How often have you been told by a friend, family member or even your beautician to apply a certain medicated cream for your acne or say a mild rash? Have you used a steroid-based cream for longer than prescribed or even at your own discretion if say the skin irritation returns? Or have you wondered why your friend is using a cream containing the steroid betamethasone to lighten her skin?
Today, besides antibiotics, another set of drugs in India are being used irrationally — these are topical corticosteroids which are basically creams, ointments or skin products that contain steroids. Topical steroids have been in use for six decades in the country and comprise over 80 percent of the total dermatology product sales in the country. They are effective in providing almost immediate relief in autoimmune, inflammatory and other dermatological conditions. But the problem arises with the unrestricted access of topical corticosteroids resulting in overuse, misuse and abuse.
Today, studies indicate around 10 out of a 100 people in the country buy topical steroids because a dermatologist told them to. Over four out of 10 people buy topical steroids on their own or without a prescription. 20 percent buy them because they are recommended by their friend, family member or neighbor and over 8 percent buy it because their beautician told them.
Today, over 95 percent of the patients who buy topical steroids in the country are unaware of their adverse effects and most of them, in some studies 100 percent, don’t know how often and how much to of the cream to use either. A dermatologist and head of department at a public hospital in Mumbai points out a 25 percent rise in patients who have misused steroid creams in just the last 4-5 years.
Topical steroids are misused in India due to the same reason antibiotics are misused in the country. The lack of enforcement of prescriptions, that is, you can buy the drug like an over the counter product. Dermatologists also point out that high potency creams are recommended by general practitioners and even pediatricians without knowing what the consequences are. For example, even small doses of high potency steroids can result in systemic absorption with children and elderly being more susceptible to it.
Also, one must be wondering why beauticians are recommending steroid creams? This is linked to an important issue of topical prescription drugs being used as fairness creams. Today, over 50 percent of topical steroids bought without a prescription are used mainly to lighten skin as they reduce melanin the natural skin pigmentation present in the body. Majority of the users are women between the ages of 10-29 years, and the most used drug is Betamethasone. Dermatologists point out that they have seen cases of women applying clobetasol one of the strongest steroid creams available as a fairness cream for over 25 years. We in India are also guilty of using other harmful substances such as hydroquinone as skin lighteners which in fact has been banned from use in cosmetics in several geographies such as Japan, UK and Europe due to its risk to human health.
Steroid creams are used mainly for symptomatic relief with the underlying pathological issue remaining unresolved and many a times continuing to aggravate. Doctors point out that this is especially the case in fungal infections where long-term usage of steroid based fungal creams can in fact worsen conditions
Also using steroid creams is a vicious cycle in fact doctors say it is addictive. For example, stopping prolonged use of steroid creams can result in almost immediate side effects such as itchy rashes, redness. Patients then tend to reuse the drug to control these side effects which then leads to inability to wean off it. Long term side effects range from thinning of the skin, redness, acne, lesions, puffiness, consistent burning, discoloration to more severe skin issues for example Tinea a group of diseases caused by fungus or weight gain, hormone fluctuation due to systemic absorption of creams.
So what needs to be done? Experts say the government needs to make prescriptions necessary for dispensing these medications. In 2016, the government did ban certain fixed dose combinations creams containing steroids and in 2018 the government banned over the counter sale of 14 steroid-laden fairness creams they need to do more. Experts say there is a need to consistently relook and monitor the combination creams and fairness products available and prevent the sale of the drugs without prescriptions. Lastly, one of the other measures include awareness within the doctor community and among patients and especially the people who self-medicate.
