Misuse and abuse of topical steroids: implications

Topical steroids, having revolutionized dermatotherapy over several decades, remain the mainstay of treatment for steroid–responsive inflammatory dermatoses worldwide. Challenges, nevertheless, abound on the usage of topical steroids, particularly with their inappropriate application. Several steps and improved formulations are constantly evolving in the scientific world, aimed at addressing most of the associated adverse events. However, until the dawn of the ‘ideal topical steroid’, the implications of application misuse will remain significant. This review discusses the concept of ‘misuse and abuse’ of topical steroids, gives an overview of topical steroids, differentiates ‘misuse’ as opposed to ‘abuse’ of application of topical steroids as they occur in different settings and provides a schematic algorithm for the appropriate and optimal application of topical steroids. Consequently, this separation will allow a more accurate estimation of the burdens of these two aspects that require different solutions.