A, Phiske M, Verma S, Lahiri K. Side-effects of topi-

cal steroids: A long overdue revisit. Indian Dermatol Online J. 

2014;5(4):416-425.

2. Sonthalia S, Errichetti E. Dermoscopy—not just for diagnosis and 

not just for Dermatologists! Kathmandu Univ Med J (KUMJ). 

2017;15(57):1-2.