An Observational Study on Topical Corticosteroid Awareness and Misuse among Dermatology Outpatients at A Tertiary Care Hospital

Abstract

Background: Topical Corticosteroids (TCS) are cornerstone treatments in dermatology, offering potent anti-inflammatory and immunosuppressive effects. However, their widespread availability, often Over-the-Counter (OTC) in Low- and Middle-Income Countries (LMICs), has led to a major public health crisis of misuse and adverse effects, including topical steroid addiction syndrome. Previous reports indicate alarming misuse rates, frequently for unindicated cosmetic purposes like skin lightening or self-treatment of common cutaneous infections such as acne and fungal infections. This study aimed to analyse the pattern of TCS use and identify primary sources of influence contributing to misuse among dermatology outpatients. Materials and Methods: This was a cross-sectional observational survey conducted among 246 dermatology outpatients at a tertiary care hospital. Data regarding patient Knowledge, Attitudes, and Practices (KAP) related to TCS use, including indication, frequency, duration, potency, method of application, and source of recommendation, were collected using a pretested KAP questionnaire. Results: TCS misuse was found to be highly prevalent across a broad spectrum of patients. The misuse pattern was concentrated in the younger age group (21-40 years), with a slight female predominance, reflecting the common pursuit of cosmetic outcomes like skin fairness and acne treatment. A significant proportion of participants reported chronic use, with approximately 35% using TCS for more than a month, and 28% reporting the use of moderate- to high-potency formulations. The major adverse effects documented included skin thinning, striae, pigmentation changes, acneiform eruptions, and Hirsutism. The majority of patients procured TCS without a prescription, often following advice from non-specialist sources such as pharmacists, friends, relatives, or local healers. Importantly, no significant association was found between the patient’s education level and the prevalence of misuse. Conclusion: The high prevalence and persistent nature of topical corticosteroid misuse in this tertiary care setting underline a systemic problem driven by easy OTC access and pervasive misinformation. Addressing this crisis requires a comprehensive, multi-pronged strategy encompassing stricter drug regulation, mandatory training for pharmacists, and targeted public awareness campaigns to ensure the rational and responsible use of these essential dermatological agents.