Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients

Awareness and Knowledge of Adverse Effects of Topical Corticosteroids Among the General Population in Jeddah, Saudi Arabia

Purpose

Corticosteroids are naturally produced in the adrenal cortex and regulate a variety of physiological processes, including but not limited to, stress homeostasis, metabolism, and inflammation. As synthetic steroids exert the same effects as natural steroids, they are used in the treatment of various skin conditions. Synthetic steroids are delivered in a variety of forms, such as topical preparations, oral preparations, and injections. Topical steroids are one of the most commonly prescribed medications in dermatology clinics. Although topical steroids were thought to provide maximum benefit with no side effects, many side effects have been reported by topical corticosteroid users. Therefore, this study examined awareness and knowledge regarding topical steroids among the general population in Jeddah, Saudi Arabia.

Methodology

This was a cross-sectional study involving 426 subjects in Jeddah, Saudi Arabia. Subjects completed a self-administered questionnaire, and data were collected from February to April 2023. The questionnaire assessed age, sex, education level, occupation, and general knowledge regarding the side effects of topical steroids.

Results

The study cohort was predominantly female (77%). Half of the participants were aged 21-39 years. Most of the subjects (70%) were steroid users, and the most common reported indication for steroid use was undetermined (37.6%). Nearly half of the participants did not know whether steroids were dangerous, and 59.4% did not know that topical steroids can cause systemic effects.

Conclusion

This study assesses knowledge regarding topical steroids among the general population in the western region of Saudi Arabia. The results revealed a lack of knowledge regarding the side effects of topical steroids. Awareness of potential topical steroid side effects should be increased among the general population to minimize the occurrence of serious side effects.

The Spectrum of Cutaneous Adverse Drug Reactions Following the Application of Topical Medications: An Observational Study at a Tertiary Care Center

Introduction

Topical medications are one of the most commonly used therapeutic agents in treating a wide spectrum of dermatological diseases. The misuse of topical medicines for inappropriate indications and an extended period may result in cutaneous adverse drug reactions (ADR).

Aims

We conducted this study to observe demographic parameters, commonly misused topical medicines, various clinical patterns of cutaneous ADR, and source of drug prescription among study participants.

Materials and methods

This cross-sectional observational study was conducted from October 2021 to May 2022 at the dermatology outpatient department (OPD) of a tertiary care center. All patients who presented with worsening pre-existing skin diseases or the development of skin disease after the topical application of some cream or ointment were included in the study with written informed consent. A detailed history was taken, and a clinical examination was done.

Results

We detected 200 cases (1.62%) of cutaneous ADR out of 12,346 OPD patients in the eight-month study period. The most common age group was 21-30 years (30%). Most of the patients had used topical medicines for fungal infections (76%). The most commonly used topical medication was a fixed drug combination (FDC) of steroid, antifungal, and antibacterial agents (40%). Tinea incognito (36%) was the most common cutaneous ADR noted.

Conclusion

This study shows that misuse of topical medications is rampant in our community because of their free and easy availability. There is an urgent requirement for strict regulations over the manufacturing, sales, and marketing of over-the-counter (OTC) topical medications to reduce the incidence of cutaneous ADR.

Topical Steroid Damaged Face: A Cross-Sectional Study from Saudi Arabia

Corticosteroids are one of the anti-inflammatory drugs that are used widely by dermatologists. Significant local adverse effects can happen if topical corticosteroids (TCs) are used incorrectly. This study aimed to assess the prevalence of facial TCs misuse and its adverse effects. This was cross-sectional research: a self-reported questionnaire was distributed among a population of Saudi Arabians aged 16 years and above who were using TCs consecutively. Statistical analysis was performed using SPSS version 26. A total of 611 participants were enrolled in the survey: 401 (65.6%) were university graduates, while 187 (30.6%) were below high school level of education. The number of participants using TCs was 279 (45.7%), while 332 (54.3%) did not use steroids topically. The most used TCs were Mometasone furoate 0.1% cream (18.2%), followed by Fusidic acid/Betamethasone cream (16.7%). A total of 46 reported facial TCs’ side effects. Peeling (52.2%) was the most reported side effect, followed by redness (41.3%). In conclusion, the use of facial TCs among the Saudi population is not uncommon (16.5%). A large population are not aware of the side effects of the unsupervised use of TCs. An effort should be made to increase awareness of the adverse effects of TCs.

Topical steroid containing combinations: Burden of adverse effects and why the recent regulatory action may not be enough

OBJECTIVES AND METHODS

In September 2018, the government of India banned 328 fixed dose combinations (FDCs), 24 of which are combinations containing topical steroids. To assess what impact can be expected from this regulatory action, we analyzed reports of adverse drug events due to topical corticosteroids at a hospital-based pharmacovigilance center between January 2017 and August 2018.

RESULTS

Among 34 different steroid-containing FDCs responsible for 485 reports of ADEs with topical steroids, only three preparations, accounting for 50.10% of ADEs, come under the umbrella of the recent ban. Clobetasone propionate (68.87%) and betamethasone (28.45%) were the corticosteroids most frequently associated with adverse events. Most of the steroid preparations (87.84%) had been bought without a prescription for the treatment of dermatophytoses (76.70%). Males (77.73%) were predominantly affected, and nearly half (47.43%) of the patients were between 21 and 30 years of age. Skin atrophy (50.10%), striae (25.54%), and hypopigmentation (19.79%) were the major ADEs.

CONCLUSION

Nearly half of the cutaneous adverse effects were due to topical steroid combinations which are still widely available over the counter.

Acne and rosacea in skin of colour

Acne and rosacea are common inflammatory skin conditions present in numerous racial and ethnic groups. There are distinct differences in clinical presentation, exacerbating factors, potential triggers and consequences of both conditions in individuals with skin of colour (SOC), classified as Fitzpatrick skin types III-VI. For example, acne can be complicated by the development of postinflammatory hyperpigmentation and keloid scarring in SOC, and this can influence treatment choice. Although rosacea is reported less frequently in SOC, this may be the result of delayed diagnosis or late presentation due to the difficulty in discerning the classic features of erythema in darker skin tones. In such cases, additional clues in the medical history and clinical examination may assist in making the diagnosis. This review aims to summarize nuances in both the diagnosis and management of these two common skin conditions in patients with SOC to support clinicians in providing an individualized treatment approach.

Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

BACKGROUND

Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited.

AIMS

This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS.

METHODS

One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher's exact test, and one-tailed Z-test.

RESULTS

Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant.

LIMITATIONS

Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS.

