According to skin influencers on TikTok, topical steroid creams are being ‘illegally sold’ in some black Afro hair and beauty supply stores, affecting black women in particular. Angela Mavalla, a pharmacist and skincare educator, has been sharing TikTok videos garnering thousands of views, encouraging black women to stop purchasing topical steroid creams from these shops – as they are meant to be prescription-only treatments used with appropriate guidance from a doctor. When used incorrectly, the creams can make potentially make skin symptoms worse and harder to manage. “Though these creams tend to address issues like acne and eczema very quickly, because of their potent nature, the skin becomes addicted to it and will flare up badly once you stop using them,” said Mavalla. “A lot my clients – [who are black women] – that I consult privately, were coming to me with issues relating to topical steroid use, such as having terrible flare-ups because they had stopped using the cream, and needed help with tapering off them. “I began making content based on these creams, mainly to warn people of them, and found that these TikTok’s would go viral in a short space of time, with lots of people relating to it, and giving their own testimonials of how the creams damaged their skin,” Mavalla added. “I have seen instances of accidental skin bleaching, worsened eczema and hyperpigmentation, topical steroidal withdrawal and addiction, and worst of all, a crippling low self-esteem and self image. It’s awful. “The first point of call when it comes to steroidal creams should always be a pharmacy. Pharmacists are always willing to help, advise and where necessary, signpost to the most appropriate medical profession, such as a dermatologist.” Dr Unnati Desai, the national GP lead, as well as safeguarding lead for GP services and dermatology lead at Nuffield Health, acknowledged that it can take sometimes take time to correctly diagnose these conditions, and might require a biopsy. It might also take a longer period of time to get symptoms under control, as skin conditions may require trying multiple different treatment regimes to find the one that suits each individual person, as well as getting to grips with individual triggers. What are topical steroid creams and what should they be used for? Doctors prescribe topical steroid creams to treat a wide range of skin complaints – but it’s important to have proper assessments first. “They are topical medications (synthetic corticosteroids) that have an anti-inflammatory action on the skin, by suppressing the skin immune system and constricting the blood vessels of the skin where applied,” Desai told the PA news agency. “They are used for dermatological conditions that result in inflamed, itchy or irritated skin – e.g. eczema, psoriasis, lichen simplex, lichen planus, lichen sclerosus and other autoimmune dermatoses.” Why do people experience topical steroid withdrawal after using steroid creams? When used incorrectly, topical steroids may have potentially significant side-effects. And as Desai warned: “Stopping any steroid treatment suddenly can often result in a flare-up of the condition, which may be worse than the original presentation.” There are some obvious signs and symptoms to look out for to figure out if you are experiencing topical steroid withdrawal, such as red, burning skin and a lumpy, papulopustular rash. “When using a steroid cream to get a dermatitis flare-up under control, especially when a more potent steroid cream has been used for a prolonged period of time, it is necessary to slowly come off the steroid cream and wean your skin off treatment by either reducing the potency of the cream, or the frequency [of application],” said Desai. “This gives the skin time to adjust to coming off the steroid cream slowly, but also clarifies whether the skin condition is coming under control with treatment. “Sometimes, severe dermatoses require long-term use of a medication to be controlled, in which case your doctor will consider alternative treatment modalities.” What damage can it do to your skin?Desai added: “Long-term use of potent steroid creams is not recommended, as there may be some systemic absorption, which can result in suppression of your body’s natural cortisol hormone at the worst. “In most cases, it is the long-term impact on the skin itself that is the concern, as regular or long-term use of steroid creams can impact the skin integrity and thickness, resulting in thinning of the skin, stretch marks, increased hair at the site of use, enlarged skin blood vessels and bruising. “Using a steroid cream when there is an underlying infection present on the skin will make the infection worse, or using steroid creams on the face can result in other chronic skin conditions, such as perioral dermatitis or other acneiform eruptions. “Occasionally, an allergy can develop to components within the cream that can make the dermatitis worse.” How can people remain safe? Desai stressed the importance of only using topical steroid treatments under the appropriate supervision of a qualified clinician. “In addition, as most chronic inflammatory skin conditions tend to result in drier skin, self-care at home with soap substitutes and emollients is important,” she said. “This includes gently cleansing the skin one to two times daily maximum (over-washing will negatively impact the skin barrier function, as will long hot bubble baths), and using unscented emollients (medical grade skin creams designed to gently hydrate the skin), which will better protect the skin and may, depending on the skin condition, make a flare-up less frequent or less severe. “If a steroid cream is needed, a doctor will recommend the amount of cream to be used according to the size of the area affected. We use the ‘Finger Tip Unit’ (FTU) – one FTU is the amount of topical steroid that is squeezed out from a standard tube along an adult’s fingertip – as a method of advising each patient how much cream they need to use with each application.” Read More House of the Year 2023 shortlist revealed by Royal Institute of British Architects Fatima Whitbread supporting new fostering campaign, as research finds ‘misconceptions put people off’ 5 key coat trends to complete your autumn/winter wardrobe 12 ways to weave some woodland wonder into your home Hibernation mode: 5 small self-care adjustments to make before the clocks change 13 possible cancer symptoms you should get checked out

