Topical Steroid Misuse Among Rural Masses.

Sir,

This is in reference to the Original Article “Prevalence of topical steroid misuse among rural masses” published in the Indian Journal of Dermatology 2016;61:119.[1] I read this article with great interest and wholeheartedly appreciate the authors for their sincere efforts. But, there are a few points in this study that concern me and should have been taken care of, in order to make it more informative for the readers.

First of all, the methodology of the study is not clear. The authors have not clearly mentioned whether they focused on misuse of topical steroids only or topical depigmenting agents or any topical product in general. The phrase “topical products/steroids” has been repeatedly used throughout, while in inclusion criteria it is mentioned that patients were enquired about the unsupervised use of any “cosmetic product.” Hence, it is difficult to understand the exact aims and objectives of this study.

Second, in this study, patients were shown pictures of “most commonly used topical steroids and depigmenting agents available in the market,” which are mentioned later in the results as creams A through M, that is, only 13 products. But at present, hundreds of such topical products (whether topical steroids or others) are available and being used by the public. Limiting the study to only 13 of such products would definitely result in a false low prevalence of their misuse. This is possibly seen in the present study too, as only fifty cases were included in the study over a period of 3 months. This can further be elucidated if the authors kindly provide the total number of outpatient department (OPD) patients during the study period.

Moreover, the results could have been more informative for the readers, if the names and/or exact composition of these 13 products were mentioned. It would help to assess the potency of steroids used and nonsteroidal components, such as antibiotics, antifungals, tretinoin, and hydroquinone, since these are some of the very commonly available combinations. Furthermore, the authors have not mentioned anything about the adverse effects of these topical preparations noted in their study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.