CONCLUSION

Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Bleaching and skin-lightening practice among female students in South India: A cross-sectional survey

BACKGROUND

Bleaching with skin-lightening preparations is a common practice in our society. Particularly, a practice simply known as "bleaching"-referring to application of skin-lightening chemicals including ammonia, hydrogen peroxide, and hypochlorite, repeated at intervals, as a salon-based or home-based procedure appears wide-spread among young females in India. However, there is limited medical literature on "bleaching."

AIMS

We aimed to estimate the prevalence of "bleaching" among female students of our campus and to assess the knowledge, attitude, and practices regarding "bleaching" in the same population.

METHODS

A cross-sectional, questionnaire-based survey was conducted among the female students of the campus following a presurvey focus group discussion with a representative group. A pilot survey conducted to standardize the survey questionnaire showed a high reliability (Cronbach's alpha > 0.7). Descriptive statistical methods were used to assess survey results, and frequencies were presented as percentages.

RESULTS

A total of 880 valid responses were analyzed (age group 17-30 years, mean age-20.24 years). 34.77% had done "bleaching" at least once. 63.8% of respondents did not know the ingredients, and 40.5% did not know about the side effects of "bleaching." 60.06% of those who bleached had experienced an adverse effect. 58.18% respondents knew about "bleaching" from friends/relatives and 17% from parlors. Only 2.3% respondents had consulted a dermatologist, and only 22.8% had used sunscreens. Top motivation to bleach was to lighten facial hairs (19.5%), for a "lighter" complexion (15.1%) and achieve "glow" before a function (15.2%).

CONCLUSION

Facial skin and hair "bleaching" is common in our society, and awareness regarding "bleaching" is low even among educated youth.

Use of Topical Steroids in Dermatology: A Questionnaire Based Study

Context

Topical steroids, the most widely prescribed drugs in dermatology are being increasingly misused.

Aims

This study was conducted to assess knowledge and practices regarding the use of topical steroids and to analyze prescriptions containing topical steroids.

Subjects and Methods

Following approval from the institutional ethics committee, participants were recruited as per the selection criteria and divided into those treated in the institution and those having outside prescription. They were administered a pre-validated questionnaire to assess knowledge and practices regarding the use of topical steroids.

Statistical Analysis Used

Comparison of awareness between two patient categories was done using Chi-square test. Prescription variables were analyzed using descriptive statistics. Significance of P value was set at 0.05.

Results

Out of 400 patients, 167 had external prescriptions whereas 233 were institutional patients. Only 5.5% of all patients knew about the type of drug prescribed whereas 31.25% were aware of the indication. A total of 33.75% of the patients knew topical steroids required a prescription and 5.6% said they were aware that topical steroid use was associated with side effects. Side effects were reported by 96 patients. Awareness regarding knowledge, indication, and need for prescription were significantly better in institutional patients whereas knowledge about side effects was lacking in both groups. Psoriasis was the most common indication overall whereas tinea was the most common indication (51.5%) among externally prescribed.

Conclusions

Although this study showed that institutional patients had comparatively better knowledge than community-treated patients, there is a need to create more awareness among patients overall and implement measures to stop irrational prescribing practices in the community.

Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients

Introduction:

Topical corticosteroids misuse has become one of the burning issues in many countries across the globe. They are known to cause a myriad of adverse effects which include local effects commonly and systemic effects rarely. In dermatology practice, one of the common problems we see these days are steroid-induced and steroid aggravated dermatoses. So, this study was done to find the prevalence of misuse of topical corticosteroid among dermatology outpatients.

Methods:

A descriptive cross-sectional study was done in the outpatient department of dermatology at a tertiary care hospital for 18 months. Ethical clearance was obtained from the Institutional Review Committee of NMCTH (Reference no. 029-076/077). Convenient sampling was done. Statistical Package for the Social Sciences (SPSS) version 16 was used to tabulate the data and analyze the results. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results:

Out of 19464 patients, 614 (3.15%) (2.91%-3.39% at 95% Confidence Interval) gave a history of applying steroid containing creams. Among them, 220 (35.8%) belonged to the age group 21-30 years. Dermatophytoses were the skin disease where TCS was most commonly misused followed by melasma in 425 (69.2%) and 115 (18.7%) respectively. Beclomethasone was the steroid preparation that was misused in the maximum number of patients in 271 (44.1%). Some form of adverse effects was seen in 554 (88.6%) patients.

Conclusions:

Non-prescription sale of topical corticosteroids is the major cause of topical corticosteroids abuse in Nepal. Creating awareness among the prescribers as well as the patients is the current need.

Developing a latent class analysis model to identify at-risk populations among people using medicine without prescription

INTRODUCTION

There exist limited strategies to address the issue of topical medication without prescription (MWP) use.

MATERIAL AND METHODS

A survey with pre-coded questionnaires was conducted with 210 patients following up in the dermatology clinic of a tertiary care center. The knowledge and attitude scores were regressed against demographics and exploratory practice questions, and latent class analysis was carried out to check any particular set of characteristics associated with study subpopulations.

RESULTS

Forty-seven (22%) participants were found using topical antimicrobial containing MWP. Participants with good knowledge score had 3.41 (95% C.I. = 1.68-7.33), 2.99 (1.37-6.73), and 2.49 (1.26-5.15) times association with opting of distance as the prime reason for availing topical MWP, habit of always reading the accompanying drug leaflet, and understanding that OTC topical medication may change the effect of the already prescribed drugs. Participants with good attitude score showed 2.76 (1.50-5.13) times association with limiting the use of steroid containing topical MWP. Latent class analysis identified one subset of participants having lesser knowledge and attitude scores and quoted financial reasons for the procurement of MWP; however, it was found to have greater income as compared to remaining participants.

CONCLUSION

The strategy to identify the target patient audience so as to deliver patient education intervention programs, regarding safe and effective use of MWP was built.

Impact of Abuse of Topical Corticosteroids and Counterfeit Cosmetic Products for the Face: Prospective Demographic Study in Basrah City, Iraq

BACKGROUND

Topical corticosteroids are highly effective compounds that are now widely used in dermatology for the treatment of various autoimmune and inflammatory disorders. Many corticosteroids are misused for diverse indications such as pigmentation, acne, pruritus, fungal or bacterial infections, rashes, and numerous other conditions. These products contain various constituents, most of which have hazards or toxic elements.

OBJECTIVE

The aim is to raise awareness among individuals in the city of Basrah, Iraq about the uses and abuses of applying fake products to the face to inform the consumers about potential harmful adverse effects.

