Help us to Fight Topical Steroid Abuse

An Appeal for Chemists by IADVL

( Indian Association of Dermatologists, Venereologists & Leprologists)

THEME IADVL 2019- “FIGHT TOPICAL STEROID MISUSE”

A common scenario in chemist’s shop

Hi, give me something for itching in the groin

Please go to a doctor. Let him examine you and decide the disease and the medicine.

Please give me now. I do not have time to visit a doctor.

Then try this.

A ringworm is then complicated by giving “Blanket” treatment

Some combination is given

• Candid-B Sofradex

• Zole-F TenovateM

• Lobate GM Candid Total

• Panderm+ Clobet GM

• Quadriderm Clodem M

• Surfaz SN Cloben G

• Betnovate C Fourderm

• Betamil GM Dermi 5

• Lupiderm GM O2 Derm

And many more ……

What happens NEXT ?

He applies cream

He feels better

He stops applying cream

Relapse

And the vicious cycle continues…

Waves of remissions and exacerbations

And then remission stops

Only exacerbation

and

Now SIDE EFFECTS start.

• Nowadays almost 20 to 25 % of patients seen by a dermatologist in India are of Ringworm ( Fungal Infection)

• Almost all are modified by application of topical steroid.

Topical steroids have many side effects

It modifies infection

Simple diagnosable ringworm

Complicated, difficult to diagnose ringworm

It thins out the skin and leads to stretch marksWalking becomes troublesome

Stretch mark is permanent damage to the skin

Steroid cream applied all over – irreversible stretch marks

Ulcers occur in the stretch marks

Bleeding occurs underneath the skin

Steroid cream applied for a fungus

Multiple stretch marks, thinning of skin

Fungal still prevails.

Severe recalcitrant fungal infection

Severe recalcitrant fungal infection

Doctor prescribes once

Patient continues lifelong

Leads to obesity, raised blood pressure, diabetes( Cushing’s

syndrome)

• Many steroid combination creams are available with antifungal and antibiotics.

• There is no rationale behind it.

• We also educate general practitioners not to prescribe them.

One more issue which requires your attention

Growing craze of Fairness in youth

• There is rat race in the society to look fair.

• Market is flooded with fairness creams.

• Many such creams contain steroids.

• Youngsters use them on recommendation of friends, relatives, parlors, chemists and even pharmaceutical companies.

SO CALLED FAIRNESS CREAMS

• SKINLITE EVEGLOW

• LOOKBRITE METACORTIL LITE

• UBFAIR MELAMET

• NOSCAR WHITE PEARL

• TRIGLOW GRAZIA

• COSMELITE METASKIN

• MELALITE –XL LITESKIN

• LOMELA MELACUT

• GETLITE MELABEST

And many more…

• Most of these youngsters then approach us (Dermatologists ) with variety of side effects on face.

• Some of them are irreversible side effects.

Permanent dilatation of blood vessels

Perioral Dermatitis

Rosacea

Persistent Erythema ( Redness)

Unwanted hairs on face

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Pimple like rash on the face

51

Pimple like rash and unwanted hairs on face

Exacerbation Of Acne

30 Dec 2013 Prepared by IADVL egroup members 53

30 Dec 2013 Prepared by IADVL egroup members 54

She applied steroid cream for melasma

Even very low potency steroid cream can cause side effects

Skin becomes thin, sensitive with burning& stinging.

She applied steroid cream even on hands for fairness

Steroid cream applied near eyes caused Glaucoma

So is topical steroid dangerous to skin health?

NO

It is like other inventions like atomic energy, television, internet, mobile etc.

These inventions can be used for our benefit but can be misused also.

• Topical steroid is very safe and very useful if used for proper indication and in right potency.

• We dermatologists use it properly and judiciously. We use it daily for various skin indications.

• Even oral and parenteral steroids are life saving and used for various inflammatory and allergic disorders.

• As a chemist you can play an important role to fight this menace of topical steroid abuse.

• Steroid is included in schedule H. Kindly do not sell it without doctor’s prescription.

• All 2in1, 3in1, 4in1 creams contain steroid.

• Kindly do not sell them on the counter

• Kindly keep in mind that creams do have side effects like tablets and injections.

• Do not sell them on the counter without doctors’ Prescriptions

• Do not sell any cream for fairness of skin

• Do not honor an old prescription. This time the disease may not be the same.

• Chemists can play an important role to educate customers about the issue of topical steroid abuse. Because each cream which patient gets goes through chemist’s hand.

Let us join hands together towards Healthy Nation.

A presentation by ITATSA(IADVL’s Taskforce Against Topical

Steroid Abuse) for chemists in public interest

THANKS