Topical Corticosteroid Abuse in Dermatology

Abstract

Topical corticosteroids are the most widely used therapeutic agents in modern dermatologic therapy. The increasing frequency of use of topical steroids has led to the detection of a number of adverse effects and is dependent upon chemical nature of the drug, the vehicle, and the location of its application. The common adverse effects on face are erythema, telangiectasia, xerosis, photosensitivity and rebound phenomenon. The improper advertisement by manufacturers, availability of steroids without prescription, improper prescribing by doctors, has resulted in the rapid emergence of topical steroid abuse. Aims and Objectives: To analyse the magnitude and adverse effects of topical steroids abuse in dermatology. Materials & Methods: This is a prospective questionnaire type study conducted in outpatient clinic of the Department of Dermatology in a tertiary hospital. A total of 200 patients of any age and of both sexes are recruited consecutively. A questionnaire eliciting demographic variables, characteristics of topical steroid use, prescription source, duration of application and adverse effects is administered to all eligible patient. Patients not consenting to answer the questionnaire or patients with co-morbidities that could cause similar changes to topical steroid side effects like Cushing's syndrome, thyroid disorders, polycystic ovaries were excluded. Statistical analysis was done using SPSS ver. 21. Results: The most common age group in which these side effects were observed is 21-30 years. Clobetasol propionate, betamethasone valerate and mometasonefuroate were the commonly used steroid by patients. It was found that 29% of patients using topical steroid were recommended by friend or pharmacist and 71% by a medical practitioner. Topical steroid abuse was seen in all 58 patients (100%) prescribed by friend or pharmacist and 58 out of 142 patients (40.84%) prescribed by medical practitioner. Tinea incognito and striae were the common side effects and were seen more commonly in non-dermatologists group. Conclusion: This study reveals that problem of topical steroid misuse is common in our country. The prevalence of side effects is significantly higher among the potent steroid users. The prevalence of side effects is significantly higher among patients of non-dermatologists (p