Misuse Of Corticosteroids Research Articles

Cutaneous and Systemic Adverse Effect of Topical Corticosteroid Misuse on Iraqi Women

Topical corticosteroids (TCS) are the most widely prescribed and abused topical medications worldwide. TCs have melanogenic, anti-pruritic, atrophogenic, immunosuppressive effects on the epidermis and sex-hormone-like, in addition to anti-inflammatory activity. Several of these, if used without judgment, may have serious local and systemic negative repercussions. The current study was designed to evaluate the possible local and systemic effects of topical corticosteroid misuse among women in Basrah City and Amara city, Iraq. Totally 125 participants were categorized into three major groups: control individuals, patients who utilize TCs for 1–3 months, and patients with long-term TC use for more than 3 months. A questionnaire was filled out, and a full skin examination was performed by a special dermatologist. Blood was drawn for hematological, hormonal, and biochemical analysis. TCS abuse was linked to the development of skin conditions with various percentages and frequencies, such as erythema, photosensitivity, dryness, acne, atrophy, infections, pigmentation, hirsutism, and rosacea. TCs also have systemic adverse effects in addition to their cutaneous ones, especially with prolonged use. TCS prolongs bleeding time compared to control group. Long-term TCS suppresses ACTH and decreases cortisol concentrations significantly while having no effect on insulin or testosterone levels. Interestingly, TCS significantly reduced serum vitamin D and serum interleukin 6 compared to the normal control group. TCS misuse is a big disaster in Iraq, associated with huge skin impacts and systemic deterioration, including hormonal and hematological consequences that require medical intervention and educational and legal approaches for successful treatment.

Incitement to misuse of corticosteroids by Arab YouTubers in a local context.

The ubiquity of social media has ushered in an era where uncontrolled content sharing extends to all subjects, including sensitive topics such as medication consumption. To quantify the prevalence of YouTube videos providing information on glucocorticoids and to underscore the risks associated with inaccurate information, which might inadvertently promote inappropriate use of these medications. The YouTube videos were selected using predefined keywords from February 20 to March 4, 2023. The videos were categorized into two groups. Category 1 promotes the misuse of corticosteroids, while Category 2 raises awareness about the risks associated with these drugs. In total, 843 YouTube videos were included. Approximately 76% of the creators were women. Of these, category 1 videos (69.63%) predominated over Category 2 videos (30.37%). Regarding Category 1, dexamethasone was mentioned in 41.53% of cases, followed by hydrocortisone (17.30%). According to these YouTubers, these products/medications are mainly obtained from community pharmacies (58.09%), online shops (20.01%), and through illicit markets and the black market (13.46%). Weight gain was the most common objective, according to 32.62% of the YouTubers. This study highlights the prevalence of YouTube videos regarding the misuse of corticosteroids. The common focus on weight gain as an objective underscores the importance of educating content creators and viewers about responsible corticosteroid use. Targeted interventions are needed to promote safe and informed medication practices within this online environment.

Purpureocillium lilacinum-related endophthalmitis: case report

PurposeTo report a case of Purpureocillium lilacinum endophthalmitis.MethodsThe case of a fungal endophthalmitis caused by Purpureocillium lilacinum documented in an immunocompetent patient with no apparent trigger.ResultsA 64-year-old male with a two-month history of panuveitis in his left eye was referred to our hospital. Initially misdiagnosed as sympathetic ophthalmia due to a previous surgery on his right eye 4 months before the onset of the left ocular picture, the patient received corticosteroid treatment, leading to a rapid deterioration of the left eye condition. An urgent exploratory vitrectomy was performed to identify the underlying cause, revealing endophthalmitis. Microbiological investigation yielded Purpureocillium lilacinum as the causative agent. Despite intensive treatment, including intravitreal antibiotics and antifungals, along with another surgical intervention, clinical evolution remained unfavourable, ultimately leading to the evisceration of the affected eye.ConclusionsPurpureocillium lilacinum poses a rare yet sever threat as a causative agent of fungal endophthalmitis. Managing such cases is challenging due to the delayed identification, fungus’s resistance to common antifungals, and its association with prior corticosteroid misuse in most patients. This case underscores the crucial importance of heightened clinical suspicion, early diagnosis, and the exploration of alternative treatment strategies in addressing Purpureocillium lilacinum endophthalmitis. The challenges posed by this rare fungal pathogen emphasize the need for a multidisciplinary approach and continued research to improve outcomes in these complex cases.

