Comparative Evaluation of Safety and Economic Burden Due to Topical Steroid Misuse in Patients with Self-medication and Prescribed Medication

Introduction: Topical corticosteroids are currently the primary drugs to treat several dermatological disorders. But they are misused for various indications such as acne, pigmentation, fungal infection, and pruritus, and many times as a cosmetic or a skin cream for any type of rash. This study is performed to compare the magnitude of adverse events between practitioner-prescribed and self-prescribed groups of patients. In addition, this study also focuses on the demographic and educational status of patients where topical steroids are most widely misused. Methodology: It is a cross-sectional, hospital-based observational study conducted in the Department of Dermatology in collaboration with the Department of Pharmacology, KIMS, Bhubaneswar. A total of 134 patients were enrolled after getting the informed consent for the study, and assessed based on their topical steroid misuse and their adverse effects. Results: The present study showed that steroid misuse was most common between 20 and 30 years of age group patients with low educational status. The most commonly applied steroid was clobetasol followed by mometasone and steroid abuse was more common in self-prescribed patients than physician-prescribed patients. The economic burden was more in the case of people using steroid cream only or steroid + anti-fungal creams because they have to be applied over a large body surface area. Incidence of adverse effects was observed more in self-prescribed patients and with low educational status. Conclusion: This study highlights the fact that self-medication increases the incidence of adverse reactions and economic burden on the patients. Continuous education of patients and strict regulations regarding over-the-counter sales of steroids may help decrease the incidence of steroid misuse.