• The reasons for use of topical steroids are fairness, melasma/other hyperpigmentary conditions, acne and as a daily cream.
• Topical Steroid Damaged/Dependent face (TSDF) is caused due to improper diagnosis or improper choice of therapy.
• Factors contributing to TSDF are easy availability OTC, lack of awareness that topical agents can cause harm, poor prescription practices.
• Since, there are no tell-tale signs of TSDF in many patients:

o  Ask everyone, irrespective of educational/socioeconomic background

o  Inverse tanning, increased facial hair, comedones in adults

o  Dermoscopy.

• Medical management of TSDF includes gentle cleanser, bland emollient, physical sunscreen, pimecrolimus, tacrolimus 0.03%, metronidazole gel and permethrin cream.

Practice sutra: While managing TSDF; stop the steroid ‘cold turkey’; diagnose underlying cause; treat underlying condition; ideally with systemic agents and counsel comfort, call for frequent follow-ups.