Local dermatologist cautions against prevalence of self-medication |17 April 2020
Photo source: Health Essentials – Cleveland Clinic
In the following interview, Dr Dusan, dermatologist at Panafricare Clinic, sheds light on the potential risks and long-term effects of using non-prescribed topical creams, lotions and ointments on our skin – a common practice both in Seychelles and around the world.
Seychelles NATION: Can you talk about these over-the-counter topical products?
Dr Dusan: There are many over the counter topical preparations in the form of creams, lotions, ointments etc. Many of these are for regular everyday use such as moisturisers for different skin types, anti-dandruff shampoos or “anti-itchy” lotions.
On the other hand, the big problem nowadays which is not only in Seychelles, is non prescribed, steroid based topicals often in combination with antibiotic or anti-fungal ingredients.
To be clear in the very beginning – all these creams separately are fantastic and extremely useful but only when prescribed according to the diagnosis.
Antibiotic creams will not help in fungal infections. Steroid creams can only worsen any skin infection. Yet again people are buying these creams over the counter in excessive amounts and often seek medical opinion once the skin is already damaged. Skin problems might look similar and familiar, and sometimes it's challenging even for experienced dermatologists to decide about the therapy.
Seychelles NATION: You mentioned that people keep buying these products; why do you think there is this tendency?
Dr Dusan: On a daily basis I see patients coming for a second opinion after using several different creams for weeks, even months without significant improvement. Most of the time they just walk in the pharmacy and buy these without consulting the doctor.
This is dangerous especially when it comes to steroid creams such as ‘Hydrocortisone’, ‘Betnovate’ or ‘Dermovate’. There is something called “potency” of steroid creams which means strength.
Every cream is completely different and depending on the potency, can be prescribed for a newborn or adult, different body sites and different durations. These creams, when used in the wrong way give a “false improvement” which can be visible for the first several days and usually follows by aggravation of the skin. This is how people fall into the trap of reapplying or even recommending a cream to their neighbours or cousins, even sharing with them.
In other countries like India, there is a strong movement among leading dermatologists to forbid selling over-the-counter steroid creams due to the severe consequences that they are experiencing at the moment. In the USA, it is forbidden to sell any steroid creams apart from low potency ones such as ‘Hydrocortisone’ but people still find a way to get them.
Seychelles NATION: You mentioned that it is best to see a dermatologist before purchasing over-the-counter topical preparations. Can you explain why?
Dr Dusan: The importance of seeing a dermatologist prior to using any of these creams is very simple – the topical will be prescribed based on the diagnosis and in order to avoid any possible side effects.
For example, there are only a few steroid creams indicated for treating babies or newborns. They are very mild (low potency). Unfortunately, much stronger creams are given to the parents and not only by pharmacists but physicians as well; this leads to further problems which we are going to discuss later. Just for you to be aware of the difference in strength between two steroid creams – ‘Clobetasol’ is 600 times more potent than ‘Hydrocortisone’.
Seychelles NATION: What are some common, long-term, negative effects of steroid creams?
Dr Dusan: There are steroid creams that should never be applied on the face with only a few exceptions. Damage can be long term and difficult to treat afterwards. Mostly people go in the sun which is hard to avoid in Seychelles. As a consequence, they develop dark pigmentations of the area where steroid creams were applied. Another issue is dermatitis / inflammation of the skin triggered by steroid creams especially on the face.
If you apply, for example, ‘Hydrocortisone’ on a ringworm / fungal infection of the skin, you will have initial relief but most of the time the fungus will spread or aggravate, and this will require oral anti-fungal medicines which we are all trying to avoid. It’s the same with applying steroid creams on any skin infection such as ‘impetigo’ for example or ‘herpes’ viral infection; it will just make everything unnecessarily worse.
If steroid creams are used continuously for weeks and months, it can lead to a very difficult situation known as “steroid dependent skin”. The skin becomes thinner and thinner, damaged, and prone to developing infections as well as many other problems.
Another important thing is to explain to people how to use the creams, especially the amount and duration. This is the second most common problem. The topical preparation is given or prescribed but patients have no instructions about the duration, amount and potential side effects of the creams.
Seychelles NATION: Would you recommend home remedies for skin problems?
Dr Dusan: I am not a big fan of home remedies for a very simple reason – I’ve seen so many people with severely damaged skin based on “home remedies” or “garden remedies”. For sure, there are some good ones, but again I don’t recommend self-treatment in any case.
Seychelles NATION: What would you advise people to do regarding any skin problems when they are unable to go to a clinic, like during the current pandemic we are facing?
Dr Dusan: People with known chronic skin diseases, especially those who I have had a chance to see, already know how and when they should use the creams given.
For those who are experiencing unknown skin problems, if they can’t visit the clinic they can always contact the doctor and exchange clinical photos and medical history – so called Teledermatology. For example, at present due to the COVID-19 pandemic, every skin centre in New York City is practicing only Teledermatology.
Panafricare Clinic is currently working on a safe online Telemedicine platform which will be available not only for the skin, but in general for any health-related problems.
Our clinic will remain open but due to the COVID-19 pandemic, we have strict measures which require booking prior to visiting the clinic. Kindly call the clinic on the number below for bookings and information.
Before we finish, I would like to point out the fact that recently I saw creams containing even 4 different medicines, all strong and potent! Please avoid these combinations and seek medical opinion prior to using any cream no matter if it is steroid/anti-fungal or anti-bacterial.
For more information:
- Telephone: 4 321 310
- Email: info@panafricare.com
- Follow ‘Panafricare Clinic by Dr Todorovic’ on Facebook
F.P.