Misuse Of Topical Corticosteroids Research Articles

Topical Corticosteroid-Induced Iatrogenic Cushing Syndrome in an Adolescent: A Case Report

Cushing syndrome (CS) is an endocrinological disorder characterized by increased blood cortisol level. It is either due to an excessive endogenous release of steroids (e.g., pituitary adenoma or adrenal hyperplasia) or exogenous administration of steroids. Iatrogenic Cushing syndrome is the most common form of Cushing syndrome. The vast majority of cases are due to oral or parenteral steroid preparations, which are commonly prescribed for pulmonary, renal, hematological or autoimmune diseases. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamo-pituitory-adrenal (HPA) axis, which is less common than that of oral or parenteral route. Iatrogenic CS due to the overuse of topical corticosteroids is rarely reported. There are only few cases that reported young children having Cushing syndrome secondary to misuse of topical corticosteroids.

Management of atopic dermatitis by pediatricians: A French national survey-based study

PurposeAtopic dermatitis (AD) is a chronic skin disease affecting 10% of children in Europe. The treatment of AD is well codified; however, a gap sometimes exists between recommendations and medical practice. The objective of this study was to assess the practice of French pediatricians regarding the management of AD. MethodsWe conducted a national practice survey from September 2021 to October 2021, using an online questionnaire emailed to pediatric physicians. ResultsA total of 83 pediatricians from 33 different departments responded to the survey. The clinical features of AD were known by the majority of pediatricians, but 15 (18%) found the diagnosis difficult to establish. All pediatricians prescribed daily applications of emollients and 78 (94%) prescribed topical corticosteroids (TCS) during AD flares, but misuses remained: only 29 (35%) pediatricians prescribed TCS when eczema (even if minimal) appeared and 43 (52%) did so at the onset of pruritus, while 45 (54%) prescribed them for extensive or disabling eczema, and 53 (64%) when eczema persisted after an initial treatment with emollients. Regarding diet, 12 (14%) pediatricians recommended a diet low on or free of cow milk, 10 (12%) systematically referred children with AD to an allergist, and 20 (24%) delayed food diversification. ConclusionDespite improvements in AD management by French pediatricians in the past 15 years, barriers to its appropriate management still persist, including the misuse of TCS and inappropriate diets.

IRRATIONAL USE OF TOPICAL STEROIDS FOR FACIAL DERMATOSES- A PROSPECTIVE STUDY.

Background: Topical corticosteroids (TCs) are potent anti-inammatory medications that provide rapid symptomatic relief. Over-the-counter (OTC) availability of TCs and their unsupervised usage are responsible for various cutaneous adverse effects like rosacea, acneiform eruptions, demodicosis, etc. These are more pronounced over the face as the skin is relatively thin and sensitive. They are more difcult to treat and cause much more distress to patients than the primary conditions for which TCs were used. To ascertain the demographics, frequency, duration, Aim: underlying conditions, and the cutaneous adverse effects of misuse of TCs over face in a tertiary care center in Krishna district. Materials & Methods: This was a prospective, observational, cross-sectional study done in a tertiary care center over a span of three months. Data was obtained from a self-constructed questionnaire, entered using MS Excel, and analyzed. A tot Results: al of 72 patients with cutaneous adverse effects following TCs abuse over the face were included in a span of three months. Most of them were females (80.56%) and the common age group was 19-28 years (47.22%). The commonest source of recommendation for TCs was- OTC without prescription (70.83%) and the average duration of usage was 1-6 months. The common underlying condition for which TCs were misused was complexion improvement (38.89%), followed by infection, and acne. The commonest adverse effects were pruritus (90.28%) and acneiform eruption (63.89%). The other adverse effects include irritation, spread of infection, topical steroid-dependent face (TSDF), altered morphology of existing lesions, etc. TCs misuse over Conclusion: face is being increasingly recognized as the cause for difcult-to-treat facial dermatoses. It can be addressed by increasing awareness about their adverse effects and by giving specic treatment based on the underlying condition

Side effects associated with misuse of topical corticosteroids (tcs) sold over the counter in litein town, Kericho county

