Hypothalamus-pituitary-adrenal axis (HPA axis) suppression with inappropriate use of steroids in recalcitrant dermatophytosis - A cross-sectional study.

Abstract

Improper use of over-the-counter (OTC) steroid medication has been linked to recalcitrant dermatophytosis. There is proven evidence of HPA axis suppression by the use of long-term oral steroids. This study aims to determine the prevalence and pattern of inappropriate OTC steroid use and its effects on the hypothalamus-pituitary-adrenal (HPA) axis in adults with recalcitrant dermatophytosis. This cross-sectional study of 2 months was conducted in a hospital setting and included patients of recalcitrant dermatophytosis with a history of OTC steroid use. Clinico-demographic details and basal serum cortisol levels were recorded in all and analyzed. Of a total of 103 patients, 59.22% (<i>n</i> = 61/103) were males, and the mean duration of steroid abuse was 17.78 months. About 48.54% (<i>n</i> = 50/103), 3.88% (<i>n</i> = 4/103), and 47.57% (<i>n</i> = 49/103) patients reported the use of topical steroids, oral steroids, and both oral and topical steroids, respectively. Among all the topical steroid users (<i>n</i> = 99), clobetasol propionate 48.48% (<i>n</i> = 48/99), while among oral steroid users (<i>n</i> = 53), prednisolone 45.28% (<i>n</i> = 24/53) were the most commonly used agents, respectively. The morning serum cortisol levels (8-9 AM) were found to be decreased in 42.7% (<i>n</i> = 44/103), with a mean value of 44.28 ± 17.34 μg/dL. Improper OTC steroid use in recalcitrant dermatophytosis leads to HPA axis suppression. This highlights the need for intervention from apex health officials.