The Hidden Epidemic of Topical Steroid Use: Prevalence and Impact Among Jordan's General Population.

Abstract

Background: Topical corticosteroids (TCS) are widely prescribed for inflammatory skin conditions, but unsupervised use carries significant health risks. In Jordan, over-the-counter availability raises concerns about misuse. Limited research exists on population-level patterns and knowledge. This study aimed to evaluate TCS use patterns, indications, and awareness in the general population, and to identify demographic factors associated with misuse.

Methods: A cross-sectional online survey was distributed via social media platforms. The questionnaire assessed demographics, corticosteroid use patterns, application sites, prescription sources, and awareness of products and side effects. Data were analyzed using Jamovi (version 2.3.28). Descriptive statistics were generated, and chi-square tests and multiple linear regression were used to identify associations with cream recognition and adverse effect reporting.

Results: A total of 714 respondents participated; 46.8% reported storing corticosteroid creams at home. The most common application sites were the hands (36.6%) and face (31.2%). Daily use was most frequent (53.1%). Creams were mainly obtained from pharmacists (22.8%) or informal sources (12.6%). Only 63.2% reported reading the leaflet, and 61.3% were aware of potential side effects. Hydrocortisone 1% was the most recognized cream (45.1%), while 29.5% could not identify any corticosteroid cream. The leading indications were eczema (32.6%) and itchiness (17%). Adverse effects were reported by 39.9%, most commonly redness, increased hair growth, and skin thinning. Chi-square analyses showed that adverse effect reporting was associated with longer duration and higher frequency of use (p < 0.05), while regression analysis demonstrated that cream recognition was lower among males and higher among employed or retired individuals compared with housewives (p < 0.05).

Conclusion: Topical corticosteroid use is widespread in Jordan, often obtained without prescription and with limited awareness of potency, indications, and risks. Targeted public education and stricter regulation of dispensing are needed to reduce misuse and ensure safer use.