Topical Steroid-Induced Perioral Dermatitis (TOP STRIPED): Case Report of a Man Who Developed Topical Steroid-Induced Rosacea-Like Dermatitis (TOP SIDE RED)

The long-term use of topical corticosteroids can result in rosacea-like dermatitis or facial perioral dermatitis. The case of a 54-year-old man is described who developed topical corticosteroid-induced perioral dermatitis (TOP STRIPED), and the features of topical corticosteroid-induced rosacea-like dermatitis are reviewed. The man presented with a painful erythematous facial eruption. Additional history revealed that he had been applying a high-potency topical corticosteroid twice daily to the affected area. Correlation of the clinical history and cutaneous examination established a diagnosis of topical corticosteroid-induced rosacea-like dermatitis (TOP SIDE RED). Treatment of the patient’s TOP SIDE RED included not only discontinuing the high-potency corticosteroid but also initiating topical and oral antibiotics. In addition, a low-potency topical corticosteroid and metronidazole gel were also applied to the affected area. His facial rash resolved within three months and has not recurred. TOP STRIPED, also referred to as TOP SIDE RED, is an adverse side effect associated with the use of high-potency topical corticosteroids to the face. Management includes discontinuing the corticosteroid. Additional treatment may include a low-potency topical corticosteroid, antibiotics (systemic or topical or both), and/or topical calcineurin inhibitors, such as tacrolimus or pimecrolimus.