{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:27:53Z","timestamp":1792290473933,"version":"4.4.0"},"reference-count":21,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T00:00:00Z","timestamp":1589760000000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Current evidence indicates an alarming increase in topical steroid (TS) misuse in India. Data regarding the magnitude and characteristics of this problem in rural India, where 68% of the population resides, are insufficient. This study analyses the magnitude, causes, characteristics and consequences of TS misuse in rural India. It also examines the association between TS misuse and patients\u2019 perception of skin disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A mixed-method observational study was conducted among the attendees of the dermatology outpatient department in a rural North Indian hospital. Those with a history of TS misuse were analysed for behaviour patterns and outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 723 patients, 213 (29.2%) misused TS. Clobetasol propionate (58.2%) was most commonly misused. Seventy brands of inappropriate fixed drug combination steroid creams were recovered from the patients. Pharmacists and local healers together contributed to 78% of the sources for steroid misuse. Almost 58% of participants perceived their skin conditions to be allergic reactions to food, when in fact 70.1% were tinea, 10% scabies and 9% acne. Eighty per cent of the respondents having tinea had tinea incognito and 97% had extensive lesions. Eighty-five per cent of the participants with scabies had atypical lesions and 80% with acne had steroid rosacea or aggravation of acne. The median expenditure incurred in purchasing these potentially harmful steroid creams was Rs 1000 (US$14.1, equivalent to 3 days\u2019 wages of a labourer).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Steroid misuse is a problem of epidemic proportion in rural India. This practice is changing the profile of many common and infective skin conditions, which portends diagnostic dilemmas and therapeutic challenges for clinicians. Misconceptions about skin disease drive the public to seek \u2018quick fixes\u2019 from non-allopathic providers who have unrestricted access to potent steroids. There is an urgent need to tighten regulatory controls over the manufacturing, sale and prescription of irrational TS combinations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-032829","type":"journal-article","created":{"date-parts":[[2020,5,19]],"date-time":"2020-05-19T05:44:57Z","timestamp":1589867097000},"page":"e032829","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Magnitude, characteristics and consequences of topical steroid misuse in rural North India: an observational study among dermatology outpatients"],"prefix":"10.1136","volume":"10","author":[{"given":"Molly","family":"Thomas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Celestine C","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2543-7578","authenticated-orcid":false,"given":"Pam","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Grills","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,18]]},"reference":[{"key":"2020051902442599000_10.5.e032829.1","doi-asserted-by":"publisher","DOI":"10.4103\/2229-5178.142483"},{"key":"2020051902442599000_10.5.e032829.2","doi-asserted-by":"publisher","DOI":"10.4103\/ijd.IJD_206_17"},{"key":"2020051902442599000_10.5.e032829.3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.4103\/0976-500X.179364","article-title":"Abuse of topical corticosteroids in India: concerns and the way forward","volume":"7","author":"Kumar","year":"2016","journal-title":"J Pharmacol Pharmacother"},{"key":"2020051902442599000_10.5.e032829.4","doi-asserted-by":"publisher","DOI":"10.4103\/0378-6323.77455"},{"key":"2020051902442599000_10.5.e032829.5","doi-asserted-by":"crossref","first-page":"259","DOI":"10.4103\/2229-5178.185492","article-title":"Misuse of topical corticosteroids on the face: a cross-sectional study among dermatology outpatients","volume":"7","author":"Jha","year":"2016","journal-title":"Indian Dermatol Online J"},{"key":"2020051902442599000_10.5.e032829.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h6079"},{"key":"2020051902442599000_10.5.e032829.7","article-title":"Topical corticosteroids abuse: a clinical study of cutaneous adverse effects","volume":"62","author":"Meena","year":"2017","journal-title":"Indian J Dermatol"},{"key":"2020051902442599000_10.5.e032829.8","first-page":"FC16","article-title":"Topical corticosteroid misuse: the scenario in patients attending a tertiary care hospital in New Delhi","volume":"10","author":"Mahar","year":"2016","journal-title":"J Clin Diagn Res"},{"key":"2020051902442599000_10.5.e032829.9","doi-asserted-by":"crossref","first-page":"618","DOI":"10.4103\/0019-5154.193666","article-title":"Topical steroid awareness and abuse: a prospective study among dermatology outpatients","volume":"61","author":"Nagesh","year":"2016","journal-title":"Indian J Dermatol"},{"key":"2020051902442599000_10.5.e032829.10","doi-asserted-by":"crossref","first-page":"326","DOI":"10.4103\/ijdvl.IJDVL_297_16","article-title":"Clinico-epidemiological study of tinea incognito with microbiological correlation","volume":"83","author":"Dutta","year":"2017","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2020051902442599000_10.5.e032829.11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.3315\/jdcr.2017.1240","article-title":"Misuse of topical corticosteroids on facial skin. A study of 200 patients","volume":"11","author":"Sharma","year":"2017","journal-title":"J Dermatol Case Rep"},{"key":"2020051902442599000_10.5.e032829.12","doi-asserted-by":"crossref","first-page":"436","DOI":"10.4103\/2229-5178.142486","article-title":"Misuse of topical corticosteroids: a clinical study of adverse effects","volume":"5","author":"Dey","year":"2014","journal-title":"Indian Dermatol Online J"},{"key":"2020051902442599000_10.5.e032829.13","unstructured":"Government of India, census, 2011. Available: http:\/\/censusindia.gov.in"},{"key":"2020051902442599000_10.5.e032829.14","unstructured":"Jann B , Schaeper H . MRTAB: Stata module to compute one- and two-way tables of multiple responses,\" Statistical Software Components S437201. Boston College Department of Economics, 2004."},{"key":"2020051902442599000_10.5.e032829.15","doi-asserted-by":"crossref","first-page":"137","DOI":"10.4103\/ijph.IJPH_318_15","article-title":"Use of skin-lightening products among outpatient attendees in a North Indian Hospital","volume":"61","author":"Wong","year":"2017","journal-title":"Indian J Public Health"},{"key":"2020051902442599000_10.5.e032829.16","doi-asserted-by":"crossref","first-page":"281","DOI":"10.4103\/ijdvl.IJDVL_224_17","article-title":"The menace of dermatophytosis in India: the evidence that we need","volume":"83","author":"Panda","year":"2017","journal-title":"Indian J Dermatol Venereol Leprol"},{"key":"2020051902442599000_10.5.e032829.17","doi-asserted-by":"publisher","DOI":"10.1111\/myc.12878"},{"key":"2020051902442599000_10.5.e032829.18","article-title":"Prevalence of topical steroid misuse among rural masses","volume":"61","author":"Sinha","year":"2016","journal-title":"Indian J Dermatol"},{"key":"2020051902442599000_10.5.e032829.19","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.4103\/jfmpc.jfmpc_410_19","article-title":"A multicentric cross-sectional study to characterize the scale and impact of polypharmacy in rural Indian communities, conducted as part of health workers training","volume":"8","author":"Balaji","year":"2019","journal-title":"J Family Med Prim Care"},{"key":"2020051902442599000_10.5.e032829.20","doi-asserted-by":"crossref","first-page":"451","DOI":"10.4103\/0019-5154.139870","article-title":"Topical corticosteroid misuse: the Indian scenario","volume":"59","author":"Coondoo","year":"2014","journal-title":"Indian J Dermatol"},{"key":"2020051902442599000_10.5.e032829.21","doi-asserted-by":"publisher","DOI":"10.4103\/0378-6323.132246"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-032829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T20:29:20Z","timestamp":1722889760000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-032829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,18]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/bmjopen-2019-032829"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-032829","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}