METHODS

This study was a prospective multi-center clinic questionnaire of a demographic that involved the outpatient dermatology departments at the Al-Basrah teaching hospital and the Abu Al-Khaseeb hospital as well as the private clinics of two dermatology specialists in Basrah. A total of 235 patients with facial dermatoses secondary to the application of topical corticosteroids and counterfeit products or, a mixed formulation, for cosmetic purposes were recruited.

RESULTS

Most enrolled patients were female with 10-20 years aged group. The majority applied these products due to friends or pharmacy encouragement. Motivations for the use of these products included: skin fairness, lightening, and general cosmetic. Interestingly, acne and erythema were common whilst, atrophy, dryness, telangiectasia, and hirsutism appear on long- term use only.

CONCLUSION

The abuse of counterfeit cosmetic products and topical corticosteroids is in progress and they have adverse health events. There are many causes behind the abuse but the lack of education, lack of restriction, profitable for sellers and low prices are the main.

A prospective study on patterns of topical steroids self-use in dermatophytoses and determinants predictive of cutaneous side effects

Nonprescription use of topical corticosteroids (TCS) is a significant concern. This can lead to cutaneous adverse effects, altered morphology of skin disorders and chronicity of cutaneous infections. To record and analyze the patterns of TCS use in patients with tinea corporis/cruris and analyze factors determining the development of cutaneous side effects. Hundred patients with a clinical diagnosis of tinea corporis/cruris who could recall the TCS preparation/s used were included. The TCS usage patterns were recorded and analyzed. Most patients had used very potent TCS (n = 66). Most reported using TCS intermittently for duration ranging from 1 to 4 weeks (n = 78). Relapse of symptoms occurred within 1 to 2 weeks of stopping TCS, triggering reuse. Cutaneous adverse effects were present in 44 patients (striae [n = 29], hypo/depigmentation [n = 11], skin thinning [n = 8], hypertrichosis [n = 1], tinea pseudoimbricata [n = 1]). There was a significant correlation between presence of cutaneous adverse effects and the total duration of TCS use (P = .0016), duration of disease (P = .016), and total amount of TCS used (P = .012). Use for >60 days and of >32 g were associated with 89% and 96.3% (respectively) probability of developing cutaneous adverse effects. Self-use of TCS is a worrisome trend. Intermittent use is a plausible reason for development of cutaneous side effects in only 44% patients.

Study of Clinical Profile of Patients Presenting with Topical Steroid-Induced Facial Dermatosis to a Tertiary Care Hospital

Background:

Topical corticosteroids (TCs) are widely used for various indications in dermatology. However, these can cause a plethora of symptoms if overused or abused. Topical steroid damaged face is a relatively new entity which was described in 2008. TC abuse cause a myriad of side effects viz, erythema, telangiectasia, acne, acneiform eruption, hyper/hypopigmentation, rosacea, and photosensitivity when used inappropriately.

Aim:

The aim of the study was to ascertain the prevalence, demographics, and clinical presentations of TC abuse on faceamong our population.

Materials and Methods:

This was a cross-sectional study performed at dermatology department of a tertiary care teaching hospitallocated in eastern India for 1 year. All patients with facial dermatoses attending the outpatient department were asked about use of TC in recent past and those with positive history were included. A detailed clinical evaluation was undertaken and various demographic and clinical data were recorded.

Results:

A total of 316 patients (53 males, 263 females) presented with topical steroid-induced facial dermatoses during the entire study period. Majority of them used these agents on suggestion of close friends and relatives, pharmacists, television commercials, and doctors. Mometasone in the form “No-Scar” preparation was the most commonly abused topical steroid in our study. The most common side effects encountered were steroid-induced acne (45.2%) or flare of pre-existing acne followed by erythema and telangiectasia (21.2%), hypertrichosis (6.6%), rosacea (2.2%), and atrophy (1.5%). The most common reason for abusing TC was to get a fairer skin tone.

Conclusion:

Our study reports the clinical patterns of TC abused facial dermatoses. The fantasy to get a fairer skin among the people of our country has led to the abuse of topical corticosteroids. We conducted this study to create awareness among these patients about the dreadful effects of steroid misuse.

Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients

INTRODUCTION

Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients' perception of skin disease.

METHODS

A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome.

RESULTS

Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days' wages of a labourer).

CONCLUSION

Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek 'quick fixes' from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations.

Evaluating Factors Related to the Abuse of Oral Corticosteroids among Community Pharmacy Customers: Using Theory of Reasoned Action

Introduction:

Although it is discouraged, community pharmacy customers can obtain oral corticosteroids (OCSs) without prescriptions from some community pharmacies in Iraq. Medication abuse is defined as the use of medication for non-medical reasons.

Objectives:

The study aimed to determine demographics, beliefs, and perceptions associated with the abuse of oral corticosteroids for non-illness reasons among community pharmacy customers.

Methods:

This cross-sectional study was conducted in fall 2018 in four provinces in Iraq. Customers of 19 community pharmacies asking for OCSs for themselves without a prescription were administered a paper survey. This study used the Theory of Reasoned Action (TRA) to measure the relationship between the motivational factors and the abuse of OCSs. Logistic regression analysis was conducted to evaluate the relationships between the use of OCSs for non-illness and six TRA factors: Normative belief, behavioral belief, evaluation of the behavior, motivation to comply, subjective norms and attitude toward behavior.

Results:

The study enrolled 141 participants (98 women and 43 men) taking asking for OCSs without prescription. Dexamethasone was the most commonly used OCSs (59.6%). Friends were the primary recommenders for corticosteroids abuse (28.4%). The main reasons for using OCSs were to increase appetite and gain weight (53.9 %). Approximately one-third (36.2 %) of the participants gained weight after using OCSs. The regression analysis of the TRA variables showed two factors were significantly related to the abuse of OCSs. Age had a significant inverse relationship with the abuse of OCSs and the "good appearance" belief had a significant positive association with OCS abuse.

Conclusion:

Some Iraqi community pharmacy customers use non-prescribed oral corticosteroids to increase appetite and gain weight. Improve body appearance represents the dominant incentive that urges people to use OCSs without prescription. Health officials and healthcare practitioners need to promote people's awareness about the risks of misusing OCSs through education programs and advertisements in public health settings, media, and social media.

