Topical Corticosteroid Misuse Among Females Attending a Dermatology Outpatient Department in Ethiopia

Abstract

Introduction: Irrational use of topical corticosteroid (TC) is quite common in Ethiopia due to the unrestricted availability and use of topical steroids (TS) not only by general public but also by physicians and chemists. This practice is highly prevalent and sought after, owing to the quick relief of symptoms in different dermatological conditions and its nature of enhancing beauty for a certain period. Objective: This study aims to evaluate and analyze the prevalence of misuse of topical steroids, causes behind the misuse and consequences after the use of topical steroids among females in a dermatology outpatient department (OPD) at Ayder Referral Hospital, Ethiopia. Materials and Methods: A cross-sectional observational questionnaire based study was conducted from April to August 2015. Patients were questioned and assessed for misuse of topical steroids in terms of indication, dose, frequency, duration, effects after use and source of recommendation of topical steroids among female clients. Results: During the study period, 104 (27.1%) patients presented with inappropriate use of topical steroids among patients (n=384) who were attended the OPD of dermatology unit at Ayder Referral Hospital, the only hospital providing treatment, care and preventive measures for dermatological cases, with a response rate of 97%. A total of 72 patients were presented with adverse effects of topical steroids resulting from the misuse of these drugs for various purposes. Misuse of topical steroids was found to be most prevalent in the age group of 21-30 years (51.15%) followed by age group between 11-20 years (21.15%), who were severely affected due to its inappropriate use. Whereas, melasma (40.38%) and rosacea (35.6%) were the most common reasons of steroid abuse, followed by facial acne (26%), use as sunscreen 44 (42.3%), non-specific dermatosis 35 (33.7%) and skin lightening (10.58%). Patients using topical corticosteroids as over-the-counter (OTC) after recommendation made by friends and family (44.8%) was found to be a factor of influence on the misuse of topical steroids followed by pharmacist and drug store vendors as over the counter patterns of use (31.7%). The least were recommended by clinicians (10.57%) for the treatment of acne, melasma/hyper-pigmentation and to improve the appearance during weddings and other ceremonies. Dermovate and dermalar (70.18%) were the most commonly used topical steroid preparations, causing the patients to often develop fungal infections such as tinea incognito (26.4%), followed by facial acne (25.6%), telangiectasia and rosacea (41%) being the most common side effects experienced. Conclusion: Misuse of topical steroids was found to be very common owing to prescriptions by dermatologists, the major reason being recommendations by healthcare professionals, pharmacists, family and friends. Abuse of these steroids causes fungal, bacterial infections and rosacea which leads to many other secondary complications.

Nghiên Cứu Tình Hình Nhiễm Nấm Da Dermatophytes Trên Bệnh Nhân Viêm Da Do Lệ Thuộc Corticosteroid Ở Mặt Tại Bệnh Viện Trường Đại Học Y Dược Cần Thơ Và Bệnh Viện Da Liễu Thành Phố Cần Thơ Năm 2021-2022

“…Trong đó: n là cỡ mẫu; Z với mong muốn mức tin cậy là 95% thì Z 1− α 2 = 1,96; p=26,4% (tỷ lệ nhiễm nấm dermatophytes trên FCAD dựa theo nghiên cứu của Zewdu và cộng sự năm 2017) [11]; d là sai số cho phép trong nghiên cứu là 7%, d=0,07. Vậy n=153.…”

“…Tỷ lệ nhiễm nấm da dermatophytes trên bệnh nhân viêm da do lệ thuộc corticosteroid ở mặt là 19,6%. Theo nghiên cứu của Zewdu và cộng sự (2017) cũng ghi nhận tỷ lệ nhiễm nấm trên bệnh nhân FCAD cao hơn một ít là 26,4%, thấp hơn kết quả nghiên cứu của Meena và cộng sự (2017) là 49,46% và cao hơn rất nhiều so với nghiên cứu của Sarawat và cộng sự (2011) là 6,7% và của Chauhan và cộng sự (2019) là 4,97% [3], [4], [8], [11]. Sự khác biệt về mặt tỷ lệ nhiễm nấm da có thể là thời tiết, khí hậu và độ ẩm từng mùa ở các nước có sự khác nhau, trong đó miền Nam nước ta có khí hậu ẩm, nóng là một yếu tố thuận lợi cho nấm dermatophytes phát triển.…”

Obsession to fairness and topical steroid induced acne: A situation analysis of patients presenting in dermatology clinic at a private hospital in Karachi

“… 1 - 3 Studies conducted in India, Nepal, Saudi Arabia, and Ethiopia have reported a considerable burden of irrational use of topical corticosteroids and fairness creams to lighten the skin tone. 4 - 6 …”

“…[1][2][3] Studies conducted in India, Nepal, Saudi Arabia, and Ethiopia have reported a considerable burden of irrational use of topical corticosteroids and fairness creams to lighten the skin tone. [4][5][6] The irrational use of topical corticosteroids and fairness creams may lead to many serious adverse effects on the skin including acne, skin atrophy, striae, rosacea, perioral dermatitis, acne, and purpura. [7][8][9]…”