Topical steroid abuse is fuelled by easy availability. It can even lead to blindness

The anti-inflammatory property of steroids lulls you into the false belief they are working. But they also suppress immunity can make skin infections worse.

The unsupervised usage of topical steroids can result in irreversible conditions. | Representational image | Image by Iqbal Nuril Anwar from Pixabay

I have treated patients from all sections of society, and their quest remains to make sure their skin is perfect, come hell or high water. Enter the rampant use of topical steroids.

I wouldn’t be exaggerating if I called it an abuse of steroids, similar to the abuse of antibiotics. A 2011 paper published in the Indian Journal of Dermatology, Venereology and Leprology quantifies the use of topical steroids to treat dermatoses— an umbrella term that refers to any disease of the skin. The causes of dermatoses can be anything—ranging from bacterial to fungal, and each cause requires a specific treatment. But by the time a patient comes to a specialist, 15 per cent of them are already on topical steroids. And as many as 29 per cent use it as fairness cream or aftershave.

This abuse is fuelled by the easy availability of potent topical steroid formulations such as clobetasol, mometasone, clobetasol, desonide, and fluticasone at pharmacies (ideally, these should not be dispersed without a valid prescription). People often get them through a friend or family member’s prescription, putting their advice above that of a doctor’s. In some cases, patients do go to a doctor but instead of going to a specialist, they go to a general physician—who may be well-intentioned but is not a subject matter expert.

The abuse of topical steroids is most commonly seen in patients who have eczema, psoriasis, vitiligo, melasma or fungal infections, and of course, an obsession with fairness.

Out of these, patients with fungal infections are the worst hit as steroids can exacerbate their condition—eventually engulfing the entire affected area, making its reversal even more difficult.

Steroids are anti-inflammatory, and due to the inflammatory nature of most lesions, their initial effect lulls you into the false belief they are working. But steroids are also immunosuppressants, which means that they damp down the activity of the immune system, and slow down or halt the treatment of the underlying infection. It’s the dermatological equivalent of using a band-aid for a bullet hole.

Harmful side effects

The use of topical steroids on the face produces peculiar adverse effects such as skin atrophy (reduction in thickness of skin), acne, puffy face with telangiectasia (distorted blood vessels), facial hypertrichosis (excessive hair growth), pigmentation disorders, pyodermas (pus-filled sores), tinea incognito (a type of ringworm), and perioral dermatitis (inflammation around the mouth).

One of the most commonly occurring side effects of prolonged steroid use is called red skin syndrome. It causes redness, burning and stinging of skin. While it may begin from the site of the steroid application, it can spread beyond that. It can even begin after you’ve stopped using the medication.

Adverse effects are a part of any medical treatment journey as everyone reacts to medicine differently. But the unsupervised usage of topical steroids can result in irreversible conditions. And it isn’t limited to dermatological effects, it can also result in glaucoma and cataracts in certain conditions.

As someone who has seen people deep in despair due to this medicinal abuse, it is time for us to be action-oriented. To start off, potent topical steroids must be categorised as Schedule H drugs, which means they can only be sold by chemists to those with an authorised specialist’s prescription. In addition, chemists should be educated about the side effects and involved in the crackdown on the abuse of such medication.

Information regarding the side effects should be made available in all languages and across all mediums.

On a preventative scale, insurance needs to cover skin issues better (including schemes that are provided by offices for their employees). There’s still a very archaic way of thinking that skin conditions are a ‘vanity’ health issue, but there is so much published literature that shows skin conditions affect your physical and mental health, and need the support that any other chronic illness needs.

The next time someone tells you about a skin issue, don’t guide them to that one medicine your doctor prescribed to you in 2021 that worked like magic. Instead, tell them to go see a dermatologist.

Dr Deepali Bhardwaj is a dermatologist, anti-allergy specialist, laser surgeon and internationally trained aesthetician. She tweets @dermatdoc. Views are personal.

(Edited by Theres Sudeep)