SKIN-TALK

Twenty-five-year Sucharita Sanyal had been using a common skin creamfor her pimples till they turned bigger, spread all over face and started bleeding. She stopped using the ointment but it aggravated the rashes even further. Her condition dramatically, though temporarily, improves if she applies that cream again. But again turns horrible the moment she stops using the cream. Her condition was eventually diagnosed as Topical Steroid Damaged Face (TSDF) which is triggered by continuous use of strong topical steroids on face. Indiscriminate uses of such creams have resulted in more than 30,000 people in Kolkata and surrounding areas suffering from this ailment, which is not fatal but can’t be cured easily. A study conducted by the Indian Association of Dermatologists, Venerologists and Leprologists (IADVL), a 6500 member strong organization, in 12 Indian cities reveal some disturbing facts. The survey was conducted in various centers in Kolkata, Chennai, Bangalore, Lucknow, Baroda, Pune, Udaipur, Dibrugarh, Aligarh and Coimbatore. The study has been published in Indian Journal of Dermatologists, Venereologists and Leprologists(IJDVL). It showed that most patients had used steroid-laden ointments like Betnovate C and N, Tenovate, Lobate, Melacare or Quadriderm which are available without a prescription. "In most of the cases these medicines were wrongly used to treat dark patches on face or to cure pimples. These medicines have a high steroid content that may turn the skin thinner, give rise to steroid dependence, increase the pimples or rashes for which you might have been using them, actually aggravate. Other serious complications like hirsutism(unwanted hair growth on face in females), perioral dermatitis, rosacea etc can also develop. The side-effects could even be systemic. Unfortunately, these creams and ointments are available over the counter without a prescription by any specialists in India, which is not the case anywhere else in the world," said Koushik Lahiri, consultant dermatologist and a senior member of the IADVL. Other than Dr. Koushik Lahiri, senior dermatologists from the city like Dr. Arijit Coondoo and Dr. Saumya Panda were also associated with this study. The association plans to approach the union health ministry and the department of pharmacy to try and press for restrictions on the sale of creams and ointments that contain potent steroids. Experts, however, argued that they had nothing against steroids that were essential for treating several skin ailments. A proper dose prescribed by dermatologists is beneficial. "But few choose to seek advise before applying these ointments which are meant for diseases like eczema and psoriasis and need to be used in a controlled way. These tubes are sold in millions and since they come under the umbrella of DPCO (Drug Price control order) they are available at a throwaway price. So, the misuse becomes even more rampant," explained Lahiri. Since drug rules prohibit over-the-counter sale of potent topical steroids internationally, this entity is virtually unknown in developed countries and naturally there is no prescribed treatment for this problem. "We have been groping in the dark and have been forced to devise our own treatment regime based on experience. Generally, we taper off the ointments rather than taking them off in a go for that leads to withdrawal effects on the skin. It is similar to the de-addiction or rehabilitation programme that drug addicts go through. But the treatment norms are still evolving," added Lahiri. The IADVL will launch a public awareness campaign in all the states of the country to keep people away from over-the-counter purchase of skin ointments containing potent steroid. "It could be difficult unless we have a law to fall back on but we must start the campaign for the sake of the millions who are falling prey to TSDF due to their ignorance," said Lahiri.