Systemic Adverse Effects of Topical Clobetasol and Counterfeit Cosmetic Products on Iraqi Women

Section: Research Paper
Issue
Vol. 20 No. (2023): Volume 20 Issue
Published
Dec 1, 2023
Pages
201-209

Abstract

Background: Topical corticosteroids (TCs) are widely used for dermatologic diseases. Unfortunately, there exists many adverse effects (local and systemic). These adverse effects are comparable to those observed when glucocorticoids are administered systemically, but they are typically less severe. Aim: To assess the systemic adverse effects of topical clobetasol (TCL) and counterfeit cosmetic products (CCP) on Iraqi women. Methods and patients: This was a cross-sectional observational study; carried out from October 2022 to March 2023. Patients visited the outpatient clinic of the Department Dermatology and Venereology in Abu-al Khasib Hospital in Basra City, Iraq. Patients may be categorized into two distinct groups: the first group of subjects utilized TCL (n=31), while the second group consisted of patients with CCP (n=32), and the remaining participants were designated as the control group (n=35). A specialized dermatologist conducted a clinical examination to make a diagnosis. A questionnaire was collected, and blood samples were obtained for laboratory investigations. Results: TCs suppressed vitamin D (Vit-D), interlukin-6 (IL-6), testosterone, and estrogen and reduced cortisol concentrations significantly. TCs elevated red blood cells (RBC), neutrophils percent (NEU%), and hemoglobin (HB) levels significantly and prolong bleeding time. While not affecting WBCs, PLT, MPV, MCH, MCV, ACTH, or insulin levels, with decreased in HCT, MCHC, Eos%, and Lym% for all groups in comparison to control group. Conclusion: Topical corticosteroids are extensively used, mostly for the treatment of dermatological conditions. However, they can be misused for their cosmetic effects as fairness creams. TCs misuse is a big problem in Iraq, resulting in massive skin effects and systemic deterioration, such as hematological and hormonal effects. Nevertheless, the general population remains ignorant of the systemic adverse effects. Educational activities targeting the public are suggested to address the systemic deterioration.