Oral Corticosteroid Abuse and Self-Prescription in Italy: A Perspective from Community Pharmacists and Sales Reports before and during the COVID-19 Era.

(1) Background: Corticosteroids are commonly used for a variety of conditions, but their use might come with significant side effects. Self-medication practices increased during the COVID-19 pandemic, potentially favoring corticosteroid misuse. Studies on this topic are lacking, thus we aim to characterize the misuse of corticosteroids in Italy through pharmacists' perspectives and sales reports. (2) Methods: We sent to territorial pharmacists a survey that aimed to investigate corticosteroid misuse before and during the pandemic. In parallel, sales reports of the major oral corticosteroids were obtained from IQVIA. (3) Results: We found that 34.8% of clients demanded systemic corticosteroids without a valid prescription, with a rise to 43.9% during the pandemic (p < 0.001). Adults and patients suffering from upper airway diseases or obstructive airway diseases most frequently asked for corticosteroids without an appropriate prescription. The greatest increase after the beginning of the pandemic was seen for lung diseases. Although sales of the major oral corticosteroids decreased during the pandemic, sales of those used for COVID-19 increased. (4) Conclusions: Self-medication with corticosteroids is common and might lead to avoidable toxicities. This tendency increased during the pandemic probably because of incorrect beliefs about the inappropriate use of corticosteroids for treating COVID-19 itself. The development of shared strategies between doctors and pharmacists is essential in defining protocols guiding appropriate patient referral in order to minimize corticosteroid misuse.

A multicentric clinical and epidemiological study of chronic and recurrent dermatophytosis in India.

There has been an alarming increase in the prevalence of chronic, recurrent and steroid modified dermatophytosis of the glabrous skin in the recent years in India. There is paucity of literature on the magnitude of this major public health problem. To estimate the prevalence of dermatophytosis and clinico-epidemiological features of chronic and recurrent dermatophytosis (CRD) across India and to evaluate the associated risk factors. This is a multicentric descriptive cross-sectional study conducted in 13 centres situated across India in two phases during dry and rainy seasons. All consecutive patients presenting with dermatophytosis were screened during the study period of 14 consecutive working days. Patients with CRD of the glabrous skin as per the case definition were included after exclusion of isolated hair and nail infections. Demography, clinical findings and results of potassium hydroxide wet mount were recorded. A total of 41,421 patients were screened, out of which 7174 (17.31%) patients had glabrous dermatophytosis. CRD was observed in 1999 (27.86%) patients with 78.08% and 21.95% of chronic and recurrent dermatophytosis, respectively. Family history was present in 50.03% of patients. History of sharing of fomites was present in 50.37% of them. Synthetic tight clothes were worn by 43.47%, while 50.9% gave history of misuse of topical corticosteroid creams. Multiple site involvement was common (69.58%) with tinea cruris (79.99%) and tinea corporis (75.69%) being the most common clinical types. CRD is associated with sharing of fomites, topical corticosteroid misuse and involvement of multiple sites.

Misuse of Corticosteroids in a Patient With Bipolar Disorder and Secondary Adrenal Insufficiency

Misuse of Corticosteroids in a Patient With Bipolar Disorder and Secondary Adrenal Insufficiency

Perioral dermatitis: Diagnosis, proposed etiologies, and management

Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. While topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis," and "periorificial dermatitis," we searched the databases PubMed, MEDLINE, and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance. This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis. In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel, and oral isotretinoin.

