The Effect of Misuse of Topical Corticosteroids on Skin
Iraqi Journal of Pharmacy,
Volume 14, Issue 1, Pages 63-75
AbstractObjectives: To assess the frequency of misuse of TC on skin , commonly used steroids and the most common dermatological problems resulting from it, as well as, to analyze the motives for such practices with the aim to raise awareness about this problem in Mosul city.
Methods: The study included 155 patients aged 0.8-49 years with dermatological disorders who attended Outpatient Department of Dermatology in Al-Salam Teaching Hospital in Mosul City . Inclusion criteria: those who had used TC without medical advice; continued use after short prescription regardless of the duration ;TC used incorrectly or used them for certain skin problems for which steroids are not indicated; Wrong indication (acne); undiagnosed dermatosis as well as a history of TC use continuously(for more than1 month) or intermittently (for more than 3 months) due to any purpose, and presented with ≥ 1 of the side-effects of these drugs as the chief complaint were criteria used to define unjustifiable/inappropriate use.
Patients with natural rosacea; those denying any history of using TC or who not consenting to answering the questionnaire; pregnant women; patients who were using prescribed TC regardless of the duration or side effects such as asthma, rheumatoid arthritis; patients with comorbidities that resembled/could cause changes similar to TC side-effects (polycystic ovaries / Cushing's syndrome/thyroid disorders)were excluded from the study. A questionnaire was designated and skin was examined to study patients.
Results: Of the 155 subjects misused TC most were females 98(63.23%) and 57(36.77%) were males; of low social class 45(29%). The majority 123(85.2%) thought that corticosteroid use was safe and 56(36.1%) did not feel guilty for using such medications.
Eighty fife(55 %)patients reported that physician and pharmacists advised them for the first time to use TC. Ninety eight (63.3%) patients obtained the drug from the pharmacies, 30(19.3%)from nurse staff and 27(17.4%) from cosmetic shop/Beautician. lightening of the skin (30.6%) was the main indication for use TC. Potent and very potent preparations were the main TC used by patients.Almost all had some features of TC side effects.
Conclusion: Inappropriate use of TC is a big problem in our country. Easy availability of very potent products without a prescription makes misuse very common which has a huge impact on dermatological practice. It is responsible for a significant proportion of visits to dermatology clinics. It is a multiphase problem that needs the cooperation of different sectors in the community to overcome it. Education of the general public through special media programs and the introduction of a continuing medical education programs for medical and paramedical personnel as well as controlling the easy intake from pharmacies are probably the most important steps that could be taken to reduce this problem.
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