Prescription and usage pattern of topical corticosteroids among out-patient attendees with dermatophyte infections and its analysis: A cross-sectional, survey-based study

Abstract

Background: There is scarce scientific data on topical corticosteroids (TCS) prescription by non-dermatologists including registered medical practitioners, ayurvedic, homeopathic practitioners, and over-the-counter (OTC) use of TCS-containing creams. Objective: The main objective of this study is to analyze the prescription and usage pattern of topical steroids among out-patient attendees with dermatophyte infection. To study health-seeking behavior of patients with dermatophyte infections. Material and Methods: An open, cross-sectional, duration-based study of 3 months. Inclusion criteria: Patients with dermatophytosis having a history of topical steroid application; either prescribed or purchased OTC and used themselves. Exclusion criteria: Patients who were not willing to give informed consent. Patient's data like socio-demographic profile, duration, frequency, site of application, contents of the topical cream used, prescriber information, and patients’ desire to continue the use of topical steroids were recorded. Results: Total of 18.40% ( n = 503) patients were already using cream-containing TCS at the time of presentation to the tertiary dermatology care center. The study shows that almost half of the patients (48.90%) were using unprescribed TCS. Registered medical practitioners were the most common source of TCS creams prescription (59.92%) in the prescribed group, while 26.07% patients were prescribed TCS by dermatologists. Clobetasol propionate (47.91%), was most common steroid agent used. Conclusion: Patients are able to get “prescription-only” drugs as OTC products. Such OTC use of TCS puts patients at risk of steroid modified dermatophytosis and topical steroid damaged skin. Even dermatologists may be culprit in creating menace of steroid abuse.

Drug utilization study of patients with dermatophytosis attending dermatology outpatient department in tertiary care teaching hospital in Central India

“…Dermatophytosis is a superficial fungal infection with diverse distribution as per age or gender. Our study showed 1.23:1 (male: female ratio) which was in accordance to the study conducted by Koshley et al, which showed 1.3:1 ratio and was 1.4:1 in trial conducted by Chaudhary et al 14,15 In our study it was seen that tinea crusis as the most common type of dermatophytosis followed by tinea cruris and tinea corporis combined. This result was in accordance with the result seen in trial conducted by Mukherjee et al 16 In our study terbinafine was the most common oral antifungal prescribed and luliconazole was the most topical antifungal.…”

Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients

“…In many Indian studies, clobetasol propionate is the commonest steroid misused. 8 , 10 , 12 , 13 In our study in dermatophytoses, beclomethasone was the most common steroid whereas, in melasma, mometasone topped the list of steroids. This is justified by the fact that in the Nepalese market most of the FDC creams available over the counter contain beclomethasone as a triple-drug combination and another two-drug combination (beclomethasone and clotrimazole) is also used very commonly as a drug for dermatophytoses over the counter.…”

“… 8 , 9 , 12 In our study, males, and female were almost equal in number similar to a few past studies. 11 – 13 Studies which include TCS use in facial skin show that the prevalence of misuse in the female is significantly high which may be because women are more conscious about the looks and melasma is commoner in females than males. 5 – 7 , 17 – 19 , 21 , 22 …”

“…In countries like Nepal and India, the easy availability of TCS over the counter at the chemist shops across the country without any valid prescription is compounding the problem of abuse which has been shown in multiple studies. 5 , 8 , 10 , 12 , 13 , 17 , 21 TCS is available in the Nepalese market either alone or as a fixed drug combination (FDC) with antibiotic and antifungal. Steroid in combination with hydroquinone and tretinoin is also available as Kligman's or modified Kligman's formula (depending on the formulation of steroid used in the cream).…”

Topical glucocorticosteroids: from high clinical efficacy to the problem of uncontrolled use (case report)

“…В исследовании R.G. Chaudhary et al среди 2 730 первичных обращений пациентов с подозрением на дерматофитию 503 (18,4%) пациента имели в анамнезе применение ТКС-содержащего крема [13]. Согласно данным S. Shrestha et al, среди 614 амбулаторных дерматологических пациентов, применявших топические ГКС, дерматофития была диагностирована у 425 (69,2%), а различные нежелательные явления наблюдались у 554 (88,6%) пациентов [14].…”