{"id":39090,"date":"2021-06-30T10:36:34","date_gmt":"2021-06-30T10:36:34","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=39090"},"modified":"2021-07-13T08:24:48","modified_gmt":"2021-07-13T08:24:48","slug":"evaluation-of-adverse-drug-reactions-caused-by-topical-steroids-in-patients-presenting-in-dermatology-department-of-teaching-institute-of-tertiary-health-care-centre-of-central-india","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol14no2\/evaluation-of-adverse-drug-reactions-caused-by-topical-steroids-in-patients-presenting-in-dermatology-department-of-teaching-institute-of-tertiary-health-care-centre-of-central-india\/","title":{"rendered":"Evaluation of Adverse Drug Reactions caused by Topical Steroids in Patients Presenting in Dermatology Department of Teaching Institute of Tertiary Health Care Centre of Central India."},"content":{"rendered":"

Introduction <\/strong><\/p>\n

Steroids have been in use as topical agents since long time.[1]<\/sup> The\u00a0 topical steroids are being increasingly used since their\u00a0 inception.[2]<\/sup>Topical corticosteroids are among the most commonly prescribed medications in dermatology practice at present[3]<\/sup>.Steroid abuse is a common due to easy availability of\u00a0 steroid creams as over-the-counter drugs.[3]<\/sup>Steroids exert – anti-inflammatory, antipruritic, melanopenic, atrophogenic, and immunosuppressive effects on the skin. All these effects can produce adverse effects from their prolonged or unwarranted use.[4]<\/sup> This study was conducted to assess the extent of steroid abuse and the clinical profile of these patients.<\/p>\n

Material and Methods <\/strong><\/p>\n

This is a prospective observational study conducted in dermatology department of M.Y.H . hospital ,Indore.200 patients of Adverse drug reactions (ADRs) were screened according to CDSCO,ICSR form. Diagnosis of ADR made by consultant .Out of 200 patients 181 patients were further evaluated who gave history of steroid application topically. Data analysed and result is interpreted in percentage.<\/p>\n

Result and Observations<\/strong><\/p>\n

Inference<\/strong><\/p>\n

Majority of cases are from young population. Children & elderly are affected least.(Table I)<\/p>\n

Table 1: Age wise distribution of adv<\/strong>erse reactions caused by topical steroids.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Age in years<\/strong><\/td>\nNumber of cases<\/strong><\/td>\nPercentage(%)<\/strong><\/td>\n<\/tr>\n
<10<\/strong><\/td>\n0<\/td>\n0<\/td>\n<\/tr>\n
11-20<\/strong><\/td>\n52<\/td>\n28.72<\/td>\n<\/tr>\n
21-30<\/strong><\/td>\n76<\/td>\n41.98<\/td>\n<\/tr>\n
31-40<\/strong><\/td>\n33<\/td>\n18.23<\/td>\n<\/tr>\n
41-50<\/strong><\/td>\n11<\/td>\n6.07<\/td>\n<\/tr>\n
51-60<\/strong><\/td>\n8<\/td>\n4.41<\/td>\n<\/tr>\n
61-70<\/strong><\/td>\n1<\/td>\n0.55<\/td>\n<\/tr>\n
>70<\/strong><\/td>\n0<\/td>\n0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Inference<\/strong><\/p>\n

There were only two major manifestations out of which Tinea Incognito is\u00a0 more common than TSDF(Table II).<\/p>\n

Table 2: Manifestation of adverse reactions caused by topical steroids<\/strong><\/p>\n\n\n\n\n\n
Manifestation<\/strong><\/td>\nFemale<\/strong><\/td>\nPercentage(%) <\/strong><\/td>\nMale<\/strong><\/td>\nPercentage(%)<\/strong><\/td>\nTotal<\/strong><\/td>\nPercentage(%)<\/strong><\/td>\n<\/tr>\n
Tinea Incognito<\/strong><\/td>\n30<\/td>\n16.57<\/td>\n75<\/td>\n41.43<\/td>\n105<\/td>\n58<\/td>\n<\/tr>\n
TSDF (topical steroid damaged face)<\/strong><\/td>\n54<\/td>\n29.83<\/td>\n22<\/td>\n12.15<\/td>\n76<\/td>\n42<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

There were only two major manifestations out of which Tinea Incognito is\u00a0 more common than TSDF(Table II).<\/p>\n

TSDF was more common\u00a0 in females while Tinea Incognito was more common in males.<\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig1\"<\/a><\/td>\nFigure 1: TSDF\u00a0 Depigmentation.<\/strong><\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig2\"<\/a><\/td>\nFigure 2: TSDF Hirsuitism.<\/strong><\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig3\"<\/a><\/td>\nFigure 3 : TSDF \u2013Melesma.<\/strong><\/p>\n

Click here to view figure\u00a0<\/a> \u00a0 \u00a0 \u00a0<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig4\"<\/a><\/td>\nFigure 4 : TSDF\u2013Acnei form eruptions.<\/strong><\/p>\n

Click here to view figure\u00a0<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig5\"<\/a><\/td>\nFigure 5: Tinea Coroporis in female.<\/strong><\/p>\n

Click here to view figure<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig6\"<\/a><\/td>\nFigure 6: Tinea Cruris in male.<\/strong><\/p>\n

Click here to view figure\u00a0<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Inference<\/strong><\/p>\n

Tinea (105 cases) was the commonest indication for which steroids were applied topically this is<\/p>\n

Followed\u00a0 by\u00a0 cosmetic reason & acne vulgaris(Table III).<\/p>\n

Table 3: Indications of offending topical steroid administration.<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n
Indication<\/strong><\/td>\nNo. of cases of topical steroid application<\/strong><\/td>\nPercentage(%)<\/strong><\/td>\n<\/tr>\n
Tinea Cruris<\/strong><\/td>\n74<\/td>\n40.88<\/td>\n<\/tr>\n
Tinea Corporis<\/strong><\/td>\n25<\/td>\n13.81<\/td>\n<\/tr>\n
Tinea\u00a0 facie<\/strong><\/td>\n5<\/td>\n2.76<\/td>\n<\/tr>\n
Tinea pedis<\/strong><\/td>\n1<\/td>\n0.55<\/td>\n<\/tr>\n
Cosmetic Reason<\/strong><\/td>\n36<\/td>\n19.88<\/td>\n<\/tr>\n
Acne Vulgaris<\/strong><\/td>\n36<\/td>\n19.88<\/td>\n<\/tr>\n
Eczema & Pruritus<\/strong><\/td>\n4<\/td>\n2.20<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Inference<\/strong><\/p>\n

Self medication is most common mode of topical steroid accessibility, while prescribed mode is least(Table IV).<\/p>\n

Table 4: Mode of accessibility to Topical steroids-<\/strong><\/p>\n\n\n\n\n\n\n
Mode of accessibility<\/strong><\/td>\nNo. of Cases<\/strong><\/td>\nPercentage(%)<\/strong><\/td>\n<\/tr>\n
Self Medication<\/strong><\/td>\n84<\/td>\n46.40<\/td>\n<\/tr>\n
OTC drug use<\/strong><\/td>\n62<\/td>\n34.25<\/td>\n<\/tr>\n
Prescribed<\/strong><\/td>\n35<\/td>\n19.33<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Inference<\/strong><\/p>\n

Betamethasone was most commonly applied topical steroid while cortisone was least commonly applied(Figure 7).<\/p>\n\n\n\n
\"Vol14No2_Eva_Vatl_fig7\"<\/a><\/td>\nFigure 7: Topical Steroids causing ADR.<\/strong><\/p>\n

Click here to view figure\u00a0<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Discussion<\/strong><\/p>\n