Epidemiology, Diagnosis, and Treatment of Atopic Dermatitis in the Developing Countries of Asia, Africa, Latin America, and the Middle East: A Review

Atopic dermatitis (AD), the leading cause of skin-related burden of disease worldwide, is increasing in prevalence in developing countries of Asia, Africa, Latin America, and the Middle East. Although AD presents similarly across racial and ethnic groups as chronic and relapsing pruritic eczematous lesions, some features of the disease may be more or less prominent in patients with darker skin. Despite a similar presentation, consistent diagnostic criteria and consistent treatment guidelines are lacking. Because of these and other challenges, adherence to treatment guidelines is difficult or impossible. Previous studies have stated that many patients with AD receive ineffective or inappropriate care, such as oral antihistamines, oral corticosteroids, or traditional medicines, if they are treated at all; one study showed that approximately one-third of patients received medical care for their dermatologic condition; of those, almost three-quarters received inappropriate or ineffective treatment. In addition, other challenges endemic to developing countries include cost, access to care, and lack of specialists in AD. Furthermore, most of the available diagnostic criteria and treatment guidelines are based on European and North American populations and few clinical trials report the racial or ethnic makeup of the study population. Drug pharmacokinetics in varying ethnicities and adverse effects in different skin physiologies are areas yet to be explored. The objective of this review is to describe the diagnosis, treatment, and management of AD in developing countries in Asia, Africa, Latin America, and the Middle East; to discuss the differences among the countries; and to establish the unmet needs of patients with AD in them. The unmet medical need for treatment of AD in developing countries can be addressed by continuing to train medical specialists, improve access to and affordability of care, and develop new and effective treatments.Funding Pfizer Inc.

Knowledge, Belief, and Perception among Youths with Acne Vulgaris

Background

Acne vulgaris is one of the commonest dermatological challenges faced by the youth. It lasts several years, running a chronic course with complications such as scarring. The fact that this occurs most commonly on the face, leads to profound psychological implications, that cause emotional trauma and affect a person's quality of life. Anxiety and depression are common issues arising from this. A lot of myths tend to float around acne in society, and people use all kinds of indigenous and home made remedies, as well as the wrong kinds of treatment, such as topical steroid based creams, which further worsen the situation.

Aims and Objectives

To assess the awareness levels amongst youths, to understand the various beliefs and perceptions related to acne, so that we may be able to tackle this condition better.

Materials and Methods

We carried out a cross-sectional study in 150 patients with acne vulgaris attending the Dermatology Out Patient Department from May 2017 to June 2018.

Results

Amongst other findings, we found that a majority of people in our study believed stress and hormones to be the major aggravating factors. Most patients preferred treatment options like healthy lifestyle and cleansers and toners in our study. Amongst the treatment options, clindamycin was more commonly used than benzoyl peroxide followed by retinoids.

Conclusion

There are several misconceptions and a gross lack of knowledge about acne amongst our younger population, that needs to be addressed.

Assessment of drug utilization pattern of steroids in a district general hospital in Amravati region

Introduction: Rational use of corticosteroids is very important in the long term for improving patient safety. The main objective of the study was to analyze the prescribing patterns of steroids in a district general hospital, Amravati.

Materials and methods: A prospective observational study was carried out over a period of six months in a district general hospital. All patients receiving any category of steroid therapy were enrolled, and the prescribing tapering patterns of steroids were reviewed. The demographic data, disease data and data on the utilization of various steroids were analyzed, and the knowledge of the patients was assessed by using a Michigan questionnaire.

Results and discussion: 179 patients were recruited for the study. Steroids were prescribed for various (29.6%) respiratory conditions, (10.1%) CVS diseases, (11.7%) CNS, (1.6%) in hepatic disorders, (1.1%) musculoskeletal disorders, (3.4%) skeletal disorders, (0.6%) renal impairments, (3.9%) GI disorders, (19.0%) skin diseases and (19.0%) other diseases. The utilization of steroid dexamethasone was the most commonly prescribed to 111 patients (63.8%) followed by hydrocortisone (57 patients, 32.8%) and prednisolone (6 patients, 3.4 %). Dexamethasone was most commonly associated with adverse effects (1.8% of such as headaches, abdominal pains, and rashes), followed by prednisolone (0.8% of such as facial swelling), clobetasol (0.4%) and fluticasone (0.4 %).

Conclusions: Very little variation was found in the prescription pattern amongst the healthcare professionals. Most of the drugs were prescribed rationally; the significance of the study is to improve the patient safety in the long-term use of steroid therapy by observing the prescribing patterns as irrational use of steroids can increase the risk of adverse effects.

Skin-lightening practices behind the veil: An epidemiological study among Saudi women

BACKGROUND

Women are adopting skin-lightening practices worldwide in an attempt to enhance their skin tone. The reasons and beliefs behind such practices vary from culture to culture. Scarce data are available for this phenomenon among Saudi women. We carried out this study to determine the practices, reasons, and correlates of skin-lightening practices among women in the northern region of Saudi Arabia.

METHOD

Using nonprobability convenient sampling, an analytical cross-sectional study was carried out among women attending two multispecialty hospitals in the Al-Jouf region. A prevalidated, self-administered questionnaire containing 35 items about demographic characteristics, skin-lightening practices, knowledge of skin-lightening products (SLPs), reasons, and perceptions about lighter skin tone was used to collect data.

RESULTS

Among 605 sampled women, usage of skin-lightening practices was found in 382 participants (63.1%). All participants had relatively lighter skin. Skin type and education affected skin-lightening practices significantly (P values = 0.002 and 0.012, respectively). The prevalent reason for using SLPs was cosmetic (66%). One-third of users faced side effects from these products. The SLP users believed that lighter skin tone plays a role in self-esteem, perception of beauty, social class, marriage, and employment opportunities (P values < 0.01) as compared to nonusers. Media was found to influence the use of SLPs (P values < 0.001).

CONCLUSION

Skin-lightening practices are prevalent among Saudi women. Such practices are reinforced by a belief that fairer skin is associated with beauty, self-esteem, and financial and social advantages. A public health educational campaign is needed to decrease the usage of SLPs.

Topical steroids: Awareness and misuse among patients, pharmacists and general medical practitioner

AIMS AND OBJECTIVES

(1) To determine the level of awareness among patients, pharmacists and general practitioners about commonly available topical steroids and its combinations.(2) To determine the source of recommendation/prescription of topical steroids and its combination creams.(3) To know and create awareness about the side effects of topical steroids in all the study groups.

METHODS

This was a prospective questionnaire-based study where three study groups, namely patients, pharmacists and general practitioners, were included. This study was approved by the institutional ethics committee. after ethical clearance. The patients who used topical steroids for dermatoses where it is an absolute contraindication, as well as those who developed side effects, were included in the study. ThoroughComplete cutaneous examination was done specifically to detect the side effects of steroids. Seminars were conducted and questionnaires were given to both the pharmacists and general practitioners of nearby areas. The questionnaire consisted of questions regarding their prescription and dispensing practices of topical steroids and its combinations.

