Title : The menace of topical steroid abuse in dermatology op
Abstract:
Context: Topical corticosteroids are one of the most widely prescribed class of topical drugs. Since they provide rapid symptomatic relief in inflammatory dermatoses, their abuse is rampant. This is aided by lack of awareness about the adverse effects of the unprescribed use of Topical steroids. In addition to this, further widening of the healthcare gap due to COVID-19 pandemic have worsened the scenario.
Aims: This study was done to find out the magnitude of topical corticosteroids abuse in dermatology OPD and its consequences thereof.
Settings and Design: An observational cross-sectional study was conducted in the dermatology OPD in a tertiary care centre in Andhra Pradesh from 11th July 2021 to 11th October 2021. All patients (excluding follow up cases) were enquired for topical steroid abuse in the last 3 months and were interviewed via structured proforma.
Methods and Material: All patients were enquired for topical steroid abuse in the last 3 months and were interviewed via structured proforma. Total 5373 patients were included in the study.
• Inclusion criteria: All consenting patients presenting to DVL OPD
• Exclusion criteria: Follow up cases, Usage of concomitant systemic steroids
Results: Of 5373 patients included in the study, 1352(25.16%) were found to have abused steroids in past 3-month duration. The most common abused steroid formulation was mixed combination consisting of steroids, anti-fungals and anti-bacterials (72.8%). Superficial fungal infection (87.68%), melasma (4.34%) and acne (2.76%) were the most common indications of steroid abuse. Pharmacists (43.2%) and quacks (23.2%) and were the most common prescribers of these topicals. Most common adverse effects of topical corticosteroid abuse were tinea incognito, steroid-induced acne/ aggravation of acne vulgaris and TSDF-Topical steroid damaged/dependent face.
Conclusions: We found that approximately one-fourth of the patients presenting in DVL OPD are abusing topical steroids. The majority of which, are suffering from superficial fungal infection leading to further aggravation the condition and a protracted course.
This study indicates towards the magnitude of the topical steroid abuse and requirement of urgent measures to control it.
Keywords: Topical Steroid, COVID-19,
Audience Take Away Notes:
- Topical corticosteroids are one of the most widely prescribed class of topical drugs. Since they provide rapid symptomatic relief in inflammatory dermatoses, their abuse is rampant.
- This is aided by lack of awareness about the adverse effects of the unprescribed use of Topical steroids. In addition to this, further widening of the healthcare gap due to COVID-19 pandemic have worsened the scenario.
- The reasons for TCSs abuse vary from wrong prescription, dubious marketing by pharmaceutical companies, free availability as OTC drugs and lack of regulations regarding the manufacturing of irrational combinations.
- Proper education, sensitization, regularization of prescriptions and strict legal rules and actions would go a long way in curbing the TSs abuse menace.
- The Indian Association of Dermatologists, Venereologists, and Leprologists (IADVL) has formed a task force against TCSs abuse, with main aims like raise public awareness, run media campaigns, form study groups for doctors, highlight the problem in journals, and meet with central and state authorities.