Topical steroid addiction among paramedical staff: a cross sectional study in a tertiary health care centre

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Topical corticosteroid misuse is one of the major causes of concern for dermatologist now-a-days. It is not only prevalent in general population but also among individuals associated with medical profession like paramedical staffs. The aim of the present study was to understand the various causes and demographic profile of paramedical staffs using steroids alone or in combination as fairness creams.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; All paramedical staffs using topical steroids as fairness creams were screened for the exclusion criteria and included in our study.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Females staffs (82.24%) predominated our study group. Betamethasone valerate (46.16%) was found to be the most common topical corticosteroid being misused and the source of recommendation was mostly from pharmacy (37.06%) without any prescriptions.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; With increasing misuse of topical corticosteroids it is the need of the hour to evaluate the intensity of the problem, contributing factors and the associated morbidity leading to impaired quality of life, not only in the general population but also among the health care provider.&lt;/p&gt;

White ambition leading to topical corticosteroid misuse - A beauty myth in skin of color

White ambition leading to topical corticosteroid misuse - A beauty myth in skin of color

Topical corticosteroid misuse: observational study to evaluate pattern of abuse and adverse drug reactions

Background: Topical corticosteroids (TC) have a reputation as anti-acne, anti-blemish effects and popularly used as fairness creams. In India, there has been a rise in misuse of TC in last10 years. The present study was conducted to analyse the magnitude of adverse effects of topical corticosteroids abuse in dermatology outpatient department of a tertiary care hospital.Methods: A retrospective observational study was conducted on patients after categorizing them as a TC misuser by dermatologists. The socio-demographic data, chief complaints, details of drugs misuse and adverse drug reaction outcome was collected.Results: A total of 1240 patients was screened, out of which 80 patients misused TC without dermatologist prescription for their skin disease. TC was mainly misused by teenagers (43.8%). Misuse of topical corticosteroids was more common among females (76.3%). Betamethasone valerate (72.5%) was most common TC misused. Most common source of advice of TC misuse was friends (37.5%). Most common purpose of TC misuse was acne (55%) followed by cosmetic purposes (21.3%). The most common morphological varieties of adverse drug reactions were burning and itching sensation (53%) followed by increase severity of acne (44%).Conclusions: TC misuse was more common in teenage females. Most common adverse effect reported is burning and itch sensation followed by increase severity of acne. The study data indicates a significance of problem and requirement of urgent measures to control TC misuse.

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.

Topical Corticosteroid Misuse Among Females Attending a Dermatology Outpatient Department in Ethiopia

Introduction: Irrational use of topical corticosteroid (TC) is quite common in Ethiopia due to the unrestricted availability and use of topical steroids (TS) not only by general public but also by physicians and chemists. This practice is highly prevalent and sought after, owing to the quick relief of symptoms in different dermatological conditions and its nature of enhancing beauty for a certain period. Objective: This study aims to evaluate and analyze the prevalence of misuse of topical steroids, causes behind the misuse and consequences after the use of topical steroids among females in a dermatology outpatient department (OPD) at Ayder Referral Hospital, Ethiopia. Materials and Methods: A cross-sectional observational questionnaire based study was conducted from April to August 2015. Patients were questioned and assessed for misuse of topical steroids in terms of indication, dose, frequency, duration, effects after use and source of recommendation of topical steroids among female clients. Results: During the study period, 104 (27.1%) patients presented with inappropriate use of topical steroids among patients (n=384) who were attended the OPD of dermatology unit at Ayder Referral Hospital, the only hospital providing treatment, care and preventive measures for dermatological cases, with a response rate of 97%. A total of 72 patients were presented with adverse effects of topical steroids resulting from the misuse of these drugs for various purposes. Misuse of topical steroids was found to be most prevalent in the age group of 21-30 years (51.15%) followed by age group between 11-20 years (21.15%), who were severely affected due to its inappropriate use. Whereas, melasma (40.38%) and rosacea (35.6%) were the most common reasons of steroid abuse, followed by facial acne (26%), use as sunscreen 44 (42.3%), non-specific dermatosis 35 (33.7%) and skin lightening (10.58%). Patients using topical corticosteroids as over-the-counter (OTC) after recommendation made by friends and family (44.8%) was found to be a factor of influence on the misuse of topical steroids followed by pharmacist and drug store vendors as over the counter patterns of use (31.7%). The least were recommended by clinicians (10.57%) for the treatment of acne, melasma/hyper-pigmentation and to improve the appearance during weddings and other ceremonies. Dermovate and dermalar (70.18%) were the most commonly used topical steroid preparations, causing the patients to often develop fungal infections such as tinea incognito (26.4%), followed by facial acne (25.6%), telangiectasia and rosacea (41%) being the most common side effects experienced. Conclusion: Misuse of topical steroids was found to be very common owing to prescriptions by dermatologists, the major reason being recommendations by healthcare professionals, pharmacists, family and friends. Abuse of these steroids causes fungal, bacterial infections and rosacea which leads to many other secondary complications.

