Hot Trends of steroid modified tinea at tertiary care hospital in India
Abstract
Dermatophytes are the common fungal agents implicated in superficial skin infections worldwide, commonly known as tinea. They include species of Trichophyton, Microsporum and Epidermophyton. Infections of this organism have dramatically increased in last one decade by misuse of topical corticosteroids cream alone or in combination with topical antibacterial and antifungal agents. So this study was conducted with the aim to study about culprits (prescribers) and various offending agents. This study was conducted on 1239 consecutive patients of tinea between ages 1-70 years. Tinea was diagnosed by detailed history and clinical examination. Detailed inquiry was made for topical steroid use by recall method or relevant prescriptions. It was found that out of 1239, 1000 (80.7%) patients were using topical corticosteroid in any form. Most common age group was 21-30 years (38.3%). Pharmacist appeared as chief culprit (50.4%) and Clobetasol was major offending agent (34.8%). Majority (55.3%) of patients applied these formulations for 4 week or more. Study concluded that use of topical corticosteroids in tinea has become menace because of unethical manufacture, sales, prescription and end misuse by patient.
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Introduction
Dermatophytoses constitute a group of superficial fungal infections of keratinized tissues, namely, the epidermis, hair, and nails.1 The causative fungi are moulds belonging to three asexual genera Microsporum, Trichophyton, and Epidermophyton.2 The distribution and frequency of dermatophytosis and their etiologic agents vary according to the geographic region studied, the socioeconomic level of the population, the time of study, the climatic variations, the presence of domestic animals, and age.3
It is an indisputable fact that there is an increase in the prevalence of dermatophytosis over last one decade across the country. One of the most formidable enemies that we have encountered in the recent times is the irrational fixed drug combination (FDC) creams containing a steroid, antifungal, and antibacterial with three to five molecules in the product.4,5 The corticosteroid may be added in the initial part of the treatment and improper use of the combination creams may lead to both failure of treatment and adverse reaction.6,7
Topical corticosteroids used in combination with antifungal agents are very often potent molecules like Clobetasol propionate, they are available over the counter and are grossly abused which includes buying over the counter and applying it for weeks, months and sometimes years.8-13
Conclusion
It can be concluded from this study that majority i.e. 80.7% of tenia patients were using topical corticosteroid in any form. Pharmacist appeared as chief culprit and Clobetasol was major offending agent. Majority of patients applied these formulations for 4 week or more. Study concluded that use of topical corticosteroids in tinea has become menace because of unethical manufacture, sales, prescription and end misuse by patient.