Topical corticosteroids abuse: A clinical study of cutaneous adverse effects

Meena, Soniya; Gupta, Lalit; Khare, Ashok Kumar; Balai, Manisha; Mittal, Asit; Mehta, Sharad; Bhatri, Garima

doi:10.4103/ijd.ijd_110_17

Cited by 22 publications

(19 citation statements)

References 18 publications

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“…However, controlling dermatitis with topical corticosteroids, immunosuppressants or anti-cytokine antibodies probably reduce damage to AT. Of course, the long-term use of topical steroids can cause side effects such as skin atrophy, rosacea-like dermatitis and dermatomycosis [27,28], and immunosuppressants or anti-cytokine antibodies may cause severe infections and malignant tumors. We should realize that dermatitis causes damage to various organs and the importance of the active treatment of dermatitis.…”

Section: Discussionmentioning

confidence: 99%

Systemic Dermatitis Model Mice Exhibit Atrophy of Visceral Adipose Tissue and Increase Stromal Cells via Skin-Derived Inflammatory Cytokines

Mizutani

Shirakami

Ichishi

et al. 2020

IJMS

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Adipose tissue (AT) is the largest endocrine organ, producing bioactive products called adipocytokines, which regulate several metabolic pathways, especially in inflammatory conditions. On the other hand, there is evidence that chronic inflammatory skin disease is closely associated with vascular sclerotic changes, cardiomegaly, and severe systemic amyloidosis in multiple organs. In psoriasis, a common chronic intractable inflammatory skin disease, several studies have shown that adipokine levels are associated with disease severity. Chronic skin disease is also associated with metabolic syndrome, including abnormal tissue remodeling; however, the mechanism is still unclear. We addressed this problem using keratin 14-specific caspase-1 overexpressing transgenic (KCASP1Tg) mice with severe erosive dermatitis from 8 weeks of age, followed by re-epithelization. The whole body and gonadal white AT (GWAT) weights were decreased. Each adipocyte was large in number, small in size and irregularly shaped; abundant inflammatory cells, including activated CD4+ or CD8+ T cells and toll-like receptor 4/CD11b-positive activated monocytes, infiltrated into the GWAT. We assumed that inflammatory cytokine production in skin lesions was the key factor for this lymphocyte/monocyte activation and AT dysregulation. We tested our hypothesis that the AT in a mouse dermatitis model shows an impaired thermogenesis ability due to systemic inflammation. After exposure to 4 °C, the mRNA expression of the thermogenic gene uncoupling protein 1 in adipocytes was elevated; however, the body temperature of the KCASP1Tg mice decreased rapidly, revealing an impaired thermogenesis ability of the AT due to atrophy. Tumor necrosis factor (TNF)-α, IL-1β and interferon (INF)-γ levels were significantly increased in KCASP1Tg mouse ear skin lesions. To investigate the direct effects of these cytokines, BL/6 wild mice were administered intraperitoneal TNF-α, IL-1β and INF-γ injections, which resulted in small adipocytes with abundant stromal cell infiltration, suggesting those cytokines have a synergistic effect on adipocytes. The systemic dermatitis model mice showed atrophy of AT and increased stromal cells. These findings were reproducible by the intraperitoneal administration of inflammatory cytokines whose production was increased in inflamed skin lesions.

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Section: Discussionmentioning

confidence: 99%

Systemic Dermatitis Model Mice Exhibit Atrophy of Visceral Adipose Tissue and Increase Stromal Cells via Skin-Derived Inflammatory Cytokines

Mizutani

Shirakami

Ichishi

et al. 2020

IJMS

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“…Earlier studies were conducted in the urban setting of tertiary care hospitals with emphasis on TS usage on face. [7][8][9][10][11][12] However, no data are available to understand the impact of this epidemic in the rural areas where 68.84% of the Indian population dwells. 13 This study analyses the magnitude, causes, characteristics, consequences and economic impact of TS misuse in a rural hospital in North India.…”

Section: Introductionmentioning

confidence: 99%

Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients

Thomas¹,

Wong

Anderson

et al. 2020

BMJ Open

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IntroductionCurrent evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients’ perception of skin disease.MethodsA mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome.ResultsOut of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days’ wages of a labourer).ConclusionSteroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek ‘quick fixes’ from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations.