References

  1. Al Janaby S, Al Timimy, G. Prevalence of Vitamin D Deficiency of Females in Karbala, Iraq, 2017.Kerbala Jorunal of Medicine.2020;13(1)
  2. Al Saleh Y., Beshyah S, Hussein W, Almadani A, Hassoun A, Al Mamari A, Al-Daghri N. Diagnosis and management of vitamin D deficiency in the Gulf Cooperative Council (GCC) countries: An expert consensus summary statement from the GCC vitamin D advisory board.Archives of osteoporosis.2020;15, 1-8.
  3. Alessi J, de Oliveira G, Schaan B, Telo G. Dexamethasone in the era of COVID-19: friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes.Diabetology & Metabolic Syndrome.2020;12:1-11.
  4. Alghamdi K. The use of topical bleaching agents among women: a crosssectional study of knowledge, attitude and practices.Journal of the European Academy of Dermatology and Venereology.2010;24(10): 1214-1219.
  5. Aljunaiyeh H, Naif A, Kadhim K. Non-prescription skin lightening preparations; their use & hazards in Iraq. J. Pharm. Res. Allied. Sci.2018;7(2): 209-17.
  6. Allenby C, Main R, Marsden R, Sparkes C. Effect on adrenal function of topically applied clobetasol propionate (Dermovate).Br Med J.1975;4(5997): 619-621.
  7. Ballin A, WaisbourdZinman O, Saab H, Yacobovich J, Zoldan M, BarzilaiBirenbaum S, Tamary H. Steroid therapy may be effective in augmenting hemoglobin levels during hemolytic crises in children with hereditary spherocytosis.Pediatric blood & cancer.2011;57(2): 303-305.
  8. Barnes P. New molecular targets for the treatment of neutrophilic diseases.Journal of Allergy and Clinical Immunology.2007;119(5): 1055-1062.
  9. Bhatti R, Flynn M. Adrenal insufficiency secondary to inappropriate oral administration of topical exogenous steroids presenting with hypercalcaemia.Case Reports.2012;
  10. Canalis E, Giustina A, Bilezikian,J. Mechanisms of anabolic therapies for osteoporosis.New England Journal of Medicine.2017;357(9):905-916.
  11. Danisova A, Sebkov E, Kolena J. Effect of corticosteroids on estradiol and testosterone secretion by granulosa cells in culture.Experimental and clinical endocrinology.1987;89(2): 165-173.
  12. De Nijs R. Glucocorticoid-induced osteoporosis: a review on pathophysiology and treatment options.Minerva medica.2008;99(1): 23.
  13. Devaraj N, Aneesa A, Abdul Hadi A, Shaira N . Topical corticosteroids in clinical practice.Med J Malaysia. 2019;74(2):187-9.
  14. Dhar S, Seth J, Parikh D. Systemic side-effects of topical corticosteroids.Indian journal of dermatology.2014;59(5): 460.
  15. Ference J, Last Choosing topical corticosteroids.American family physician. 2009;79(2): 135-140
  16. Giaccone V, Polizzotto G, Macaluso A, Cammilleri G, Ferrantelli V. Determination of ten corticosteroids in illegal cosmetic products by a simple, rapid, and high-performance LC-MS/MS method.International Journal of Analytical Chemistry.2017.
  17. Gras M, Verrecchia F, Uitto J, Mauviel A. Downregulation of human type VII collagen (COL7A1) promoter activity by dexamethasone: Identification of a glucocorticoid receptor binding region.Experimental dermatology.2001;10(1): 28-34.
  18. Gven A, Glmser , zgen T. Cushing's syndrome and adrenocortical insufficiency caused by topical steroids: misuse or abuse?.Journal of Pediatric Endocrinology and Metabolism. 2007;20(11):1173-1182.
  19. Hantoosh H, Mahdi M, Imran B, Yahya A. Prevalence of vitamin D deficiency in Iraqi female at reproductive age.Med J Babylon.2019;16(2):119-122.
  20. Horn E, Domm S, Katz H, Lebwohl M, Mrowietz U, Kragballe K. International Psoriasis Council. Topical corticosteroids in psoriasis: strategies for improving safety.Journal of the European Academy of Dermatology and Venereology. 2010;24(2), 119-124.
  21. Humbert P, Guichard A. The topical corticosteroid classification called into question: towards a new approach.Experimental Dermatology. 2015;24(5):393-395.
  22. Hussein I, Mansour A, Nwayyir H ,Almomin A, Alibrahim N, Alidrisi H, Alhamza A. Real-Life Data on Total Vitamin D3 (25-Hydroxyvitamin D) Concentrations in Basrah, Iraq.Biomedical & Pharmacology Journal.2021;14(4):2191-2198.
  23. Hwang J, Weiss R. Steroidinduced diabetes: a clinical and molecular approach to understanding and treatment.Diabetes/metabolism research and reviews.2014;30(2): 96-102.
  24. Jaccob A, Yaqoub A, Rahmani M. Impact of abuse of topical corticosteroids and counterfeit cosmetic products for the face: prospective demographic study in basrah city, Iraq.Current Drug Safety.2020;15(1): 25-31.
  25. Macekov Z, Kubkov A, De Sanctis J, Hajdch M. Effect of glucocorticosteroids in Diamond-Blackfan anaemia: maybe not as elusive as it seems.International Journal of Molecular Sciences.2022;23(3): 1886.
  26. Mahe A, Ly F, Aymard G, Dangou J. Skin diseases associated with the cosmetic use of bleaching products in women from Dakar. Senegal.British journal of dermatology.2003;148(3): 493-500.
  27. McKay L, Cidlowski J. Physiologic and pharmacologic effects of corticosteroids.Holland-Frei cancer medicine.2003;6.
  28. Nguyen L, Lim S, Oates T, Chung K. Increase in airway neutrophils after oral but not inhaled corticosteroid therapy in mild asthma.Respiratory medicine.2005;99(2): 200-207.
  29. Olsen E, Cornell R.. Topical clobetasol-17-propionate: review of its clinical efficacy and safety.Journal of the American Academy of Dermatology. 1986;15(2):246-255.
  30. Pasternak Y, Yarden-Bilavsky H, Kodman Y, Zoldan M, Tamary H, Ashkenazi S. Inhaled corticosteroids increase blood neutrophil count by decreasing the expression of neutrophil adhesion molecules Mac-1 and L-selectin.The American journal of emergency medicine.2016;34(10): 1977-1981.
  31. Poetker D, Reh D. A comprehensive review of the adverse effects of systemic corticosteroids.Otolaryngologic Clinics of North America.2012;43(4): 753-768.
  32. Praituan W, Rojnuckarin P. Faster platelet recovery by high-dose dexamethasone compared with standard-dose prednisolone in adult immune thrombocytopenia: a prospective randomized trial.Journal of Thrombosis and Haemostasis.2009;7(6):1036-1038.
  33. Rathi SK, DSouza P. Abuse of topical corticosteroid as cosmetic cream: a social background of steroid dermatitis. A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse. 2018;129-35.
  34. Royer B, Gruson B., Roszkiewicz F, Al Khedr A., Colson A., Marolleau J. Methylprednisolone-induced immune thrombocytopenia.Blood, The Journal of the American Society of Hematology.2010;115(26): 5431-5432.
  35. SnchezArmendriz K, GarcaGil A, Romero C, ContrerasRuiz J, KaramOrante, M, BalcazarAntonio D, DomnguezCherit J. