Combating Topical Corticosteroids Abuse at the Community Level

Level

Issue involved

Action needed

Bureaucratic red tape

• Loopholes in schedule H permitting over-the-counter sale of TCs

Modify the schedule

• Approval of irrational drug combinations containing TCs

Ban such combinations

• Inability to stop indiscriminate sale of TCs as OTC products at chemists

Better supervision and check

Pharmaceuticals

• Marketing scientifically unethical combinations

Pressure to be brought to prevent manufacture of such combinations

• Advertisement of TC containing products as fairness creams

Boycott of such rogue companies by doctor community

Prescribers

• Dermatologists: incomplete prescriptions or counselling

Education, lectures, meetings

• Non-dermatologists: not aware of norms of TC use

Education

• Quacks: no knowledge about TCs

Education and punitive action

Chemists

• All TCs are sold as OTC products

Education supervision by drug inspectors

• Salesmen considered as medical advisors by patients

• Sell TCs of all potencies for wrong indications

• Promote TCs as fairness creams

Patients

• Apply TCs on advice of friends, neighbours or relatives

Education through counselling, brochures, social, visual and print media

• Apply TCs in diseases which are not steroid responsive or may be aggravated by TCs

• Repeat TC prescriptions indefinitely

• Apply potent TCs of all potencies for melasma

Laymen other than patients

• Misuse of TCs as fairness creams

Education through brochures, social, visual and print media

33.3.1 Dermatologists

It is obvious that dermatologists are primary stakeholders. They prescribe the steroids maximum and they know the steroids and perhaps also abuse them. Surprisingly, this has proved to be a challenge, partly because of attitude and partly because of compulsions of practices. The reasons are as follows:

a.

Many dermatologists don’t think that this is an important area. They feel it is much ado about a small thing and there are different, more pressing areas such as leprosy, eczema, cancer, vitiligo, HIV infection, etc.
b.

They find fixed drug combinations (FDCs) as useful tools in practice.
c.

They feel, somewhat smugly, they can convince patients about rational use of these combinations.
d.

They also feel that highlighting the issue will lead to steroid phobia.
e.

Lastly, they feel they are the best judges of what they do and resent suggestions for change in practice styles.