The aim of the study was to determine the side effects associated with the misuse of topical corticosteroids in Litein Town, Kericho County. A convenient random sample of 57 respondents was selected for the study. Self-developed structured questionnaire was used in data collection. In this study, figures were used to present data. The latest version of the SPSS data analysis tool was used to derive frequencies and percentages from the demographic information provided the use of corticosteroids and side effects associated with the use of corticosteroids. Common side effects related to the misuse of TCS include reduced immunity, change in skin pigmentation, thinning of skin, itching and abnormal drying. TCS are readily bought from community pharmacies for treatment and cosmetic purposes. Various brands are available in the market, with clozole cream as the most commonly known. The majority buy TCS for treatment purposes, while others for cosmetic purposes. Common side effects include drying, itching, change in pigmentation and dryness. This study recommends that necessary measures are to be put in place to improve the outcome of patients undergoing treatment for dermatological conditions using TCS through occasional monitoring of the patient. In addition, formulating scientists should work on formulating TCS with good anti-inflammatory effects and minimal adverse effects. This will ensure good compliance among patients.

Topical Steroid Damaged Face: A Cross-Sectional Study from Saudi Arabia.

Corticosteroids are one of the anti-inflammatory drugs that are used widely by dermatologists. Significant local adverse effects can happen if topical corticosteroids (TCs) are used incorrectly. This study aimed to assess the prevalence of facial TCs misuse and its adverse effects. This was cross-sectional research: a self-reported questionnaire was distributed among a population of Saudi Arabians aged 16 years and above who were using TCs consecutively. Statistical analysis was performed using SPSS version 26. A total of 611 participants were enrolled in the survey: 401 (65.6%) were university graduates, while 187 (30.6%) were below high school level of education. The number of participants using TCs was 279 (45.7%), while 332 (54.3%) did not use steroids topically. The most used TCs were Mometasone furoate 0.1% cream (18.2%), followed by Fusidic acid/Betamethasone cream (16.7%). A total of 46 reported facial TCs’ side effects. Peeling (52.2%) was the most reported side effect, followed by redness (41.3%). In conclusion, the use of facial TCs among the Saudi population is not uncommon (16.5%). A large population are not aware of the side effects of the unsupervised use of TCs. An effort should be made to increase awareness of the adverse effects of TCs.

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.

Pharmacists’ Insights and Behaviors in Preventing the Misuse of Topical Corticosteroids in Pakistan: A Mixed-Method Study

Topical corticosteroids (TCs) misuse has become a common issue for healthcare professionals and patients, particularly in Pakistan, as no stringent laws or rules are prohibiting the selling of over-the-counter medicines. The present study was designed to examine pharmacists’ insights and behaviors regarding TCs and their potential role in preventing the misuse of TCs in Pakistan. The study was a cross-sectional mixed-methods research design (phase 1, quantitative; and phase 2, qualitative) conducted from January to June 2021. The pharmacists working in various settings in Karachi were approached through different social media platforms. Data were collected through a web link of an online questionnaire with 30 closed-ended questions. Different statistical methods were employed for tabulating the quantitative data, while inductive thematic analysis was directed to classify themes from the qualitative data and to conclude findings. The mean cumulative knowledge score was 10.59 ± 1.63. The community pharmacists knew more about the available over-the-counter TCs (p = 0.041). The experienced pharmacists were more conversant than fresh pharmacists, regarding the mode of action (p = 0.008), choice of TC potency (p = 0.001), and most common local and systemic adverse effects of TCs (p = 0.001). Overall, respondents had a favorable attitude, with more than 80% agreeing that pharmacists could ensure that important safety issues are communicated with patients, and assist considerably in avoiding TC misuse. Analysis of data has produced 7 themes, 10 sub-themes, and 30 categories. Major themes included: use and misuse of TCs, adverse drug events due to TCs, cosmeto-vigilance, patient education, referral to a physician, and future perspectives for preventing TC misuse. The respondents were well versed with the dilemma of TCs misuse, and they considered patient characteristics, free availability of TCs, and lack of physician-pharmacist coordination as the major reasons. The major barriers for patient education stated by nearly all the respondents were a lack of time and lack of material/information for counseling. They emphasized the need for stringent legal strategies and the enforcement of current drug-control regulations, so that TCs are not supplied without appropriate prescriptions. The present findings indicate that pharmacists had appropriate knowledge and a positive attitude towards their potential role in preventing the misuse of TCs. Further education and sensitization in areas of deprived knowledge will undoubtedly aid in the prevention of TCs misuse by the community.

