A hospital-based observational study on the frequency of different skin diseases and patterns of topical steroid misuse

Background: Over-the-counter (OTC), unlabeled steroids are widely available as cosmetics and have been a recent area of interest in research and clinical practice due to the side effects. However, less is known about OTC-labeled steroid misuse for various cutaneous diseases at a primary care or community level. Objective: The present study was aimed to assess the frequency of different skin diseases and patterns of topical steroid (TS) misuse in them. Materials and Methods: All new patients attending dermatology outpatient department (OPD) on 6 random OPD days in November 2016 for skin diseases were inquired about the use of any unsupervised steroid-containing medication on their skin lesions. The diagnosis and the prescription of the chief consultant/faculty for the disease were also screened in the context of steroid prescription. Data were presented in absolute number and percentage scale, and risk of misuse was analyzed using INSTAT software. Results: A total of 463 patients with a mean age of 27.01 ± 14.57 years (range 3 months to 92 years) were included. The majority (66.09%) were male. The most common disease was infectious in nature (933.19%) of which tinea infection was the most common (22.69%). A total of 119 (25.70%) patients had used unsupervised and OTC TSs; 4.20% presented with steroid dermatitis. Misuse was highest in photodermatitis and melasma (60 and 50%, respectively). TS misuse was more common in 15–40 years' age group and in diseases affecting face (relative risk 1.64 and 1.70, respectively; P < 0.01). Gender was not a risk factor. Conclusion: TS misuse is rampant (25.70%), and steroid dermatitis is a frequent complication. Patients aged 15–40 years and those with diseases affecting face are at risk of misusing it