Misuse of steroid-laden lotions rampant in India
The widespread misuse of skin creams and lotions that contain steroids in India is harmful and out of control, argues an expert in The BMJ this week.
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.
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.
Shyam B Verma, a consultant dermatologist based in Gujuarat, says that “Indian doctors are witnessing a pandemic of adverse effects induced by topical corticosteroids”.
A study of 2,926 dermatology patients in 2013 showed that 433 (14.8%) were using topical steroids and 392 (90.5%) 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. “This needs urgent revision,” he says.
Another problem that leads to the inappropriate use of topical steroids is that too few specialist dermatologists are available. The majority of India’s some 8,500 dermatologists are based in cities, while most of India’s population is dispersed in villages.
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.
In 2014-15, the market was worth Rs15.55bn, 11 percent higher than the previous year. Around 85 percent of the market comprises “steroid cocktails”–these are topical steroids that contain one or two antibiotics and antifungals.
“This problem highlights the low priority that dermatology receives in India,” Verma argues, and calls for the “health ministry’s drug technical advisory boards [to] include more dermatologists to advise the drug controller’s office and state representatives.”
In addition, he says “the public, as well as doctors of all specialties, need to be informed and educated about safe use of topical corticosteroids.”
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