Maheshwari V, Chaturvedi R, Meshram S, Bhalsinge R. 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. Biomed Pharmacol J 2021;14(2).

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Manuscript received on :09-01-2021
Manuscript accepted on :11-03-2021
Published online on: 07-06-2021

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Plagiarism Check: Yes
Reviewed by: Dr. Mohammad Barary  
Second Review by: Dr. Tejaswi Chavan  
Final Approval by: Dr. Ian James Martin

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Vatsala Maheshwari¹, Richa Chaturvedi² , Sonali Meshram³ and Rahul Bhalsinge*

¹L.N.Medical College and J K Hospital ,Lnct University, Bhopal- 462042

²Department of Pharmacology, Gandhi Medical College,Bhopal-462001.

Corresponding Author E-mail : Rahulbhalsinge@Gmail.Com

DOI : https://dx.doi.org/10.13005/bpj/2196

Abstract

Introduction : Topical steroids are most commonly being used today. Mostly these are being misused due to lack of awareness of their adverse effects. Malpractice  and easy availability of these agents also responsible for their abuse. Aim : To Evaluate Topical Steroid abuse in various parameters according to CDSCO ADR forms. Objectives : This study was conducted  to know the extent of abuse of topical steroid ,along with clinical profile and mode of accessibility in dermatology  department of a teaching institute of tertiary health care centre of central India. Material and Method: First 200 patients of adverse drug reaction attending dermatology department were screened according to ICSR form of CDSCO in a period of December 2015 to November 2016 and 181 patients of them who gave history of topical steroid application were further analyzed. Result: Most commonly affected people belong to age of 21 to 30 years (41.98%),Tinea incognito (58%) was the commonest manifestation of steroid abuse, Tinea  (58%)was the most common indication of steroid application, self medication (46.40%) was most common mode of steroid accessibility, betamethasone  (61.87%) was most commonly applied topical steroid. Conclusion :Self medication and over the counter drug use were most common mode of steroid accessibility both can be controlled by  making strict health regulatory policies . Simultaneously health education program must be targeted to young population who are more vulnerable to steroid abuse to make them aware regarding harmful effects of unguided or misguided use of topical steroid.

Keywords

OTC Drugs; Steroid abuse; Self Medication; Tinea incognito; TSDF

Introduction

Steroids have been in use as topical agents since long time.^[1] The  topical steroids are being increasingly used since their  inception.^[2]Topical corticosteroids are among the most commonly prescribed medications in dermatology practice at present^[3].Steroid abuse is a common due to easy availability of  steroid creams as over-the-counter drugs.^[3]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] This study was conducted to assess the extent of steroid abuse and the clinical profile of these patients.

Material and Methods

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.

Result and Observations

Inference

Majority of cases are from young population. Children & elderly are affected least.(Table I)

Table 1: Age wise distribution of adverse reactions caused by topical steroids.

Inference

There were only two major manifestations out of which Tinea Incognito is  more common than TSDF(Table II).

Table 2: Manifestation of adverse reactions caused by topical steroids

There were only two major manifestations out of which Tinea Incognito is  more common than TSDF(Table II).

TSDF was more common  in females while Tinea Incognito was more common in males.

Figure 1: TSDF  Depigmentation. Click here to view figure

Figure 2: TSDF Hirsuitism. Click here to view figure

Figure 3 : TSDF –Melesma. Click here to view figure

Figure 4 : TSDF–Acnei form eruptions. Click here to view figure

Figure 5: Tinea Coroporis in female. Click here to view figure

Figure 6: Tinea Cruris in male. Click here to view figure

Inference

Tinea (105 cases) was the commonest indication for which steroids were applied topically this is

Followed  by  cosmetic reason & acne vulgaris(Table III).

Table 3: Indications of offending topical steroid administration.

Inference

Self medication is most common mode of topical steroid accessibility, while prescribed mode is least(Table IV).

Table 4: Mode of accessibility to Topical steroids-

Inference

Betamethasone was most commonly applied topical steroid while cortisone was least commonly applied(Figure 7).

Figure 7: Topical Steroids causing ADR. Click here to view figure

Discussion

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  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] and some other studies^[6],[7],[8] this is because people in this age group is more likely accessible to  self medication compared to elderly people and children.

In this study there were only two manifestation of topical   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]. TCs by suppressing the normal cutaneous immune response enhance fungal infections.^[9]

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.^[10]

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]

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

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

Conclusion

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  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.

References

1. Ljubojeviae S, Basta JA, Lipozeneiae J. Steroid dermatitis resembling rosacea: aetiopathogenesis and treatment. J Eur Acad Dermatol Venerol. 2002;16:121-6.
   CrossRef
2. Yasmeen J Bhat, Sheikh Manzoor, Seema Qayoom. Steroid-induced rosacea: a clinical study of 200 patients. Indian Journal of Dermatology. 2011;56(1).
   CrossRef
3. Vivek Kumar Dey. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatology. 2014;5.
   CrossRef
4. Hengge UR, Ruzicka T, Schwartz RA, Cork MJ. Adverse effects of topical glucocorticosteroids. J Am Acad Dermatol. 2006;54:1-15.
   CrossRef
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
   CrossRef
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.
7. Dey VK. Misuse of topical corticosteroids: A clinical study of adverse effects. Indian Dermatol Online J 2014;5:436-40.
   CrossRef
8. Rathod PR, Shankar R, Sawant A. Clinical study of topical corticosteroids misuse. Int J Recent Trends Sci Technol 2015;15:322-3.
9. Verma S, Madhu R. The Great Indian epidemic of superficial dermatophytosis: An appraisal. Indian J Dermatol 2017;62:227-36.
10. Lahiri K, Coondoo A. Topical steroid damaged/dependent face (TSDF): An entity of cutaneous pharmacodependence. Indian J Dermatol 2016;61:265-72.
    CrossRef