Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients

Abstract

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 atertiary 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.

Pattern of Skin Diseases in Geriatric Population

“…The geographical area where the study was conducted experiences tropical weather, which favors dermato-phytic growth. Rampant use of over the counter topical corticosteroids is common in Nepal[ 6 ] which has further increased the problem of tinea. Dermato-phytic infections favor the summer months due to increased heat and humidity.…”

A clinicoepidemiological study on tinea incognita with assessment of its treatment strategies and drug prescribing practices in a tertiary care hospital

“…A brief literature search revealed that TCs are more commonly misused for dermatophyte infections. A study by Shrestha et al 10 analysed that the TCs are more commonly misused for dermatophytosis. Jhaj et al 11 concluded that most of the steroid preparations had been bought without a prescription for the treatment of dermatophytosis.…”

“…Srivastava 14 also concluded that the primary dermatosis for which TCs misused was dermatophytosis. Initially, these TCs suppress the normal cutaneous immune responses to dermatophytes resulting in ineffective elimination of dermatophytes culminating in chronic, widespread infection and allowing the fungus to grow easily 10 . As the inflammation is suppressed, the fungal infection becomes less visible, and the associated symptoms are reduced.…”

“…Initially, these TCs suppress the normal cutaneous immune responses to dermatophytes resulting in ineffective elimination of dermatophytes culminating in chronic, widespread infection and allowing the fungus to grow easily. 10 As the inflammation is suppressed, the fungal infection becomes less visible, and the associated symptoms are reduced. After stopping the treatment with steroids, fungal infection relapses with varying severity.…”

Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China

“…Several studies (15,29,30) have also focused on the inappropriate use of systemic glucocorticoids in primary care institutions. Other studies have described prescribing patterns of topical glucocorticoids (31)(32)(33)(34)(35), and factors associated with their inappropriate use (36-39). However, few studies have comprehensively examined the prescription patterns and factors associated with inappropriate use of systemic glucocorticoid in primary care institutions.…”