Topical corticosteroids: Regulatory aspects

Abstract

Topical steroids are the keystones of dermatologic therapy. When used rationally, for the right indications, they are extremely effective and cause minimal effects. Sadly, their (mis)use is often fraught with adverse effects. Their potential for causing addiction has led to enormous psycho-socio-economic burden, in addition to long term and, at times, permanent disfiguring physical sequelae. Rampant abuse of irrational combinations of topical steroidantifungal, with or without antibiotics, has led to the epidemic of recalcitrant steroid modified dermatophytosis in India. Regulatory aspects related to permissions to sell irrational steroid containing topical fixed drug combinations, drug dispensing without valid prescriptions, lack of control over who can prescribe steroid preparations and advertisements to lay public promoting steroid-hydroquinone-tretinoin creams as fairness creams have led to the menace of topical steroid abuse. If these flaws in the system are not corrected on a war-footing, the nightmare would worsen rapidly.