TCD is a popular treatment modalities for acne. The steroid component of TCD presents potential problem in the long-term management of acne.

1. IS TCD STILL RELEVANT
FOR ACNE TREATMENT?
Peter Nugraha Soekmadji
Department of Dermatovenereology
Faculty of Medicine
Maranatha Christian University
Bandung

2. Conflict of Interest Statement
• NO support or commercial funding for this
presentation or for any products mentioned
here

3. TCD
Dexame-
thasone
Clinda-
mycin
Treti-
noin

4. Corticosteroids use in acne is
limited to certain indications

5. INDICATIONS FOR
ORAL STEROID USE IN ACNE
Acne
conglobata
Acne
fulminans
Hormonal
imbalance

6. Krakowski AC, Stendardo S, Eichenfield LF. Practical Considerations in Acne Treatment and the Clinical Impact of Topical
Combination Therapy. Pediatric DermatologyVol. 25 Suppl. 1 1–14, 2008
Congenital adrenal
hyperplasia
Polycystic ovarian
syndrome

7. Local adverse effects of topical corticosteroids
use are
more prevalent than systemic reactions

8. Local
Adverse
Effects
Saraswat A et al. Topical corticosteroid abuse on the face: a prospective multicenter study of dermatology outpatients. Indian J
Dermatol Venereol Leprol 2011;77:160-6
ACNE, 57.5
ROSACEA,
21.8
ATROPHY,
16.4
STEROID
ADDICTION,
15
HYPOPIGME
NTATION, 9
PERIORAL
DERMATITIS
, 8.4
TINEA
INCOGNITO,
6.7
HIRSUTISM,
6.3

9. Mahar S, Mahajan K, Agarwal S et al. Topical Corticosteroid Misuse - The Scenario in Patients Attending a Tertiary Care Hospital in
New Delhi. Journal of Clinical and Diagnostic Research. 2016 Dec, Vol-10(12): FC16-FC20
STEROID ACNE

10. Mahar S, Mahajan K, Agarwal S et al. Topical Corticosteroid Misuse - The Scenario in Patients Attending a Tertiary Care Hospital in
New Delhi. Journal of Clinical and Diagnostic Research. 2016 Dec, Vol-10(12): FC16-FC20
STEROID ROSACEA

11. SKIN ATROPHY

12. HYPOPIGMENTATION

13. PERIORAL DERMATITIS

14. TINEA INCOGNITO

15. HYPERTRICHOSIS

16. 0
5
10
15
20
25
30
1 w-1 mo 1-3 mo 3-6 mo 6 mo-1 y > 1 year
Duration of Use
Saraswat A et al. Topical corticosteroid abuse on the face: a prospective multicenter study of dermatology outpatients. Indian J
Dermatol Venereol Leprol 2011;77:160-6

17. Reasons
For Misuse
Acne , 29.2
Itch, 13.2
Lightening,
18.4
Melasma,
7.2
Infection,
3.6
Mahar S, Mahajan K, Agarwal S et al. Topical Corticosteroid Misuse - The Scenario in Patients Attending a Tertiary Care Hospital in
New Delhi. Journal of Clinical and Diagnostic Research. 2016 Dec, Vol-10(12): FC16-FC20

19. Coman GC, Holliday AC, Mazloom SE et al. A randomized, split-face, controlled, double-blind, single-center clinical study: Transient
Addition of a Topical Corticosteroid to a Topical Retinoid in Acne Patients to Reduce Initial Irritation.

20. Coman GC, Holliday AC, Mazloom SE et al. A randomized, split-face, controlled, double-blind, single-center clinical study: Transient
Addition of a Topical Corticosteroid to a Topical Retinoid in Acne Patients to Reduce Initial Irritation.
20 patients enrolled
4 patients dropped-out
Triamcinolone
0.025% cream
Emollient (Eucerin)
Tretinoin 0.05% cream
16 patients analyzed

21. Coman GC, Holliday AC, Mazloom SE et al. A randomized, split-face, controlled, double-blind, single-center clinical study: Transient
Addition of a Topical Corticosteroid to a Topical Retinoid in Acne Patients to Reduce Initial Irritation.

22. Subject Preference
0
10
20
30
40
50
60
70
80
90
100
Week 2 Week 4
CS
Emollient
Coman GC, Holliday AC, Mazloom SE et al. A randomized, split-face, controlled, double-blind, single-center clinical study: Transient
Addition of a Topical Corticosteroid to a Topical Retinoid in Acne Patients to Reduce Initial Irritation.

23. TAKE HOME MESSAGE
• There is limited indication for topical
corticosteroid use in acne
• Better to use another method to reduce irritation
– Use mild cleanser
– Delay retinoids application after washing face
– Use less irritating formulations of retinoids
– Gradual introduction of retinoids
– Short contact application regimens
– Alternate day applications of retinoids
Coman GC, Holliday AC, Mazloom SE et al. A randomized, split-face, controlled, double-blind, single-center clinical study: Transient
Addition of a Topical Corticosteroid to a Topical Retinoid in Acne Patients to Reduce Initial Irritation.