Publication:

Comparative study of topical steroid misuse in urban and rural patients: public health implications

Background Topical corticosteroids are widely used for a variety of dermatological conditions, but their irrational and unsupervised use has become a major public health concern, particularly in low- and middle-income countries. Misuse can lead to adverse effects such as tinea incognito, steroid-induced acne, skin atrophy, and other cutaneous complications. This study aimed to compare the prevalence, patterns, sources, potency, duration, and adverse effects of topical steroid misuse between urban and rural patients.

Methods This cross-sectional comparative study was conducted from July 2025 to December 2025, in the dermatology outpatient department at Mymensingh Medical College Hospital, Mymensingh, Bangladesh to assess topical steroid misuse in urban and rural populations. A total of 102 patients were enrolled, divided into urban (n=52) and rural (n=50) groups.

Results Urban patients mainly misused topical steroids for acne (34.6%), while rural patients primarily used them for fungal infections (44%, p 3 months) were significantly higher in rural patients (36% and 68%, respectively, p<0.05). Adverse effects differed by setting, with tinea incognito more frequent in rural patients (44%, p=0.01) and steroid-induced acne more common in urban patients (30.8%, p=0.048); other complications showed no significant differences.

Conclusions Topical steroid misuse is common across both urban and rural populations, with rural patients tending to use steroids for longer periods, depending more on pharmacists, and experiencing more fungal-related complications, whereas urban patients primarily misuse them for acne treatment and cosmetic purposes.