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“…In many Indian studies, clobetasol propionate is the commonest steroid misused. 8 , 10 , 12 , 13 In our study in dermatophytoses, beclomethasone was the most common steroid whereas, in melasma, mometasone topped the list of steroids. This is justified by the fact that in the Nepalese market most of the FDC creams available over the counter contain beclomethasone as a triple-drug combination and another two-drug combination (beclomethasone and clotrimazole) is also used very commonly as a drug for dermatophytoses over the counter.…”

Section: Discussionmentioning

confidence: 70%

“…TCS is misused in an ample number of dermatological diseases, but we have seen that dermatophytoses are the dermatoses where TCS is significantly misused which is similar to several other studies. 8 – 10 , 12 The second most common indication for misusing TCS was melasma. The use of TCS on facial skin as a lightening agent has shown an alarming increase which has been depicted in many studies.…”

Section: Discussionmentioning

confidence: 99%

“…In countries like Nepal and India, the easy availability of TCS over the counter at the chemist shops across the country without any valid prescription is compounding the problem of abuse which has been shown in multiple studies. 5 , 8 , 10 , 12 , 13 , 17 , 21 TCS is available in the Nepalese market either alone or as a fixed drug combination (FDC) with antibiotic and antifungal. Steroid in combination with hydroquinone and tretinoin is also available as Kligman's or modified Kligman's formula (depending on the formulation of steroid used in the cream).…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients

Shrestha¹,

Joshi²,

Bhandari³

2020

J Nepal Med Assoc

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Introduction: Topical corticosteroids misuse has become one of the burning issues in many countries across the globe. They are known to cause a myriad of adverse effects which include local effects commonly and systemic effects rarely. In dermatology practice, one of the common problems we see these days are steroid-induced and steroid aggravated dermatoses. So, this study was done to find the prevalence of misuse of topical corticosteroid among dermatology outpatients. Methods: A descriptive cross-sectional study was done in the outpatient department of dermatology at atertiary care hospital for 18 months. Ethical clearance was obtained from the Institutional Review Committee of NMCTH (Reference no. 029-076/077). Convenient sampling was done. Statistical Package for the Social Sciences (SPSS) version 16 was used to tabulate the data and analyze the results. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Results: Out of 19464 patients, 614 (3.15%) (2.91%-3.39% at 95% Confidence Interval) gave a history of applying steroid containing creams. Among them, 220 (35.8%) belonged to the age group 21-30 years. Dermatophytoses were the skin disease where TCS was most commonly misused followed by melasma in 425 (69.2%) and 115 (18.7%) respectively. Beclomethasone was the steroid preparation that was misused in the maximum number of patients in 271 (44.1%). Some form of adverse effects was seen in 554 (88.6%) patients. Conclusions: Non-prescription sale of topical corticosteroids is the major cause of topical corticosteroids abuse in Nepal. Creating awareness among the prescribers as well as the patients is the current need.

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Topical corticosteroids abuse: A clinical study of cutaneous adverse effects

Cited by 22 publications

References 18 publications

Systemic Dermatitis Model Mice Exhibit Atrophy of Visceral Adipose Tissue and Increase Stromal Cells via Skin-Derived Inflammatory Cytokines

Systemic Dermatitis Model Mice Exhibit Atrophy of Visceral Adipose Tissue and Increase Stromal Cells via Skin-Derived Inflammatory Cytokines

Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients

Prevalence of Misuse of Topical Corticosteroid among Dermatology Outpatients

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