Topical Steroid: A Study on Awareness, Misuse and Perceptions Among Patients and Pharmacists

Topical corticosteroids (steroids) are one of the most widely prescribed and effective treatments for a variety of dermatological conditions, including eczema, psoriasis, dermatitis and allergic reactions. These medications, which are synthetic derivatives of corticosteroid hormones, act by reducing inflammation, suppressing immune responses and controlling symptoms such as redness, swelling and itching in the skin. Topical steroids are applied directly to the affected area, offering targeted relief with minimal systemic absorption.[1] They are available in different potencies, ranging from mild to super potent with various formulations, including creams, ointments, lotions and gels, designed to suit specific types of skin conditions. The choice of potency and formulation is often determined by the severity of the condition and the area of skin affected. Despite their effectiveness, the use of topical steroids has been associated with potential side effects such as skin thinning, delayed wound healing and the development of conditions like steroid-induced rosacea or perioral dermatitis. Long-term or excessive use can also lead to complications, making the optimal use of these medications a subject of ongoing research and clinical scrutiny.[2] This research project aims to examine the clinical applications of topical steroids, focusing on their efficacy, safety and the long-term impact on patients' skin health. The study will also explore alternative treatment strategies to mitigate the risks associated with their use. Understanding these aspects is crucial for improving treatment outcomes, ensuring patient safety and optimizing therapeutic strategies for managing chronic inflammatory skin diseases. By investigating the clinical practices surrounding topical steroid use, this research intends to contribute to better guidelines and enhance pharmacy practice in dermatology.[3]

Types of topical steroid

1. Creams and ointments
2. Nose (nasal) sprays
3. Nose drops
4. Eye drops or ointments
5. Ear drops
6. Preparations which can be inserted into the rectum

Classification

Pharmacological Properties and Mechanism of Action

TCs function by modulating inflammatory responses through the suppression of pro-inflammatory cytokines and the inhibition of inflammatory cell migration. Their efficacy is largely attributed to their ability to penetrate the skin barrier and bind to glucocorticoid receptors, leading to the transcriptional regulation of target genes involved in inflammation.[3]

Indications for Use

These agents are indicated for a wide array of dermatological conditions, including:?

• Atopic dermatitis
• Psoriasis?
• Seborrheic dermatitis?
• Eczema
• Lichen planus? [4]

Adverse Effects

• Local Effects: Skin thinning (atrophy), striae, telangiectasia, hypopigmentation, and delayed wound healing.

• Systemic Effects: Potential suppression of the hypothalamic-pituitary-adrenal (HPA) axis, leading to adrenal insufficiency. [5,6]

METHODOLOGY

Estimated sample size – 100 people Basic statistical tool- Frequencies and Percentages, Mean, Median, Mode, Standard Deviation (SD)are proposed to be used in this study.[7,8]

Questionaries

Comparative Study

Parameter Analyzed for this Study are as follows

1. Age group
2. Profession
3. Prescription
4. Frequency of topical steriod use
5. Steroid purpose insights
6. Source of Information
7. Perception of long-term skin damage from topical steroid misuse
8. Side effects
9. Misuse of topical steroid
10. Guidance of healthcare professional on topical steroid
11. Raising awareness about topical steroid 
12. Effective approches to educate patients on TcS usage

Study Population: 114 Participant.

1. Age Group

The table presents the distribution of participants across different age groups in the study on awareness and misuse of topical steroids among patients and pharmacists. The majority of participants (75.4%) fall within the 18–24 age group, indicating that young adults form the primary demographic of this study. The 25–34 age group constitutes 13.2%, followed by the 35–44 age group with 10.5%. Only a small fraction (0.9%) of participants belong to the 45+ age group. This data highlights that the younger population is the most represented, which may influence the patterns of awareness and misuse analyzed in the study.

Table No 1. Age Group

Fig 1. Age Group

The table presents data on the distribution of responses collected from various groups based on their profession in a study about awareness and misuse of topical steroids. The majority of responses were recorded from pharmacists, who constituted 60.2% of the total participants (65 responses). Patients accounted for 33.3% of the responses, with 36 participants. Doctors formed the smallest group, contributing only 6.5% of the responses (42 participants). This distribution highlights that pharmacists play a crucial role in the supply and guidance regarding topical steroids. However, the significant percentage of patients indicates the need to focus on direct consumer education to reduce misuse. The relatively smaller proportion of doctors emphasizes their involvement in ensuring correct prescriptions and guidance for such medications.

