Skin creams containing steroids widely misused in India

Doctors in India are witnessing a pandemic of adverse effects induced by the widespread misuse of skin creams and lotions containing steroids, an Indian dermatologist has warned.
Corticosteroids, also known as steroids, are anti-inflammatory medicines used for a range of conditions.
However, these can lead to substantial and permanent damage, especially on thin skin, such as on the face and groin, researchers said.
Side effects include pigmentation and breakdown of the skin, small and widened blood vessels on the skin, as well as bacterial and fungal infections.
Misuse can lead to resistance of infections that can make these difficult to diagnose and treat.

"Indian doctors are witnessing a pandemic of adverse effects induced by topical corticosteroids," Shyam B Verma, a consultant dermatologist based in Gujarat wrote in a study published in The BMJ.

The study of 2,926 dermatology patients in 2013 showed that 433 (14.8 per cent) were using topical steroids and 392 (90.5 per cent) had harmful effects.
As required by law in India, strong steroids can be sold only with a registered medical practitioner's prescription. However, topical steroids are exempt and can be purchased over the counter.
Another problem that leads to the inappropriate use of topical steroids is that too few specialist dermatologists are available, Verma said.

The majority of India's some 8,500 dermatologists are based in cities, while most of India's population is dispersed in villages, he said.
"So many patients seek treatment for skin disease from primary care providers, including thousands of ayurvedic and homeopathic practitioners and unqualified charlatans," he said.
Although it is illegal, they may prescribe topical corticosteroids with little or no knowledge of dermatology, and many pharmacists sell steroid creams without a prescription, ignoring the box warnings, Verma said.
Due to costs and the inconvenience of specialist dermatological consultations, patients with prescriptions often re-purchase and share drugs with friends and relatives with similar symptoms.

"Sales of such products would be unthinkable in developed nations but even qualified medical practitioners in India are ignorant about rational prescribing," he said, calling for these "irrational combinations" to be banned.
"Most developed countries restrict sales of topical corticosteroids strictly by prescription, because they should be used judiciously, for appropriate indications and duration," Verma said.
"This problem highlights the low priority that dermatology receives in India," he said.