RESULTS

Out of 95 patients seen, the most commonly used steroid molecule was clobetasol propionate 0.05% in 44 (46.3%) patients, the common source of recommendation was general practitioners in 36 (37.8%), the common indication was superficial dermatophytosis in 85 (89%) and the most common adverse effect was recurrence/increase in the extent of the infection in 72 (75.78%) patients. Out of total 44 general practitioners enrolled in the study, 22 (50%) were qualified allopathic medical practitioners and22 (50%) were homeopathic/ayurvedic doctors. Superficial dermatophytosis [19 (43.18%)] was the common dermatosis seen by them. While 29 (65.90%) preferred prescribing topical steroids or its combination, rest of them preferred plain steroid creams. Out of 179 pharmacists, 74 (41.34%) did not have appropriate knowledge of topical steroids, 35 (19.55%) were not aware that steroids are isschedule "H" drugs. Commonest molecule sold over the counterwas clobetasol propionate 0.05% by 74 (41.89%). The limitations of our study were small study group and short duration.

CONCLUSION

As dermatologists, it is our responsibility, to correctly educate the society, particularly the non-dermatologist medical fraternity, about ethical and rational use of topical steroids.

A clinicoepidemiological study of topical corticosteroid misuse at a tertiary care center

Background: Misuse of topical corticosteroids (TCS) has become a burning issue in many countries across the globe. Nonprescriptional sale, lack of awareness, and nonavailability of qualified dermatologist are some of the contributing factors. Aim: To assess the clinicoepidemiological profile of patients misusing TCS and assess various factors contributing to it. Methods: All the patients presenting to the dermatology OPD of a tertiary care center were screened by asking for application of any topical medication. Those patients who were found to be using TCS inappropriately as per clinical diagnosis were included in the study. Results: A total of 324 out of 8621 (3.76%) patients were included in the study. Maximum number of patients belonged to the age-group of 21-30 years. The most common steroid was clobetasol followed by mometasone and beclomethasone. The most common primary dermatosis was dermatophytosis followed by acne vulgaris and melasma. Unavailability of dermatologist was the most common reason cited by the patients for the use of these preparations. Conclusion: Nonprescriptional sale of TCS is the major factor responsible for TCS abuse in India. Creating awareness (both amongst patients and prescribers) and adequate dermatology training to undergraduate medical students is the need of the hour.

EXPERIENCE OF COMBINED APPLICATION OF METHYLPREDNISOLONE ACEPONATE AND MOLETOLO COSMETICS STEROIDSANDVIAGRAJY IN THE TREATMENT OF DERMATOSES

Skin diseases of non-infectious etiology, such as allergic contact dermatitis, atopic dermatitis, eczema  and chronic actinic dermatitis have a significant impact on the quality of patient’s life, greatly reducing it. The most important place in the therapy of these diseases is found in topical glucocorticosteroids in combination with competent basic therapy.The aim of the study was to evaluate the clinical efficacy, safety profile, and tolerability of an external corticosteroid drug with a combination composition: methylprednisolone aceponate 0.1 % + urea 2 % (Komfoderm M2) in combination with dextpanthenol, allantoin and Shea butter (Dexpan plus cream) in dermatological practice in the treatment of eczematous process.Materials and methods. 48 patients, from 18 to 58 years old with mild to middle-severe eczematous process, were under observation, including 16 with allergic contact dermatitis, 14 patients with atopic dermatitis and 10 patients with eczema brushes, and 8 people with actinic dermatitis. Cream Komfoderm M2 was applied to the affected skin areas once a day in combination with cream Dexpan plus as standard therapy and emollient cosmetic. We investigated the parameters of the DLQI questionnaire “Dermatological Quality of Life Index” .Results As a result of the conducted observational study, data were obtained on the high effectiveness of therapy with the combined use of the drug Komfoderm M2 and Dexpan plus. An excellent evaluation of the efficacy of the scheme used was found in 37 (77 %) patients, a good one in 9 (18,8 %) and 2 (4.2 %) patients had a satisfactory result.Conclusions. This clinical study proves the high efficacy, safety and tolerability of the drugs — Cream with 0.1 % MPA and urea 2 % (Komfoderm M2) in combination with a cream containing dexpanthenol, allantonoin and Shea butter (Dexpan plus) in the treatment of eczematous process.

Topical Steroid Damaged/Dependent Face (TSDF): A Study from a Tertiary Care Hospital in Eastern India

Background:

Awareness against abuse of topical corticosteroids (TC), especially over the face, has been going on for last 5 years in India. In spite of that we are getting lots of cases in our hospitals.

Aims:

The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face among the dermatology outpatient department (OPD) attendees and to analyze its causes.

Methods:

This study was conducted in a tertiary care medical center of eastern India. Patients with relevant facial dermatoses were asked about their current use of topical formulations and confirmed to be TSDF were included in the study.

Results:

A total of 748 patients with facial dermatoses were screened, of which 271 (36.22%) were using TC. Of them mostly young adults between 20 and 29 years (37.10%) were using TC. Average duration between starting of use of medication and the onset of symptoms was 5 months. Ninety-eight (36.16%) patients were using topical corticosteroid for the treatment of acne and 74 (27.30%) were using as depigmenting cream. About 108 (39.85%) patients bought medicine over the counter being recommended by pharmacist/shop owner. Rosacea like features with photosensitivity was the most common adverse effect found in 79 (29.15%) patients whereas comedonal acne/acne exacerbation were found in 68 (25.09%) patients. Most of them (227, 83.76%) were unaware about the side effects of steroids.

Conclusions:

TC misuse in patients with facial dermatoses is still quite common even after efforts to grow the awareness among population.

Living with Acne: Belief and Perception in a Sample of Indian Youths

Background:

Acne vulgaris is a common disease among adolescent. There is paucity of information on knowledge and understanding of acne patients about their condition.

Objective:

This study was carried out to evaluate beliefs and perception of acne patient toward their understanding of disease, treatment option, and information source.

Materials and Methods:

A cross-sectional study was conducted on acne patients by means of a questionnaire during 2013–2014 at MMIMSR, Ambala. An adapted version of questionnaire of Brigitte et al. was used and was modified to suit Indian sentiments.

Results:

A total of 200 acne patients were participated in the study. Mean age of participants was 19.80 years. Male:female ratio was 2:1. Causes implicated were diet (85%), puberty (65%), and mood swings (46%). Fatty food and stress were most common agents held responsible for acne flaring. Popular sources of information were friends and parents. 102 patients had used steroids one way or the other. Acne was considered curable by 65% with an anticipated duration of treatment lasting up to 12 months.

