Corticosteroids over the counter
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Over-the-Counter Corticosteroids: Safety and Usage Concerns
Introduction to Over-the-Counter Corticosteroids
Corticosteroids are a class of steroid hormones that are used to treat a variety of conditions due to their anti-inflammatory and immunosuppressive properties. They are available in various forms, including topical creams, intranasal sprays, and oral medications. While some corticosteroids are available over-the-counter (OTC), others require a prescription due to potential side effects and the need for medical supervision.
Intranasal Corticosteroids: Prescription-Only Recommendation
Intranasal corticosteroids (INS) are commonly used to treat allergic rhinitis and other nasal inflammatory conditions. However, there are significant safety concerns regarding their OTC availability. The Joint Task Force for the American Academy of Allergy, Asthma, and Immunology, and the American College of Allergy, Asthma, and Immunology reviewed the literature and concluded that INS should remain prescription-only. This decision was based on potential adverse effects such as growth suppression, ocular effects, bone density reduction, hypothalamic-pituitary-adrenal axis suppression, and local adverse effects. The insidious nature of these side effects and the potential for overuse further support the need for medical supervision.
Topical Corticosteroids: Usage Patterns and Safety
Appropriate Use of OTC Hydrocortisone
Hydrocortisone cream, a low-potency topical corticosteroid, is available OTC and is commonly used for minor dermatological conditions. A survey of 2000 US adults revealed that most users adhere to label directions, applying the cream appropriately and for limited durations. This suggests that OTC hydrocortisone is generally used safely and effectively by consumers.
Risks of Overuse and Misuse
Despite the general safe use of OTC hydrocortisone, there are significant concerns about the misuse and overuse of more potent topical corticosteroids. In Australia, for example, there have been reports of "steroid withdrawal syndrome" due to the overuse of topical corticosteroids. Additionally, cases of iatrogenic Cushing syndrome have been documented due to the inappropriate use of potent topical corticosteroids, highlighting the risks associated with unsupervised use .
Misuse in Cosmetic Applications
In some regions, the misuse of topical corticosteroids as "fairness creams" has led to serious complications such as acne, steroid dependence, skin atrophy, rosacea, and perioral dermatitis. This misuse is often driven by social media, peer pressure, and unethical marketing practices, particularly in countries where these medications are readily available OTC.
Safety of Intranasal Corticosteroids: Updated Perspectives
Recent studies continue to support the safety of newer generation intranasal corticosteroids when used appropriately. These studies have not identified significant new safety concerns and suggest that these medications can be used safely with proper medical oversight. However, the long-term safety of these medications without professional supervision remains uncertain .
Conclusion
While some corticosteroids, such as OTC hydrocortisone, are generally used safely by consumers, the potential for misuse and serious side effects necessitates caution. Intranasal corticosteroids should remain prescription-only to ensure proper medical supervision and minimize risks. The misuse of potent topical corticosteroids, particularly in cosmetic applications, underscores the need for better education and regulation to prevent adverse health outcomes. Regular follow-up and patient education are crucial to ensure the safe use of these powerful medications.
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