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

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

Musculoskeletal Consequences of Systemic Corticosteroid Misuse in a Patient with Psoriasis

This is a case history of a patient with psoriasis with indiscriminate systemic corticosteroid use for a prolonged period. A single patient can be victim of multiple deleterious effects of corticosteroids. The aim of this case discussion is not only to describe the myriads of sequels of corticosteroid misuse effecting musculoskeletal system severely but simultaneously to rethink about prescription of steroid in psoriasis, too.Chatt Maa Shi Hosp Med Coll J; Vol.14 (2); Jul 2015; Page 80-82

Red scrotum syndrome: idiopathic neurovascular phenomenon or steroid addiction?

Red scrotum syndrome (RSS) is not infrequent but is often misdiagnosed or underdiagnosed, and seldom reported. The exact etiopathogeneis is still unknown but it almost always follows the prolonged application of topical corticosteroids and is characterised by persistent erythema of the scrotum, associated with severe itching, hyperalgesia and a burning sensation. To evaluate the clinicoepidemiological profile and assess the efficacy of various treatment modalities in addition to corticosteroid abstinence in the treatment of RSS. Twelve patients with RSS, who presented to us during 2010 and 2011, were identified, and various aspects of their illness and treatment were studied. Patch testing was performed in all patients. A skin biopsy was done in seven patients. The average age of the patients was 45.83 years (26-62 years). The average duration of illness or the duration of topical steroid use was 27.41 months (6-56 months). Psychiatric comorbidities were seen in 9 (75%) out of 12 patients. Histopathology revealed features resembling erythematotelengiectatic rosacea in four of the biopsied patients. Patch test results were negative. All patients reported improvement of their symptoms within 4 weeks of starting doxycycline with amitriptyline or pregabalin; the treatment had to be continued for 3-4 months. RSS appears to be a manifestation of corticosteroid misuse rather than a primary disease. We suggest that RSS is a rosacea-like dermatosis or steroid-induced rebound vasodilation based on clinical and histopathological features. Our patients responded to cessation of steroids and doxycycline in combination with amitryptaline or pregabalin.

Recent developments in the use of isotope ratio mass spectrometry in sports drug testing

According to the annual report of the World Anti-Doping Agency, steroids are the most frequently detected class of doping agents. Detecting the misuse of endogenously occurring steroids, i.e. steroids such as testosterone that are produced naturally by humans, is one of the most challenging issues in doping control analysis. The established thresholds for urinary concentrations or concentration ratios such as the testosterone/epitestosterone quotient are sometimes inconclusive owing to the large biological variation in these parameters.For more than 15 years, doping control laboratories focused on the carbon isotope ratios of endogenous steroids to distinguish between naturally elevated steroid profile parameters and illicit administration of steroids. A variety of different methods has been developed throughout the last decade and the number of different steroids under investigation by isotope ratio mass spectrometry has recently grown considerably. Besides norandrosterone, boldenone was found to occur endogenously in rare cases and the misuse of corticosteroids or epitestosterone can now be detected with the aid of carbon isotope ratios as well. In addition, steroids excreted as sulfoconjugates were investigated, and the first results regarding hydrogen isotope ratios recently became available.All of these will be presented in detail within this review together with some considerations on validation issues and on identification of parameters influencing steroidal isotope ratios in urine.