Conclusion:

Misconceptions are widespread among the population. A health education program is needed which should be included in school curriculum to improve their understanding of the condition.

Misuse of Topical Corticosteroids for Cosmetic Purpose in Antananarivo, Madagascar

This cross-sectional study was conducted in Antananarivo, Madagascar, from June to September 2012. We aim to evaluate the misuse of TC on the face for cosmetic purpose and the adverse effects due to its application. A questionnaire-based analysis was done among females who use topical corticosteroids on the face for cosmetic purpose. Of the 770 women questioned, 384 (49,8%) used topical corticosteroids for cosmetic purpose whose mean age was 38 years (range 16-73 years). Two hundred and sixty-one females (68%) used TC combined with handcrafted cosmetics, and 123 (32%) used TC alone. "Pandalao," which contains salicylic acid, peppermint oil, lanolin, powder of Juanes de Vigo (mercury powder), and Vaseline, is the most handcrafted cosmetic combined with TC in our study (used by 29,4% respondents). Only one (0,26%) had obtained the TC by physician's prescription, 234 (61%) from cosmetic retailers, 92 (23%) directly from local pharmacies, 49 (12%) from beauticians, and 15 (4%) from unspecified sources. Lightening of skin color was the main reason for using TC in 44,8% of respondents in the absence of any primary dermatosis. Pigmentation disorders (63,2%) and cutaneous atrophy (52,1%) were the most adverse effects noted.

Bilateral Morganella Morganii keratitis in a patient with facial topical corticosteroid-induced rosacea-like dermatitis: a case report

Background

Bilateral keratitis rarely occurs in individuals without predisposing factors. Here we describe the clinical course of a patient who developed a bilateral keratitis caused by Morganella. morganii which might be associated with long term using of topical corticosteroids-containing preparations on the face.

Case presentation

A 52-year-old female patient presented with marked bilateral corneal infiltration and hypopyon without any usual predisposing factors for bilateral infectious keratitis. There was diffuse erythema with itching on face before the onset of eye discomforts. Microbiological culture of materials from both corneas revealed significant growth of Morganella morganii. Topical corticosteroid-induced rosacea-like dermatitis was diagnosed by dermatologist because of the characteristic eruptions and long history of using the corticosteroids-containing cosmetic creams on her face. The corneal ulcers responded well to levofloxacin eye drops and ofloxacin ointment and healed with opacity and neovascularization.

Conclusion

This case illustrates that bilateral bacterial corneal infection can develop in patients with long term using of topical corticosteroids-containing preparations on the face. To our knowledge, this is the first case of bilateral keratitis caused by Morganella morganii.

Topical corticosteroids knowledge, attitudes, and practices of primary care physicians

OBJECTIVES

To assess knowledge, attitudes, and practices of primary care physicians (PCPs) toward topical corticosteroids (TCs). Methods: A cross-sectional, 53-item questionnaire based study on TCs was conducted among PCPs in Riyadh, Kingdom of Saudi Arabia between January and March 2015. A maximum score of 30 was calculated for the knowledge portion. Results: Out of 420 PCPs, 336 responded (80%). Most participants (89.6%) reported prescribing TCs. The mean knowledge score was 17.14 (SD=5.48). Only 39% PCPs correctly identified that there are 7 or 4 TCs potency groups (2 different classification systems). The MBBS/MD and diploma-certified physicians scored lower than board-qualified PCPs (p less than 0.05). Family medicine physicians scored higher than general practitioners (GPs) (p less than 0.05). Hospital-based PCPs scored better than private practice PCPs (p less than 0.05). Moreover, those who felt somewhat comfortable (32.5%) in treating dermatology patients were more knowledgeable (p less than 0.05). Lastly, 76.5% of physicians were interested in attending courses on dermatologic therapies.  Conclusion: Knowledge of TCs among PCPs was inadequate. Targeted educational interventions delivered by dermatologists are recommended.

Misuse of topical corticosteroids on facial skin. A study of 200 patients

BACKGROUND

Topical corticosteroids have become available as over the counter drugs and are widely misused for various conditions.

OBJECTIVE

The aim of this study is to assess the clinical and epidemiological aspects of the unjustified use of topical corticosteroids for facial skin.

METHODS

A total of 200 patients with facial dermatoses and topical corticosteroid misapplication daily over face for not less than 30 days were included in the study. This was a prospective study conducted in a tertiary care dermatology outpatient centre of the Jammu region. A detailed clinical history regarding topical corticosteroid use was taken and adverse effects analysed.

RESULTS

A total of 166 patients were women and 34 were men. The predominant age was 31-40 years. A total of 170 patients (85%) were in the age group of 21-50 years. Duration of application was over 1 month up to 3 years, daily. Betamethasone or clobetasol ointments were used in 75 patients (37.5%) and momatasone was used in 15 patients (7.5%). Indication for using steroids were: general / cosmetic purposes (72 patients; 36.0%), acne (59; 29.5%), hyperpigmentation (41; 20.5%), tinea (6; 3%), undiagnosed dermatoses (28; 14.0%). The use of corticosteroids was attributed to the advice of pharmacists (69; 34.5%), friends and relatives (61; 30.5%), cosmetologists (22; 11.0%), non-dermatology physicians (30; 15.0%) and dermatologists (18; 9%). Adverse effects included acneiform lesions, telengiectasias, dyspigmentation, hypertrichosis, perioral dermatitis and tinea incognito. A total of 89 (44.5%) patients fulfilled the criteria of "topical steroid dependent face". These patients reported erythema, burning and itching on stopping the application of topical corticosteroids.

CONCLUSION

In most cases the use prolonged use of topical corticosteroids on facial skin was recommended by non-professional persons. The adverse events ranged from transient to permanent. The results of this study underline the indispensable role of dermatology specialists in diagnosing and treating cutaneous disorders.

Topical Corticosteroid Misuse: The Scenario in Patients Attending a Tertiary Care Hospital in New Delhi

INTRODUCTION

Irrational use of Topical Corticosteroid (TC) is quite common in India due to unrestricted availability and use of TC not only by general public but also by physicians and chemists due to quick relief of symptoms in different dermatological conditions.

AIM

The present study was conducted to evaluate and analyse the prevalence of misuse of TC and the causes behind misuse of TC among patients in a dermatology outpatient department in New Delhi.

MATERIALS AND METHODS

This was a cross-sectional observational questionnaire based study conducted over a period of 5 months (1^st June 2015 to 30^th November 2015). Patients were questioned and assessed for misuse of TCs in terms of indication, dose, frequency, duration and source of recommendation of TC.

