KOLKATA: Twenty-five-year-old Sucharita Sanyal had been using a common skin ointment for her pimples till they turned bigger, spread all over her face and started bleeding. She stopped using the ointment, but it aggravated the rashes even further. Sucharita lost her appetite and even had a partial loss of vision.
Her condition was eventually diagnosed as Topical Steroid Damaged Face (TSDF) which is triggered by steroids in skin ointments. Indiscriminate use of such creams have resulted in more than 30,000 people in Kolkata suffering from the disease, which is not fatal but can’t be cured completely.
“But few choose to seek advice before applying these ointments which are meant for diseases like eczema and psoriasis and need to be used in a controlled way. These tubes are sold in millions and since they come under the umbrella of DPCO (Drug Price Control Order) they are available at a throwaway price. So, the misuse becomes even more rampant,” explained Lahiri.
Since drug rules prohibit over-the-counter sale of potent topical steroids internationally, this entity is virtually unknown in developed countries and naturally there is no prescribed treatment for this problem. “We have been groping in the dark and have been forced to devise our own treatment regime based on experience. Generally, we taper off the ointments rather than taking them off in a go, for that leads to withdrawal effects on the skin. It is similar to the de-addiction or rehabilitation programme that drug addicts go through. But the treatment norms are still evolving,” added Lahiri.
Whos fault is it when drugs like this are misused? Is it the doctors’ fault for not explaining in detail on the usage of such controlled drugs? Or is it the patients fault for not asking for proper medical advice, which resulted in misuse?
My view is that patients are not trained medically. The onus is on the doctors to explain the risks and the proper usage by virtue they are trained professionals. As an engineer, I don’t teach pilots how to fly a plane, they teach me instead.
Second, if I may, all steroids of all potencies should be listed as controlled drugs. All patients usage should be monitored and kept in a central registry. This provides an additional data medium for dermatologists as a diagnostic tool, one with a clear history of topical usage to determine if steroid addiction is the problem rather than atopic dermatitis.
The problem I face is when I enter a doctor’s room, the doctor takes a few glance and tell me it is ezcema. They then prescribe a bunch of TS that I don’t need. When I ask them “is it really ezcema” they say it is confidently. That is how diagnosis is done – via simple pattern recognition. One needs to question their premise on the 1st pattern that they base their subsequent diagnosis on. If their premise is weak, so is their diagnosis.