Topical corticosteroids over the counter
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Over-the-Counter Topical Corticosteroids: Prevalence and Patterns of Use
The misuse of topical corticosteroids (TCs) as over-the-counter (OTC) products is a widespread issue in many countries, especially in South Asia. Studies consistently show that a significant proportion of patients with skin conditions use TCs without medical supervision, often for inappropriate indications such as fairness, acne, or fungal infections Saraswat2011Kunduru2023B2020+5 MORE.
Common Reasons for OTC Topical Corticosteroid Use
The most frequent reasons for OTC TC use include attempts to lighten skin complexion, treat acne, or manage superficial fungal infections. Many users are influenced by non-medical recommendations from friends, family, or pharmacists, rather than dermatologists Saraswat2011Kunduru2023Swaroop2019+1 MORE. In several studies, more than half of the patients obtained TCs without a prescription, and a large number used them for cosmetic purposes like fairness creams Saraswat2011Kunduru2023Swaroop2019+2 MORE.
Demographics and Duration of Use
OTC TC misuse is most common among young adults, particularly females, and is often seen in rural or suburban populations Saraswat2011Kunduru2023B2020+2 MORE. The duration of use varies, but many patients report using these products for several months, sometimes even longer than a year Kunduru2023Swaroop2019.
Adverse Effects of Unsupervised Topical Corticosteroid Use
The unsupervised use of TCs leads to a high rate of adverse effects. The most common problems include acneiform eruptions, pruritus (itching), skin irritation, pigmentation changes, and the worsening of existing skin infections, especially fungal infections (tinea incognita) Saraswat2011Kunduru2023B2020+5 MORE. In rare cases, severe systemic side effects like iatrogenic Cushing syndrome and topical corticosteroid withdrawal syndrome have been reported after prolonged use Nguyen2021Bhusal2019.
Role of Irrational Combinations and Potent Steroids
Many OTC products contain irrational combinations of potent corticosteroids with antibiotics or antifungals, which further increases the risk of side effects and complicates the treatment of skin infections B2020Poorana2020Swaroop2019+1 MORE. Potent and super-potent steroids are often used, especially among younger users and in rural areas Saraswat2011B2020Poorana2020+1 MORE.
Need for Regulation and Public Awareness
The easy availability of TCs as OTC products, combined with a lack of public awareness about their risks, contributes to widespread misuse and difficult-to-treat skin conditions Saraswat2011Kunduru2023Swaroop2019+3 MORE. Experts recommend stricter regulation of TC sales, better education for both patients and pharmacists, and targeted awareness campaigns to reduce inappropriate use and prevent harm Saraswat2011Kunduru2023Chudal2021+2 MORE.
Conclusion
OTC topical corticosteroid misuse is a significant public health concern, leading to frequent and sometimes severe skin and systemic side effects. Most misuse is driven by non-medical advice and the pursuit of cosmetic benefits. Addressing this issue requires stronger regulation, increased awareness, and education for both the public and healthcare providers.
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Most relevant research papers on this topic
Topical corticosteroid abuse on the face: a prospective, multicenter study of dermatology outpatients.
Topical corticosteroid misuse in patients with facial dermatoses is common, with most unwarranted use, and fairness cream use is the most common indication.
Clinicoepidemiological profile of steroid modified dermatophytosis following abuse of irrational combination of topical corticosteroid containing preparations (ICSP)
Irrational usage of topical corticosteroid containing preparations (ICSP) in dermatophytosis treatment leads to resistance and difficulty in treating the infection, with betnovate GM being the most commonly abused brand.
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