RESULTS

During the study period, 256 (11.77%) patients presented with inappropriate use of TC out of 2174 patients attending OPD of dermatology unit of a government hospital. A total of 250 patients presented with adverse effects of TC resulting from the misuse of these drugs. There were 60%female patients and 20-29 years (38%) was the most common age group affected. We found fungal infection (38%) was the most common reason of abuse followed by facial acne (29%) and lightening of skin colour (8.4%). Friends and family (33.2%) were found to be the most influencing factors for misuse of TC. Betamethasone (72.8%) was the most commonly used TC preparation and tinea incognito (26.4%) followed by facial acne (25.6%) were the most common side effect experienced.

CONCLUSION

Outcome of the misuse of TC could be dreadful and the cause for same lies at all levels- patients, family, physicians and the regulatory authorities.

Misuse of Topical Corticosteroids over Face: A Clinical Study

Introduction:

Topical corticosteroids (TCS) have been widely used in various dermatological diseases. However, because of inadvertent use, TCS misuse has become a common problem faced by dermatologists in various parts of the world. Prolonged use over the face can cause various side effects such as steroid rosacea, acneiform eruptions, and hypertrichosis.

Aim:

To study the effects of TCS misuse and analyze various factors promoting its use on face.

Materials and Methods:

A total of 100 patients presenting with various facial dermatoses following the misuse of TCS on the face were studied. Detailed history was noted and the various side effects were recorded.

Results:

Majority of the patients (70%) were females with maximum number of patients belonging to the age group of 11–20 years. Eighty-five percent of the patients were applying TCS for medical conditions, with acne being the most common indication, and the rest were applying as a general face cream. Pruritus and acneiform eruptions were the most common side effects observed and the other reported were erythema, photosensitivity, steroid dependent face, and telangiectasia.

Conclusion:

TCS misuse especially over the face can lead to a multitude of side effects. It is high time to create awareness among the patients as well as doctors regarding the proper usage of this wonder drug.

Topical Corticosteroids Abuse: A Clinical Study of Cutaneous Adverse Effects

Background:

Topical corticosteroids (TC) are one of the most widely used agents in dermatology practice. Misuse of these agents may lead to a wide range of adverse effects.

Aim:

This study was conducted to assess the magnitude of abuse of topical corticosteroids (TC) and clinical patterns of cutaneous adverse effects amongst patients attending dermatology department of a teaching hospital at South Rajasthan.

Materials and Methods:

All patients who reported with adverse effects of topical steroids during one year from September 2015 to August 2016 were evaluated. Patients fulfilling the study criteria were registered for further workup.

Results:

Out of the 85280 new patients, 370 (0.43%) presented with adverse effects of TC. Males (232/370;62.70%) outnumbered females (138/370;37.30). Age group 11-30 years was most commonly (74.05%) affected. The main reason for using TC was fungal infection (52.43%). Tinea incognito (49.46%) and acne (30.27%) were the most common adverse effects recorded.

Conclusions:

Abuse of TC, particularly the superpotent and potent is rampant amongst general population. Topical corticosteroids are frequently used for indications where they should be avoided.

Misuse of topical corticosteroids on the face: A cross-sectional study among dermatology outpatients

Background:

Topical corticosteroids (TC) are being misused widely on the face without a prescription from the dermatologist.

Aim:

To evaluate the misuse of TC-containing preparations on the face and the adverse effects due to its application.

Materials and Methods:

A questionnaire-based analysis was done among patients attending the dermatology outpatient department of a tertiary care hospital between March 2014 and March 2015. Patients with various facial dermatoses were asked about their current use of topical preparations and on further followup questioning, those who revealed the use of TCs (25g or more) continuously or intermittently for a minimum duration of four weeks were included in the study and observed for local adverse effects.

Results:

A total of 410 patients were observed, 306 were females (74.6%) and 104 were males (25.3%). One hundred and seventy-eight patients (43.4%) used topical steroids alone, 124 (30.2%) used creams containing TC, hydroquinone, and tretinoin, 108 (26.3%) used creams containing a combination of TC, antibiotic, and/or antifungal. One hundred and seventy-six patients (42.9%) bought TC or TC containing creams over the counter on their own, without the prescription of a dermatologist, 35 (8.5%) were recommended TC by a beautician (beauty parlors), 82 (20%) by their friends, family members, or neighbors, 75 (18.2%) by a non-dermatologist practitioner, and 42 (10.2%) by a dermatologist.

Limitations:

The sample size was small.

Conclusion:

Dispensing of TCs must be regulated in India; they should only be issued against a doctor's prescription.

Topical Steroid Damaged/Dependent Face (TSDF): An Entity of Cutaneous Pharmacodependence

Topical Steroid Damaged/Dependent face (TSDF) is a phenomenon which has been described very recently (2008). It is characterized by a plethora of symptoms caused by an usually unsupervised misuse/abuse/overuse of topical corticosteroid of any potency on the face over an unspecified and/or prolonged period of time. This misuse and damage have a serious effect on the quality of life of the patients in general and the skin of the face in particular. Management is difficult and necessitates psychological counseling as well as physical soothing of the sensitive skin.

Topical Steroid Awareness and Abuse: A Prospective Study among Dermatology Outpatients

Background:

Topical steroids are one of the most commonly abused drugs. There are only a few studies available which have highlighted the severity of this problem in India. However, these studies have concentrated mainly on the topical steroid abuse and its side effects over the face.

Aims:

The aim of this study was to know the awareness among the people about various commonly available topical steroids and their combinations irrespective of usage and to know the extent of misuse of these drugs. Along with this, we also tried to find the source of recommendation of these medicines which will help to sensitize people about this menace.

Materials and Methods:

This was a prospective, questionnaire-based study done at a tertiary care hospital. A total of 1000 adult patients attending the dermatology outpatient department were administered a questionnaire about awareness and usage of topical steroid and its combinations.

Results:

A total of 1000 adult patients were included in the study, out of which 809 (80.9%) patients had heard about at least one of the topical steroids or its combinations mentioned in the questionnaire. Six hundred and twelve (61.2%) patients had used these creams. Acne and pigmentation were the most common indications for which topical steroid was used. These medicines were recommended by general practitioners in 302 (49.5%) patients and pharmacists in 71 (11.6%) patients. Totally, 318 (51.9%) patients complained of some form of side effect after using these creams. Aggravation of the symptoms and increased pigmentation were the most common adverse effects.

