Abuse of Topical Glucocorticoids among Patients Visiting Community Pharmacy in Basrah-Iraq

Abstract

Introduction: Topical glucocorticoids have been the mainstay for the treatment of many skin conditions since
their introduction due to their anti-inflammatory, anti-proliferative vasoconstrictive and immunosuppressive
properties.Availability of topical glucocorticoids in different potencies as over the counter medication in
Iraq encourages their use for non-labeled indications , thus increasing the side effect of such drugs.
Objectives: The aim of this study was toevaluate the use, knowledge of the patients and patient education
oftopical glucocorticoids.
Methodology: A cross sectional community pharmacy based survey was conducted throughout Basrah
city.Inclusion criteria were costumers visiting the community pharmacies asking for topical corticosteroids
without prescription, aging 15 years and older and willing to participate in the study.600 questionnaire
formafor topical corticosteroids were distributed in the center and the districts of Basrah city. 254 forma out
of 600 were returned out of which 212 were completed. Incomplete forma were excluded.
Result: 106 (50%) participants out of 212misused topical glucocorticoids. As a single product, Betamethasone
valerate and Clobetasol propionate was majorly used by the participants which are potent and ultra-high
potent topical steroid respectively. The major source of topical steroid prescription was relatives.49.8%
participants didn’t recognize any side effect of topical glucocorticoids while hypopigmentation was the
most side effect identified by the participants (21.8%).Only 35% of the participants,whom topical steroid
prescription source by physicians and pharmacists, was educated about the use of topical glucocorticoids.
Conclusion: Topical glucocorticoids are commonly abused in Basrah city and probably other cities of Iraq.
Looking fair and improving face appearance is a common cultural believe in Iraq that push people to seek
topical glucocorticoids from community pharmacies for skin lightening in addition to other unapproved
indications without prescription.