面部滥用皮质类固醇：皮肤科门诊患者的前瞻性、多中心研究。
Topical corticosteroid abuse on the face: a prospective, multicenter study of dermatology outpatients.
机构信息
Indushree Skin Clinic, Lucknow, India.
出版信息
Indian J Dermatol Venereol Leprol. 2011 Mar-Apr;77(2):160-6. doi: 10.4103/0378-6323.77455.
BACKGROUND
Abuse of topical corticosteroids (TC), especially over the face, is prevalent worldwide, including in India. Data about the magnitude of this problem in our country is lacking.
AIMS
The aims of this study were to ascertain the demographics, magnitude and clinical features of TC misuse on the face in the dermatology outpatient department (OPD) attendees in order to raise awareness about this problem and to analyze its causes.
METHODS
This was a prospective multicenter questionnaire-based clinical study conducted at 12 dermatology centers nationwide. Patients with relevant facial dermatoses reporting to the investigator were asked about their current use of over-the-counter topical formulations and a structured questionnaire applied in case the same was confirmed to be TC.
RESULTS
A total of 2926 patients with facial dermatoses were screened, of which 433 (14.8%) were using TC. TC was used as a fairness/general purpose cream or aftershave in 126 (29%) and in 104 (24%) for acne. Steroid combinations were used by 258 (59.6%). Potent and super-potent TC were significantly (P = 0.05) more frequently used by the rural/suburban population. The younger age groups used more potent formulations. A non-physician recommendation for TC use was obtainable in 257 (59.3%) patients. Of these, 232 (90.3%) were for potent/super-potent steroids. Among 176 physician prescriptions, 78 (44.3%) were from non-dermatologists. All non-physician prescriptions and 146 (83%) physician prescriptions for TC were inappropriately refilled. Adverse effects were seen in 392 (90.5%) TC users. Acne/exacerbation of acne was the most common adverse effect.
CONCLUSIONS
TC misuse in patients with facial dermatoses is quite common, and most of this use is unwarranted. Use as a fairness cream is the most common indication in this cohort.
LIMITATIONS
This was an OPD-based study and, therefore, it may or may not accurately reflect the community data.
背景
滥用外用皮质类固醇（TC），特别是在面部，在全球范围内都很普遍，包括在印度。关于我们国家这个问题的严重程度的数据是缺乏的。
目的
本研究的目的是确定皮肤科门诊（OPD）就诊者面部 TC 滥用的人口统计学、严重程度和临床特征，以提高对这一问题的认识，并分析其原因。
方法
这是一项在全国 12 个皮肤科中心进行的前瞻性多中心基于问卷的临床研究。向调查员报告有相关面部皮肤病的患者被问及他们目前使用的非处方外用制剂，如果证实是 TC，则会使用结构化问卷。
结果
共筛选出 2926 例面部皮肤病患者，其中 433 例（14.8%）正在使用 TC。TC 被用作美容/通用面霜或须后水的有 126 例（29%），用于治疗痤疮的有 104 例（24%）。使用皮质类固醇联合制剂的有 258 例（59.6%）。强效和超强效 TC 更频繁地被农村/郊区人群使用（P=0.05）。年龄较小的群体使用更有效的制剂。257 例（59.3%）患者可以获得非医师推荐使用 TC，其中 232 例（90.3%）为强效/超强效皮质类固醇。在 176 份医生处方中，有 78 份（44.3%）来自非皮肤科医生。所有非医师处方和 146 份（83%）医师处方中的 TC 都被不当续方。392 例（90.5%）TC 使用者出现了不良反应。痤疮/痤疮加重是最常见的不良反应。
结论
在面部皮肤病患者中，TC 滥用相当普遍，而且大多数使用都是不必要的。作为美容霜使用是这一人群中最常见的指征。
局限性
这是一项基于 OPD 的研究，因此它可能准确或不准确地反映社区数据。
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