President Joe Biden signed an executive order on Thursday allowing the Pentagon to tap an additional 3,000 military reservists to support the US mission in Europe to bolster Nato amid the ongoing Russian invasion of Ukraine. The additional troops will join the estimated 100,000 US service members already on the European continent. "These authorities will enable the department to better support and sustain its enhanced presence and level of operations,” Lt Gen Douglas Sims told Military.com of the move. The current US mission in Europe, dubbed Atlantic Resolve, began in 2014, as Russia annexed Crimea and put pressure on Ukraine’s Donbas region, a prelude to its wider invasion in 2022. So far, the US has sent more than $76bn in aid to Ukraine, according to the Council on Foreign Relations, more than $46bn of which has been military-related. The additional US forces came as President Biden made a high-profile swing through Europe for Nato summit in Lithuania on Wednesday. On Thursday, speaking from Helsinki, Mr Biden reiterated US support for Nato. “There’s overwhelming support from the American people. There’s overwhelming support from the members of the Congress, both House and Senate, in both parties,” he said, though he conceded “some extreme elements” of the Republican Party feel differently. The previous day, Mr Biden voiced his awe at the “unbroken” people of Ukraine,” who had shown “incredible dignity” in the face of Russia aggression. “One country cannot be allowed to seize his neighbour territory by force,” Mr Biden said. The US visit to Europe was not without its complications. Shortly before the Nato summit, Mr Biden threw cold water on the idea of Ukraine joining the defensive organisation in the near term. “I don’t think there is unanimity in Nato about whether or not to bring Ukraine into the Nato family now, at this moment, in the middle of a war,” he told CNN last week. The president also said that Ukraine would need to make reforms in terms of “democratization” before joining the alliance. Read More Thousands of Ukraine civilians are being held in Russian prisons. Russia plans to build many more Marjorie Taylor Greene’s antics show that the 2024 election will be about America’s role in the world Pentagon says cluster munitions have arrived in Ukraine The Body in the Woods | An Independent TV Original Documentary The harrowing discovery at centre of The Independent’s new documentary

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Russian textbooks praising President Vladimir Putin’s invasion of Ukraine are an attempt to encourage “self-sacrifice” among schoolchildren, experts have warned. In September, Russia rolled out new history textbooks to schools that claim Ukraine is an “ultranationalist state” being used as a “battering ram” by the United States to “destroy Russia”. One chapter claims Ukrainian membership of NATO could have led to a catastrophic war and “possibly the end of civilisation” that Russia had to prevent. Jaroslava Barbieri, academic and author of dozens of articles on Russian affairs, said the textbooks and lessons instructing children on how to use drones were all part of a wider plan. “Patriotic education is nothing new,” Ms Barbieri, doctoral researcher at the University of Birmingham, told The Independent. “But it has acquired new momentum under Putin. It is an attempt to indoctrinate the next generation, by equating patriotism to self-sacrifice.” The textbook, which devotes 28 pages to Russia’s war in Ukraine, is also intended to convince children Russia has “always been surrounded by enemies,” Ms Barbieri said. “It is about militarising the youth, making them believe they have always been surrounded by constant enemies and that they should serve the needs of the state,” she said. In July, the Russian Defence Ministry approved plans for new lessons instructing schoolchildren on how to operate combat drones, assault rifles and hand grenades. Deputy Minister of Defence Ruslan Tsalikov said the programme will include basic operating information and methods to counter enemy weapons, including UAVs. Ms Barbieri said this was evidence the Kremlin had recognised the changing nature of warfare and Ukraine’s extensive use of commercial drones – as well as contributing to a militarised society. Katie Stallard, Global Fellow at the Wilson Center think tank, said Putin has always been obsessed by history and the textbooks reflect his desire to have a firmer grip on Russia’s historical narratives. “Mr Putin has poured government money into patriotic education and other so-called patriotic initiatives during his two decades in power,” she told the Independent. “It has long been clear he was not just seeking to promote a glorious, idealised version of the Russian past, but to limit challenges to the official narratives so he can consolidate power.” Between 2016 and 2020, Russia’s federal budget allocated about £18.5m to military-patriotic education, research shows. The implementation of military-patriotic education is guided by the military, schools and clubs, research suggests. “Control of the past has become a political priority as Mr Putin attempts to consolidate power in the present, particularly since his full-scale invasion of Ukraine,” Ms Stallard added. But so far, the Kremlin’s indoctrination tactics have not led to “queues of would-be soldiers lining up outside recruitment offices”, Ms Stallard said. “In fact, the opposite has happened, with the authorities tightening controls to make it harder for citizens to avoid military service,” she added. “There is little evidence that this will make much difference to the Russian war effort in the short term by generating an outpouring of public support.” In February 2022, an estimated 300,000 people fled Russia when its military invaded Ukraine. This number increased to about 700,000 by the end of the year, some estimates suggest. “Tighter education doesn’t mean Mr Putin will succeed and people will unquestionably believe what they read in their school history books. “The Soviet approach did not succeed either. It was a population skilled in understanding the correct sentiments to voice in public, while voicing their dissatisfaction in private,” Ms Stallard said. Read More Russian students are returning to school, where they face new lessons to boost their patriotism The Ukraine war, propaganda-style, is coming to Russian movie screens. Will people watch? Kremlin rushes out schoolbook praising Putin’s Ukraine invasion

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