Prescribing practices of topical corticosteroids in the outpatient dermatology department of a rural tertiary care teaching hospital

Abstract

Background:Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs.Aim:The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra.Materials and Methods:A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed.Results:About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids.Conclusion:Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.

Topical corticosteroids knowledge, attitudes, and practices of primary care physicians

“… 5 Topical corticosteroids can cause cutaneous side effects (atrophy, striae, telangiectasia, hypo-pigmentation, acne, rosacea, perioral dermatitis, and hypertrichosis), as well as systemic side effects (cataracts, hyperglycemia, and hypothalamic-pituitary-adrenal suppression). 6 While their prescribing patterns have been studied, 7 - 10 the knowledge based upon which these PCPs choose a TC has not been identified. Our study aims to assess the current knowledge, attitudes, and practices of PCPs toward TCs in Riyadh, Kingdom of Saudi Arabia (KSA).…”

Off-label Drug Prescribing: Deciphering the Ambiguity

“…A study conducted at a rural tertiary care hospital in India concluded that 28% of prescription had Topical steroids, out of which 98% were very potent corticosteroids; and in 85% of cases, the basis of prescribing these could not be established. 16 Widespread use of topical steroids in off label manner is supported by the evidence that these medications are perceived to be safe by the prescribing physicians as they do not cause systemic steroid toxicity. However topical adverse effects of these medications are often ignored.…”

Abuse of topical corticosteroids in India: Concerns and the way forward

“…Also, it has been sometime observed that even trained physicians and dermatologists are prescribing either the wrong strength of TC or for the wrong indication. [ 8 ] Regular continuing medical education and workshops to create awareness regarding this important issue will go a long way to ensure rational use of TCs. Along with this, there is need to sensitize patients, the actual user, about the adverse effects of TC abuse on face.…”

“…[ 4 5 ] However, the more serious concern is its inappropriate use in symptomatic treatment for varied dermatological disorders like acne, primary bacterial and fungal infections, undiagnosed skin rash and as fairness cream by non-registered practitioners or on the advice of pharmacist at chemist shops. [ 6 7 8 ] These people are not qualified and competent to treat dermatological disorders and prescribe topical steroids which often provide quick symptomatic relief without treating the underlying pathology of the disease. Ironically, the Indian market is flooded with several fixed-dose combinations (FDCs) of corticosteroids with antibacterial and fungal agents, which in no way can be considered as scientific and rational.…”

“…Recently, a study done at rural tertiary care teaching hospital in Maharashtra, India concluded that 28% of 500 prescriptions had TCs, out of which 98% were very potent corticosteroids; and in 85% of cases, the basis of prescribing TCs could not be established. [ 8 ] Besides this, a new emerging dangerous pattern regarding use of TCs as fairness cream is being observed in India. A multicenter study conducted in India concluded that 14.8% of patients with facial dermatoses were using TCs, and that fairness or shaving cream (29%) was the most common reason for its use among the study cohort.…”