Topical corticosteroid abuse on the face: A prospective, multicenter study of dermatology outpatients
Date
2011-10-06
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Medknow Publications on behalf of The Indian Association of Dermatologists, Venereologists and Leprologists (IADVL)
Abstract
Description
Background: Abuse of topical corticosteroids (TC), especially over the
face, is prevalent worldwide, including in India. Data about the
magnitude of this problem in our country is lacking. Aims: The aims of
this study were to ascertain the demographics, magnitude and clinical
features of TC misuse on the face in the dermatology outpatient
department (OPD) attendees in order to raise awareness about this
problem and to analyze its causes. Methods: This was a prospective
multicenter questionnaire-based clinical study conducted at 12
dermatology centers nationwide. Patients with relevant facial
dermatoses reporting to the investigator were asked about their current
use of over-the-counter topical formulations and a structured
questionnaire applied in case the same was confirmed to be TC.
Results: A total of 2926 patients with facial dermatoses were screened,
of which 433 (14.8%) were using TC. TC was used as a fairness/general
purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne.
Steroid combinations were used by 258 (59.6%). Potent and super-potent
TC were significantly (P = 0.05) more frequently used by the
rural/suburban population. The younger age groups used more potent
formulations. A non-physician recommendation for TC use was obtainable
in 257 (59.3%) patients. Of these, 232 (90.3%) were for
potent/super-potent steroids. Among 176 physician prescriptions, 78
(44.3%) were from non-dermatologists. All non-physician prescriptions
and 146 (83%) physician prescriptions for TC were inappropriately
refilled. Adverse effects were seen in 392 (90.5%) TC users.
Acne/exacerbation of acne was the most common adverse effect.
Conclusions: TC misuse in patients with facial dermatoses is quite
common, and most of this use is unwarranted. Use as a fairness cream is
the most common indication in this cohort. Limitations: This was an
OPD-based study and, therefore, it may or may not accurately reflect
the community data.
Keywords
topical steroid damaged face, potent, adverse effects, Abuse
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