Abuse of topical corticosteroids in India: Concerns and the way forward

Topical corticosteroids (TCs) are among the most commonly used medications in dermatology clinics.[1] They are highly efficacious drugs which are used for the treatment of varied autoimmune and inflammatory dermatological conditions.[1,2] In India, the annual sales figure of TCs was 14 billion rupees in 2013, which accounts for almost 82% of total dermatological product sale in the country.[3] Prescription of TC has become ubiquitous with dermatologists and concerns have also been raised regarding its misuse for non‑labeled indications. As per the information available on the Central Drugs Standard Control Organization (CDSCO) website regarding approved dermatological indications of TC (although indications are not mentioned for all the TC molecules), its off‑label use seems to be a common clinical practice in India [Table 1].[4,5] However, the more serious concern is its inappropriate use in symptomatic treatment for varied dermatological disorders like acne, primary bacterial and fungal infections, undiagnosed skin rash and as fairness cream by non‑registered practitioners or on the advice of pharmacist at chemist shops.[6‑8] These people are not qualified and competent to treat dermatological disorders and prescribe topical steroids which often provide quick symptomatic relief without treating the underlying pathology of the disease. Ironically, the Indian market is flooded with several fixed‑dose combinations (FDCs) of corticosteroids with antibacterial and fungal agents, which in no way can be considered as scientific and rational. Incidentally, two of such irrational FDCs of corticosteroids, antibacterial and antifungal agents, were the top selling formulations of TCs in India in 2013