Steroid-induced Rosacea- A Study From a Tertiary Care Hospital of Eastern Nepal

Introduction: Topical corticosteroids (TC) are useful for treatment of various dermatological conditions in all age groups. Due to its cosmetic application TCs misuse is intertwined with fairness creams in our colour conscious society where people are obsessed with fair colour.
 
 Aims and Objectives: To find the clinical presentations of steroid induced rosacea like-dermatitis on the face and to evaluate the purpose behind misusing TCs on the face.
 
 Materials and methods: Descriptive prospective questionnaire-type case series study was approved by Institutional Ethical Committee of BPKIHS which involved 205 patients diagnosed as Steroid Induced Rosacea who consulted Dermatology OPD between March to June 2017.
 
 Results: Among 205 patients enrolled, majority were from second to fourth decade (87.31%) of their life and maximum being females I.e. 91.2%. Around 97% of the study population were unaware of side effects of TCs. Most patients use Mometasone fuorate (58.04%) for melisma (88.29%). Friends acted as source of prescription (29.75%), followed by Pharmacist (24.88%) & Beauty centers (20%). Dermatologists prescribed TCs in only 6.34% cases. Sun exposure was identified as the triggering factor for steroid induced rosacea in 73.17% patients. Cheek was the commonest site involve in 92.19%, followed by forehead (65.36%), perioral area (46.83%), and chin (9.75%). Mixed type of lesions was the commonest lesion found in 52.20% patients, followed by diffuse facial erythema (36.09%), & telangiectasia (33.17%).
 
 Conclusion: TCs misuse in the younger people for the sake of fairer skin with little or no knowledge about the adverse effects of this medication should be stopped.

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.

Misuse of Topical Corticosteroids in Dermatological Disorders in Tribhuvan University Teaching Hospital.

Topical corticosteroids are one of the most commonly used drugs in dermatology. Their improper use lead to serious adverse effects. However, it's commonly misused by patients and chemists in Nepal. The main objective of the study was to determine the pattern of misuse of topical corticosteroids, its adverse effects, and factors associated with its misuse. This was a hospital-based, descriptive study conducted in a tertiary center of Nepal for three months. Patients meeting the inclusion criteria were enrolled in this study. Purposive sampling technique was used. Ethical approval was taken prior to study. Informed consent was taken from patients and interviewed using semi-structured questionnaire. The data was analyzed using Microsoft Excel and SPSS software. Two hundred sixteen patients comprised the study population where males (54.5%) outnumbered females. The mean age was 28.72 years with 21-30 years as the most frequent range. Beclomethasone dipropionate (27.3 %) and clobetasol propionate (26.9%) were the most commonly misused drugs. The most common purposes for the application of these drugs were fungal infections (66%), pigmentary disorders (15%), such as fairness cream, acne, etc. Over-the-counter sale of topical corticosteroids (62%) was significantly higher than other forms of prescription. Aggravation of fungal infections (61.6%), acneiform erruptions, striae, and steroid induced dermatoses were common adverse effects. Topical corticosteroids are common misused drug with high over the counter sales. It is advised that drug authority should take necessary actions for its unethical use. Besides, awareness programs should be conducted for its rational use in public.

Prevalence of topical corticosteroid use without prescription in Saudi Arabia: A cross-sectional study

Background: Misuse of topical corticosteroids (TCS) is common and constitutes a serious problem in many parts of the world where they can be obtained without prescription. Limited studies have been performed in Saudi Arabia to address this issue. Purpose: We aim to study the prevalence, predisposing factors, and adverse consequences of TCS use without prescription in Saudi Arabia. Methods: A cross-sectional study was performed using an Arabic questionnaire distributed through social media applications in May 2020 in Saudi Arabia. Individuals aged 18 years and above who used TCS within the last 2 years were included. The questionnaire consisted of detailed questions about TCS use and demographic information. Results: A total of 720 participants completed the questionnaire. TCS were used without prescription by 43.1% of respondents. Being female was the only identified risk factor for the use of TCS without prescription. The main reason for purchasing TCS without prescription was that the problem seemed too trivial to consult a physician (36.6%). The most common conditions for which TCS were used were treatment of pruritus without skin disease (23.7%) and cosmetic reasons (19.9%). Side effects were reported in 25.6% of participants. The most common side effects were hypopigmentation, itching, redness, and skin sensitivity. Conclusion: The use of TCS without prescription is prevalent in Saudi Arabia. We recommend that local health authorities regulate the use of TCS.

Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients.

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. 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. 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. 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.

Psoriasis-like tinea incognita: a case report and literature review

Tinea incognita is an atypical presentation of fungal infection of the skin, the clinical presentation of which has been modified by misuse of topical corticosteroids or calcineurin inhibitors. Such dermatophyte infections often have an atypical clinical presentation and are difficult to diagnose, but with the rise of immunosuppressive drugs and self-prescribed topical therapies, they are becoming increasingly prevalent. Here we report the case of a 68-year-old male patient with a history of psoriasis, presenting with erythematous scaly lesions, that did not respond to conventional treatment for psoriasis, as would be expected. A diagnosis of tinea incognita was made with histopathological examination with periodic acid-Schiff stain of a skin biopsy sample. This case highlights the fact that dermatophyte infections are widespread but sometimes neglected and can occur concomitantly with other dermatoses.

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> All paramedical staffs using topical steroids as fairness creams were screened for the exclusion criteria and included in our study.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Topical corticosteroids induced hyper-pigmentation: a case report

<p>Hyper-pigmentation is a common skin condition in which increased melanin production results in darker patches of skin. Although hyper-pigmentation is harmless but still mostly people wish to get rid of them because of increasing craze of beautification in India. Topical corticosteroids (TC) application showed quick amelioration of post-inflammatory hyper-pigmentation patches. Prolonged and unsupervised use of TC leads to skin atrophy and reappearance of hyper-pigmentation patches. We present two cases of hyper-pigmentation induced by TC misuse. In case-1, a 20 year old female came to OPD with a complaint of hyper-pigmentation and itch sensation along with drug history of Betnovate cream for the last 2 years for acne treatment. On examination, she showed signs of hyper-pigmentation on cheeks. She was counselled to stop the further use of Betnovate cream and prescribed demelanizing agents along with sunscreen and emollients. The patches improved significantly with above management within 15 days. In case-2, a 33 year old female came to OPD with complaints of redness over whole face, increased facial hair growth and burning sensation along with drug history of using Betnovate cream for 2 years. On examination she showed signs of hyper-pigmentation and redness on cheeks, bruise and tearing of skin and increased facial hair growth. She was counselled to stop the further use of Betnovate cream. She was prescribed retinoic acid cream, sunscreen agents, anti-allergic tablets and emollient cream. The patches improved significantly with above management within 15 days.</p><p class="abstract"> </p>

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.

The Effect of Misuse of Topical Corticosteroids on Skin

The Effect of Misuse of Topical Corticosteroids on Skin

Misuse of topical corticosteroids in women in Hail region Saudi Arabia

Background: A lot of women seek to get beautified. Consequently, some of the women often resort to using the products contained corticosteroids (CS) and other kinds of cosmetics, and this significantly increased with year 2018, due to the influence of social media. Despite the benefits, that excessive use of corticosteroids leads to serious side effects.Methods: 769 electronic questionnaires were completed by women for using corticosteroids in Hail, Saudi Arabia. Statistical comparison was done using SPSS (ANOVA test) was used to compare the answers given by the participants and P values less than 0.05 were considered significant.Results: 769 women responded. More than 30.3% of the patients were in the age group 31 to 40 years. The main reason for using the topical corticosteroids was to lighten skin color and reduce wrinkles.Conclusions: Misuse of topical corticosteroids is widely spread among women in Hail city, and this due to various reasons, the most important of which is to get bleaching and get rid of skin blemishes.

Topical Corticosteroids Misuse: A Burning Issue

Since the introduction of hydrocortisone into dermatology, a tremendous development has occurred in the field of topical corticosteroids. With the growing use of topical corticosteroids, a serious concern for its misuse is to be highlighted. This matter is of a great concern. Proper guidelines and legislation on the use of topical corticosteroids are warranted to combat this serious issue.