This study was done to know the extent of topical steroid abuse and subsequent adverse effects in terms of age group affected, manifestation of abuse, indication of\u00a0 steroid application, mode of accessibility and most common steroid abused topically. In this study age group most commonly affected belong to 21 to 30 years (41.98 %) followed by 11to 20 years (28.72%) this finding is similar to study conducted by Meena S et al.[5]<\/sup> and some other studies[6],[7],[8]<\/sup> this is because people in this age group is more likely accessible to\u00a0 self medication compared to elderly people and children.<\/p>\n

In this study there were only two manifestation of topical\u00a0\u00a0 steroid abuse firstly Tinea incognito (58%) , secondly TSDF (42%) ,Meena S et.al. also found Tinea incognito as the commonest adverse effect in their study[5]<\/sup>. TCs by suppressing the normal cutaneous immune response enhance fungal infections.[<\/sup><\/a>9]<\/sup><\/p>\n

TSDF or red face syndrome is a recently described entity characterized by plethora of symptoms caused by unsupervised misuse \/abuse\/overuse of TC of any potency on the face over an unspecified and\/or prolonged period.[<\/sup><\/a>10]<\/sup><\/p>\n

In this study Tinea (58%) was the most common indication for which steroid was abused followed by cosmetic reason (19.88%) and acne vulgaris (19.88%).This finding is similar to study conducted by Meena S et.al.[5]<\/sup><\/p>\n

Self medication (46.40%) was most common mode of steroid accessibility followed by over the counter\u00a0\u00a0\u00a0\u00a0\u00a0 (OTC) drug use (34.25%) while prescribed mode (19.33%) was least common. This finding is similar to other studies[6],[7],[8]<\/sup> .<\/p>\n

In this study betamethasone (61.87%) was most commonly abused steroid this finding is different from study conducted by Meena S et.al.[5]<\/sup> in which clobetasol was most commonly abused but similar to some other studies[7],[8]<\/sup> .<\/p>\n

Conclusion<\/strong><\/p>\n

As revealed by this study young people are more vulnerable to topical steroid abuse , so our health education program must be targeted to these people. There is a need\u00a0 to strengthen the health regulatory policies and strict control over the OTC drug sale. People must be awared regarding harmful effects of unguided use of topical steroid, they should use steroid only when prescribed by registered practitioner or dermatologist.<\/p>\n

References<\/strong><\/p>\n

    \n
  1. Ljubojeviae S, Basta JA, Lipozeneiae J. Steroid dermatitis resembling rosacea: aetiopathogenesis and treatment. J Eur Acad Dermatol Venerol. 2002;16:121-6.
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  2. Yasmeen J Bhat, Sheikh Manzoor, Seema Qayoom. Steroid-induced rosacea: a clinical study of 200 patients. Indian Journal of Dermatology. 2011;56(1).
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  3. Vivek Kumar Dey. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatology. 2014;5.
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  4. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54:1-15.
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  5. Meena S, Gupta LK, Khare AK, Balai M, Mittal A, Mehta S, Bhatri G. Topical corticosteroids abuse: A clinical study of cutaneous adverse effects. Indian J Dermatol 2017;62:675
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  6. Al-Dhalimi MA, Aljawahiry N. Misuse of topical corticosteroids: A clinical study in an Iraqi hospital.East Mediterr Health J 2006;12:847-52.<\/li>\n
  7. Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatol Online J 2014;5:436-40.
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  8. Rathod PR, Shankar R, Sawant A. Clinical study of topical corticosteroids misuse. Int J Recent Trends Sci Technol 2015;15:322-3.<\/li>\n
  9. Verma S, Madhu R. The Great Indian epidemic of superficial dermatophytosis: An appraisal. Indian J Dermatol 2017;62:227-36.<\/li>\n
  10. Lahiri K, Coondoo A. Topical steroid damaged\/dependent face (TSDF): An entity of cutaneous pharmacodependence. Indian J Dermatol 2016;61:265-72.
    \n    CrossRef<\/a><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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