India with population of 1.25 billon people are passing through a transitional phase of desemination of knowledge and service in the field of health care facilities. In this article I only try to draw your attention on a very important issue related to our specialty i.e. Topical Cortico-Steroid misuse.
Abuse of topical steroids has increased alarmingly and an increasing number of cases of Topical Steroid Damaged Face (TSDF) is being confronted by our member dermatologists all across our country.
An alarming concern is the use of these creams as fairness creams in beauty clinics and self medication by patients themselves.
A multicentric study at 12 centres conducted in a cross-section of the Indian populace it was found that 59.3% of patients using TC on the face without any doctor’s prescription. Of the remainder only 26.7% patients had used TC prescribed by a dermatologist.
The sale of topical steroid in India accounts for 82% of sale all topical drugs in India. The financial stakes can be easily gauged from the sales figures of TC in 2013 which stood at Rs 1400 crore (approximately $233 million)
A special Task Force titled IADVL Task force Against Topical Steroid Abuse (ITASTA) has recently been constituted. Most of our members have taken pledge to fight this menace by minimizing use of these cocktail steroid combinations.
We have approached the pharma industry
1) To increase awareness among General Practitioners about this scourge and to motivate and facilitate them in discontinuing their indiscriminate prescriptions.
2) To minimize and avoid if possible manufacture , sales and promotion of irrational steroid based cocktail combinations
3) To avoid and discourage organizing camps where samples of such preparations are dispensed free in guise of fairness creams.
4) To educate your retail vendors to avoid dispensing such potentially harmful preparations without valid prescriptions
5) To limit potent steroid promotion only to dermatologists
6) Avoid promoting these products to alternative medical practitioners
7) helping us in preparing health education posters, pamphlets and videos- such posters need to be put up in all medical shops and in clinics
8) Insert an advisory in bold letters on all tubes that it is meant for prescription by dermatologist only
9) Insert a special advisory in all drug brochures in the tubes on the side effects of this menace- we can help you in preparing such advisory
Topical corticosteroids are the backbone of the dermatology therapeutic armamentarium. Rampant & injudicious use has lead to a lot of side effects and topical steroid dependence. Most of these side effects are seen with long-term use, but some may be noticed within days.
Adverse effects of topicalsteorids on skin
1. Steorid atrophy 11. Pharmacological side effects
2. Telangiectasia 12. Steroid rebound phenomenon
3. Striae 13. Steroid addiction
4. Purpura 14. Tachyphylaxis
5. Stellate pseudoscars 15. Steroid acne
6. Ulceration 16. Perioral dermatitis
7. Easy bruisability 17. Steroid rosacea
8. Infections 18. Hirsutism
9. Tinea incognito 19. Hyperpigmentation
10. Granuloma gluteale infantum 20. Hypopigmentation
Systemic Side Effects of Topical Steroid
In addition to local side effects, prolonged use of topical steroids can cause systemic side effects which are less common than those due to systemic corticosteroids. These occur especially in infants and elderly patients. The documented adverse effects are :
- Suppression of the hypothalamic-pituitary-adrenal axis
- Iatrogenic Caushing’s syndrome
- Growth retadation in infants and children
- Ocular: Glaucoma and loss of vision
- Avascular necrosis of femoral head
- Severe disseminated cytomegalovirus infection resulting in death in infants.
I have no personal knowledge & experience about The Global Scenario of Topical Steroid Abuse in the community but in our country the situation definitely calls for urgent attention of the Government, Pharmaceutical Industry, Professional bodies of doctors and pharmacists.
We should also take up the matter with Advertising council of India so that the products containing topical steroids in different so called over the counter products must be stopped to safe guard the public interest.
Due to lack of space, I restrain from elaborating the difficulties that as dermatologists we face to treat the fall out conditions or complications out of this menace. All the stakeholders must join hands in this fight for justice for skin, the largest organ in the body before it is too late.
Academic Supports from:
Prof. R. N. Dutta, Ex-HOD, SSKM MC&H, Kolkata
Dr. Koushik Lahiri, Chairperson, ITATSA/IADVL
Dr. Avijit Mondal, Assistant Professor, Dermatology, Kalyani, Nadia
