Title: Topical Corticosteroids - A Great Challenge to Avoid Misuse on Face
Authors: Dr Sandhya Chauhan, Dr Ashok Garg, Dr Prem Lal, Dr Ajay Ahluwalia
DOI: https://dx.doi.org/10.18535/jmscr/v5i9.01
Abstract
Introduction: Topical corticosteroids (TCS) are the most commonly prescribed topical drugs not only by dermatologists but also by non-dermatologists. Over the counter availability, irrational prescription and prolonged use by patients has resulted in their misuse. Steroid rosacea, hypertrichosis, steroid dependent face (SDF), atrophy and acneform eruptions are some of facial side effects of these drugs.
Objective: To know clinico-epidemiological profile of patients misusing the TCS over face. To determine adverse effects, source of prescriptions, commonly misused preparations of TCS.
Methods: This is an observational study conducted over a period of six months from January to June 2016. Patients misusing TCS for more than one month and who presented with at least one side effect over the face were enrolled for this study. A detailed history regarding clinico-epidemiological parameters, duration of misuse, source, preparation and reason for use of TCS was taken. Adverse side effects were noted down and clinical photographs of patient were also taken after their consent.
Results: A total of 412 patients including 315 females and 97 males were studied. Majority of patients were in the age group of 11-40 years. Duration of application of TCS was <6 months in majority, longest being 5 years. Nearly 73.3% of the patients were using it on a daily/intermittent basis. Most commonly misused TCS was betamethasone in 37.9% followed by clobetasole in 32.3%. Indications for using TCS in descending order were; acne (31.5%), fairness cream (23.8%), pigmentation (19.9%), tinea faci (10.4%), facial dermatitis (5.6%) and various other dermatoses of face (8.8%). TCS were taken after the advice of chemists/pharmacists in 38.8%, friends and relatives 24.8%, paramedical persons 20.34%, non-dermatologists12.9% and dermatologists 3.1%. Commonest side effect was acneform eruptions and other side effects were SDF, rosacea and rosacea diathesis, hypertrichosis, dyspigmentation, infections and perioral dermatitis.
Conclusion: From our study it was concluded that misuse of TCS is very prevalent among young females in our setup. Immediate relief of signs and symptoms and unawareness about their side effects are the main reasons for their misuse. Further, over the counter availability, irrational prescriptions and poor access of patients to dermatologists worsen the abuse. Although it’s a great challenge to overcome this problem but general public awareness, patient education and medical/paramedical personnel sensitization can help to some extent.
Key Words: Steroids, Facial abuse, Rosacea, Hypertrichosis, Acne.
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