Conclusion:

Misuse of topical steroids not just over the face but also as a cream for any skin problem is quite common. Most of the times, it is recommended by general practitioners or pharmacists. It is very important to sensitize these people about the possible complications of these drugs and the extent of problem the society is facing because of irrational and unregulated use of these drugs.

A combined topical therapy of chronic dermatoses

The article analyzes literature sources on the etticacy ot the topical glucocorticosteroid therapy ot chronic dermatoses. Special attention is paid to evidence-based studies ot the etticacy and satety ot a combination therapy ot complicated chronic dermatoses using the Akriderm GK drug.

Medication misuse in India: a major public health issue in India

BACKGROUND

In India, it has been estimated that 50% of family spending on healthcare is on unnecessary medications or investigations. This, combined with the wide availability of medications, has seemingly contributed to increasing rates of antibiotic resistance and further impoverishment. In this literature review, we aim to characterize the extent of misuse and describe underlying factors contributing to the misuse of medication in India.

METHODS

This literature review included relevant articles published after 2000 that assessed medication use and misuse in India. A narrative review framework was used to analyse each article, confirm its inclusion, extract relevant information and group the findings under thematic areas.

RESULTS

There were 115 articles included in this literature review. The literature demonstrated that the misuse of medications in India is widespread. The factors resulting in this involves all levels of the health system including regulation, enforcement and policy, healthcare providers and consumers.

CONCLUSIONS

This is one of the most comprehensive reviews of medication misuse in India. It indicates the widespread nature of the problem and so highlights the need for action. This review provides a detailed understanding as to the complex interplay of factors that result in medication misuse in India.

A systematic review of topical corticosteroid withdrawal ("steroid addiction") in patients with atopic dermatitis and other dermatoses

BACKGROUND

The National Eczema Association has received increasing numbers of patient inquiries regarding "steroid addiction syndrome," coinciding with the growing presence of social media dedicated to this topic. Although many of the side effects of topical corticosteroids (TCS) are addressed in guidelines, TCS addiction is not.

OBJECTIVE

We sought to assess the current evidence regarding addiction/withdrawal.

METHODS

We performed a systematic review of the current literature.

RESULTS

Our initial search yielded 294 results with 34 studies meeting inclusion criteria. TCS withdrawal was reported mostly on the face and genital area (99.3%) of women (81.0%) primarily in the setting of long-term inappropriate use of potent TCS. Burning and stinging were the most frequently reported symptoms (65.5%) with erythema being the most common sign (92.3%). TCS withdrawal syndrome can be divided into papulopustular and erythematoedematous subtypes, with the latter presenting with more burning and edema.

LIMITATIONS

Low quality of evidence, variability in the extent of data, and the lack of studies with rigorous steroid addiction methodology are limitations.

CONCLUSIONS

TCS withdrawal is likely a distinct clinical adverse effect of TCS misuse. Patients and providers should be aware of its clinical presentation and risk factors.

Misuse of topical corticosteroids: A clinical study of adverse effects

Background:

Misuse of topical corticosteroids is a widespread phenomenon among young people in India, especially women. The practice is associated with significant adverse effects and poor awareness of these effects among the general public.

Aim:

This study was conducted to examine the misuse and adverse effects of topical corticosteroids among the people in Bastar region in Chhattisgarh state of India.

Materials and Methods:

Data collected from patients presenting with at least one of the adverse effects of topical corticosteroids as the chief complaint, from November 2010 to October 2011.

Results:

Out of the 6723 new patients, 379 (5.63%) had presented with misuse and adverse effects of topical corticosteroids, of whom 78.89% were females. More than 65% of the patients were in the age group 10-29 years. The main reason for using the topical corticosteroids was to lighten skin colour and treat melasma and suntan. Acne (37.99%) and telangiectasia (18.99%) were the most common adverse effects noted.

Conclusions:

Misuse of topical corticosteroids has a huge impact on dermatological practice, leading to a significant proportion of visits to the dermatologist. This hydra-headed problem needs multi-dimensional interventions, involving educational, legal and managerial approaches with cooperation from different sectors of society.

Side-effects of topical steroids: A long overdue revisit

The introduction of topical steroids (TS) of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. However the usefulness of these has become a double edged sword with constantly rising instances of abuse and misuse leading to serious local, systemic and psychological side effects. These side effects occur more with TS of higher potency and on particular areas of the body like face and genitalia. The article reviews the side effects of TS with special mention about peadiatric age group, also includes the measures for preventing the side effects.

Topical corticosteroid misuse: the Indian scenario

Topical corticosteroids (TC) have been available for more than six decades during which they have completely changed the face of therapy of dermatological disorders. Despite being the most useful drug for such treatment they are known to produce serious local, systemic and psychological side-effects when overused or misused. Though the drug has been misused sporadically earlier, the menace has become more acute during the last two decades. In India, damaging effects to the human body particularly the skin have been reported regularly during the last decade. The misuse occurs at various levels such as manufacturing, marketing, prescription, sales and end-use by patients and laymen. During the last decade dermatologists in India have been regularly campaigning against such misuse. However, the menace keeps on increasing alarmingly. The need to accelerate the momentum of the campaign against TC misuse has been increasingly felt by dermatologists all over India. This symposium aims to contribute significantly to the campaign against misuse of TC.

Ethical use of topical corticosteroids

Dermatologists rely very heavily on corticosteroids for treating many common dermatoses. Concerns about their incorrect use are widely expressed both in lay public and specialist discourse. From the point of view of medical ethics, issues of autonomy, beneficence and non-maleficence are all raised frequently when we prescribe topical corticosteroids to our patients. We need to be aware of situations when conflicts between these issues arise and have a clear thought process about resolving them. This can only be achieved if we have a thorough understanding of the skin disease being treated coupled with expertise in the use of the varied potencies and available dosage forms of topical corticosteroids. A good understanding of human psychology and effective communication is also needed to use these agents optimally.

Topical corticosteroid addiction and phobia

Corticosteroids, one of the most widely prescribed topical drugs, have been used for about six decades till date. However, rampant misuse and abuse down the years has given the drug a bad name. Topical steroid abuse may lead to two major problems which lie at the opposing ends of the psychosomatic spectrum. Topical steroid addiction, a phenomenon that came to be recognized about a decade after the introduction of the molecule is manifested as psychological distress and rebound phenomenon on stoppage of the drug. The rebound phenomenon, which can affect various parts of the body particularly the face and the genitalia has been reported by various names in the literature. TC phobia which lies at the opposite end of the psychiatric spectrum of steroid abuse has been reported particularly among parents of atopic children. Management of both conditions is difficult and frustrating. Psychological counseling and support can be of immense help in both the conditions.