Side effects include pigmentation and breakdown of the skin, small and widened blood vessels on the skin, as well as bacterial and fungal infections. Misuse can lead to resistance of infections that can make these difficult to diagnose and treat.

"Indian doctors are witnessing a pandemic of adverse effects induced by topical corticosteroids," consultant dermatologist Shyam Verma said in an article published in the journal The BMJ, formerly the British Medical Journal.

Another problem that leads to the inappropriate use of topical steroids is that too few specialist dermatologists are available.

The majority of India's some 8,500 dermatologists are based in cities, while most of India's population are dispersed in villages, Verma said.

"So many patients seek treatment for skin disease from primary care providers, including thousands of ayurvedic and homeopathic practitioners and unqualified charlatans," he explained.

"Although it is illegal, they may prescribe topical corticosteroids with little or no knowledge of dermatology," Verma said, adding that many pharmacists "sell steroid creams without a prescription, ignoring the box warnings.


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