Full paper link here: Rational and Ethical Use of Topical Corticosteroids Based on Safety and Efficacy.
Highlighting the important points:
However, over the years it has become increasingly apparent that TC are being abused by doctors and patients alike. Apart from the well-known indications such as psoriasis, atopic dermatitis, vitiligo, lichen planus, lichen simplex chronicus, discoid lupus erythematosus, etc., they are being used for conditions such as melasma, urticaria, and even undiagnosed skin rash by dermatologists and general physicians. This is because of the quick amelioration of signs and symptoms of many skin disorders by the application of TC in the first instance. This can buy time and hold patient a while longer more so with a nonspecialist. Studies in patients presenting with steroid-related eruptions have shown that there are several nonmedical advisers like friends, neighbors, beauticians, barbers, etc. telling them to use it as fairness/cosmetic creams, anti-acne, anti-fungal therapy and for that matter any skin eruptions. There is a tendency to reuse old prescription for a recurrent or new rash. Prescription sharing with relatives and friends on the presumption that similar looking skin problems can be self-treated by simple prescription copying is rampant. To compound this problem, there is easy availability of these drugs almost for the asking without a valid prescription at every chemist shop. Moreover, store pharmacists also double up as doctors doling out advice about which TC to use. These instances, although reported from many places worldwide,[7–9] have significant impact in our country of a billion plus people with an adverse specialist-to-patient ratio.
…..As a dermatologist, the onus of responsibility lies on us, for whom these drugs are a strong weapon to fight many skin diseases, to correctly educate the society including our non-dermatologist medical fraternity about ethical and rational use of TC. It is good to recall the Biologist Van Rensselaer Potter who proposed the term “bioethics” in 1970, to encompass a field that lay at the intersection of ethics and the biological sciences in general. The primary goal underlying all ethical issues in health care, in our case the use of TC, is to see that the knowledge gained through research should benefit and not cause harm to the society and that knowledge should be disseminated correctly.
We will quickly realize that despite the best efforts undertaken at our level, many of these problems will continue to persist because they were not contributed by us alone. To address them, interventions have to be multidimensional, involving political, educational and legal approaches. Opportunity may have to be seized by the leadership of Indian Association of Dermatologists, Venereologists and Leprologists at every available forum. Political leaders and government officials should be repeatedly apprised of the prevailing situation and the need to curb this menace. Use of media for public education on topical steroid misuse is warranted, and the involvement of general practitioners, nurses. and pharmacists is needed. The legal approach should include the enforcement of the existing legislation related to the control of these drugs, so that TC are not sold without proper prescriptions. Pharmaceutical companies should be made to ensure proper labeling of TC products which should include inserts containing clear “finger tip unit” instruction, preferably with images and chart to show the numbers of unit required for specific areas of the body. This will greatly help in optimal and safe use of TC. The legal aspect should also include measures aimed at strengthening the ethical responsibilities of pharmacists in correctly advising patients about the safety of medicines bought over the counter. Once the measures are in place and working, we hopefully may see the beginning of the reversal of the misuse/abuse of TC and the consolidation of the well-established benefits of this wonderful group of drugs.
As much as I hate TS for causing my shitty circumstances, the root problem is not with the medicine alone, but multi-dimensional. This is a great paper, one that acknowledges the existence of misuse of topical steroids and their effects, as well being highly informational on proper topical steroid usage.
I believe TS as a medicine has it’s place and time for the proper treatment of certain skin problems, IF and ONLY IF, doctors take full responsibility in proper diagnosis and prescription AND patients take full responsibility in accepting the disclosed risks. However, I’ll bet with great certainty that if patients were given the full risk disclosure of potential TSW symptoms, many rational patients would choose to steer away from TS and look for alternative treatment instead.
Until then, we can only work with bits and pieces, spreading awareness and education (as my core goal at the moment).
What about your thoughts?