Table No 2. Profession

Fig 2. Profession

Topical Steroid Prescription provides insights into the prescription practices of topical steroids among participants. The findings reveal that 43.4% of the respondents (49 individuals) reported receiving prescriptions for topical steroids, while the remaining 56.6% (64 individuals) indicated that they had not received such prescriptions. This indicates that a significant proportion of participants had not been prescribed topical steroids, which may reflect a gap in the regulated use or a preference for over-the-counter availability of these medications.

Table No 3. Prescription

Fig 3. Prescription

The table illustrates the distribution of responses regarding the frequency of topical steroid use among the surveyed individuals. A significant proportion of participants (47%) reported that they had never used topical steroids. However, 42% admitted to occasional usage, indicating potential sporadic or situational reliance. Weekly usage was noted by 9% of the participants, while only 0.9% reported daily application, reflecting a small but concerning group with frequent usage. Additionally, 1.1% of respondents chose not to answer the question.

Table No 4. Frequency Of Topical Steroid Use

Fig 4. Frequency Of Topical Steroid Use

A survey was conducted to assess the level of awareness regarding the main purpose of topical steroids among patients and pharmacists. A total of 114 responses were collected. Of these, 76 participants (66.7%) acknowledged awareness of the purpose of topical steroids, indicating a relatively high level of knowledge. However, 34 participants (29.8%) reported not being aware of their main purpose, highlighting a gap in understanding. Additionally, 4 respondents (3.5%) did not provide a response to the question. These results suggest that while a majority of participants have an understanding of topical steroids, there remains a significant portion with limited knowledge or awareness, which may contribute to misuse or improper application of these medications.

Table No 5. Steroid Purpose Insights

Fig 5. Steroid Purpose Insights

The chart highlights the sources of information regarding topical steroid usage among patients and pharmacists. The majority of respondents (41, 35.9%) reported that they rely on doctors or healthcare providers for guidance, making them the primary source of information. Pharmacists were the second most common source, cited by 32 respondents (28.6%). Additionally, 19 participants (16.3%) turned to the internet for information, while 17 respondents (14.9%) relied on family and friends. A smaller proportion, 3 respondents (2.6%), sought information from social media, and 2 respondents (1.7%) did not provide an answer

Table No 6. Source of Information

Fig 6. Source of Information

The chart shows that 51.3% of respondents are aware of long-term skin damage from topical steroid misuse, 35.9% are unsure, 12% deny the risk, and 0.8% did not respond. This highlights the need for better awareness and education on the safe use of topical steroids among patients and pharmacists.

Table No 7. Perception of Long-Term Skin Damage from Topical Steroid Misuse

Fig 7. Perception of Long-Term Skin Damage from Topical Steroid Misuse

The data highlights the occurrence of side effects from topical steroid use among patients and pharmacists. While 77.3% of respondents reported no side effects, 20.1% experienced adverse effects, and 2.6% did not disclose their experience. This emphasizes the need for increased awareness and proper guidance to minimize risks associated with topical steroid misuse.

Table No 8. Side effects

Fig 8. Side effects

The data illustrates the misuse of topical steroids among patients and pharmacists. While 77.3% of respondents denied misuse, 21.1% admitted to it, and 1.6% chose not to respond. This indicates that a significant minority engages in improper use, emphasizing the need for targeted awareness campaigns and stricter guidance from healthcare providers to prevent misuse.

Table No 9. Misuse of topical steroid

Fig 9. Misuse of topical steroid

The survey on topical steroid awareness highlights a concerning knowledge gap. When asked if healthcare professionals adequately inform patients about proper use, opinions were divided: 34.2% believed they do, 29.8% thought they don't, and 36% were uncertain. This ambiguity underscores the need for enhanced patient education and awareness initiatives to ensure safe and effective topical steroid use.

Table No 10. Guidance of healthcare professional on topical steroid

Fig 10. Guidance Of Healthcare Professional on Topical Steroid

An overwhelming 78.9% of respondents advocated for increased public awareness campaigns about the risks of topical steroid misuse, highlighting a strong demand for education and prevention efforts. In contrast, only 6.3% disagreed, while 14% remained uncertain, and 1 respondent didn't answer. This resounding call to action underscores the need for targeted awareness initiatives to inform the public about the potential dangers of topical steroid misuse.

Table No 18. Raising awareness about topical steroid

Fig 19. Raising Awareness About Topical Steroid