Hypopituitarism in the tropics

Hypopituitarism in the tropics

Study of Dexamethasone Urinary Excretion Profile in Cattle by LC−MS/MS: Comparison between Therapeutic and Growth-Promoting Administration

Dexamethasone is a potent synthetic corticosteroid widely employed as a therapeutic agent in cattle. Besides this legal use, corticosteroids are also administered at low dosages as growth-promoters either alone or in combination with other steroids or with beta-agonists. For this reason, appropriate control plans are established to survey corticosteroid misuse, using liver or urine as biological matrices. Since few data are available about the kinetics of dexamethasone excretion in meat cattle, an experimental study was designed to assess the drug residue levels in urines following either a therapeutic (60 microg of dexamethasone sodium phosphate/kg b.w., for three consecutive days) or a growth-promoting schedule (0.7 or 1.4 mg of dexamethasone sodium phosphate per capita/day for 60 days). The urinary elimination of dexamethasone, which was predominantly excreted in the unmodified form, was determined by high-performance liquid chromatography/tandem mass spectrometry at different time intervals, i.e. during the treatments and after appropriate withdrawal times. Our findings confirm the high and rapid rate of dexamethasone urinary excretion irrespective of the nature of the treatment, and provide useful reference values that can be conveniently employed for forensic purposes.

Le syndrome de Cushing factice : deux observations

Search of corticosteroid use is an important precaution before any exploration of hypercorticism. Nevertheless, this use may be factitious leading to serious misdiagnosis and pitfalls. We report two cases of 29 and 60 years old male patients, referred for hypercorticism with patent features including metabolic and trophical signs. Laboratories findings revealed unelevated urinary cortisol values (40 and 27 microg/ day) in both cases with normal ACTH and normal plasmatic cortisol response to synacthène (32,5 and 35 microg/dl). Corticosteroid use, initially denied, was finally approved by the patients (hydrocortisone and dexamethasone for the first patient and betametasone for the second). So, they were assigned to psychiatric therapy. Our cases emphasize that corticosteroid misuse must be evoked in patients with unexpected hormonal assessment of pituitary adrenal axis despite patent clinical features of hypercorticism. Several specific tests are actually available for detect factitious Cushing syndrome. However, differential diagnostic remains difficult mainly with pseudo Cushing and cyclical Cushing syndromes.

Application of Hyphenated Mass Spectrometric Techniques to the Determination of Corticosteroid Residues in Biological Matrices

Fifty years after the discovery of natural corticosteroid hormones and their anti-inflammatory properties many synthetic derivatives of these molecules are now available. Most are widely used in human and veterinary medicine, legally but under regulated conditions. These compounds can also be used as growth promoters in animal breeding, although such use is illegal in Europe. Consequently, analytical methods have been developed to monitor use of corticosteroids in cattle. This paper, based on the authors experience and the main relevant literature, describes the different mass spectrometric approaches used for measurement of corticosteroid residues (parent drug, metabolites, and esters) in biological matrices (urine, meat, hair), including gas chromatography–mass spectrometry (GC–MS) and liquid chromatography–tandem mass spectrometry (LC–MS2). The respective advantages of liquid chromatography and gas chromatography, in conjunction with different derivatisation reactions, are discussed. The behavior of corticosteroids with different ionization techniques is also discussed. Application to monitoring corticosteroid misuse and to investigation of pharmacokinetics and metabolism in bovine species is described and new data are presented relating to elimination and hair fixation kinetics for free and ester forms and the nature and proportions of corticosteroid phase I and phase II metabolites. Finally, this work reviews ten years experience of the use of a variety of mass spectrometric techniques for analysis of corticosteroids in animals produced as food.