Topical corticosteroid-induced acne - Three treatment strategies to break the 'addiction' cycle

A 2-year-old girl had a facial rash that had waxed and waned for 6 months. Throughout this period she was treated several times daily with clotrimazole 1% plus betamethasone 0.05% cream and desonide 0.05% cream, which were in the household medicine cabinet. Initial improvement was followed by exacerbations of the rash, which could be controlled only with continued use of these topical medications. Examination revealed dozens of acneiform papules and papulopustules, 0.1 to 1.0 mm in diameter, and background erythema in a perioral and perinasal distribution (figure 1). The diagnosis of topical corticosteroid-induced acne was made. The topical corticosteroids were discontinued, and treatment with oral erythromycin ethylsuccinate (in 200 mg/5 mt suspension, 5 mt twice a day for 3 weeks) and topical clindamycin (10 mg/mL lotion, twice a day for 6 weeks) was begun. The rash became worse immediately after discontinuation of topical cortico-steroids but gradually improved, and after 6 weeks of treatment it had cleared.