The Study of Body Dysmorphic Disorder and Psychiatric Comorbidities in Patients of Topical Steroid Damaged Face Attending Dermatology OPD in a Tertiary Care Centre: Hospital-Based Study

Abstract

Introduction: Topical corticosteroids are widely used for their anti-inflammatory effects in dermatology. However, prolonged and unsupervised use, particularly on the face, can result in topical steroid damaged face (TSDF), characterized by skin thinning, erythema, photosensitivity, and acneiform or rosacea-like eruptions. These visible skin changes may lead to significant psychological distress, including body dysmorphic disorder (BDD) and other psychiatric comorbidities. The study aims to assess the prevalence of BDD and associated psychiatric comorbidities among TSDF patients attending a tertiary care center. Material and Methods: A cross-sectional observational study was conducted in the Department of Dermatology at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, from May 2023 to October 2024. A total of 200 patients with TSDF were enrolled. Screening tools included BDDQ-DV, BDD-SS, HADS, BAI, and BDI. Patients meeting BDD criteria were referred for psychiatric evaluation. Statistical analysis involved descriptive statistics, chi-square tests, t-tests, and Pearson correlation. Results: BDD was identified in 15.5% of TSDF patients. There were no significant associations between BDD and demographic variables. Strong positive correlations were observed between BDD and psychiatric scores: HADS-Anxiety (r = 0.37), HADS-Depression (r = 0.42), BAI (r = 0.44), and BDI (r = 0.52); all p-values < 0.001. Clinical anxiety and moderate depression were present in all BDD-positive cases. Among dermatological signs, photosensitivity and dryness were significantly associated with BDD. Conclusion: There is a notable psychiatric burden in TSDF patients. Routine psychiatric screening, interdisciplinary care, public awareness, and clinician training are essential for improving outcomes and preventing corticosteroid misuse.