1992
39,256
1993
37,274
1994
35,257
1995
34,366
1996
33,252
The table above clearly shows spending on topical steroids decreased steadily once the link between medical practices and pharmacies was removed.
22.5 The Media and Topical Steroid Use in Japan
Due to the issues with the NHI system and the previous drug price margin, overprescribing of medications was a hot topic in the Japanese media in the 1980s and 1990s. In 1992, the “News Station”, a popular show in Japan, discussed the issue of overprescribing topical steroids. Dr. Takehara criticised the show repeatedly for their negative attitude towards the use of topical steroids. His views were widely published in newspaper articles, magazines, books and journals. He was particularly scathing towards the broadcaster of this programme for closing the programme with the line: “We know that, in the end, these topical steroids are drugs that will be used to the bitter end”. However, the comment had actually been made by a pharmacology professor. Dr. Takehara later coauthored the Japanese Dermatological Association’s atopic dermatitis guidelines.
22.6 Medical Malpractice Claims Regarding Topical Steroid Prescribing
Patients in Japan have sued over the management of their dermatological condition. The Kawasaki Steroid lawsuit [1] became famous. In this case, the patient experienced rosacea-like dermatitis to her face secondary to topical steroid use. Topical steroids had been prescribed over several years by multiple doctors in different medical facilities. The patient ultimately lost the case. Here is an extract of the expert opinion provided by Dr. Kawashima from Tokyo Women’s Medical University:
It is easy for dermatologists to diagnosis atopic dermatitis if they focus on the itching, the characteristic skin eruption and the chronic clinical course. We believe misdiagnosis of this condition by a dermatologist with sufficient training is very unlikely. However, from the latter half of 1975, an increase in the number of patients with conspicuous facial erythema was observed and a diagnosis of atopic dermatitis was possible by considering skin eruptions at other sites. There is no consensus in determining whether facial lesions are (a) side effects of topical steroids, (b) the concomitant presence of atopic dermatitis and side effects or (c) symptoms of atopic dermatitis. We need to make clinical decisions based on the patient’s history—including drug use history, current symptoms and examination findings. At that time, this facial erythema was suspected to be rosacea-like dermatitis, which was commonly seen in patients who had used topical steroids like make-up to healthy skin, but the facial skin eruptions in this condition and those in rosacea-like dermatitis are different. The former are eczematous lesions, while the latter are a mixture of acne and pustules and characterised by a burning sensation rather than itching. Most of the facial symptoms seen in this patient were of atopic dermatitis and we believe they should be considered to represent a case of atopic dermatitis.Related posts:
Evolution and Development of Topical Corticosteroids
Topical Corticosteroids: Pharmacology
Systemic Side Effects of Topical Corticosteroids
Use and Misuse of Topical Corticosteroid in Genital Dermatosis
Topical Corticosteroid Abuse: Southeast Asia Perspective
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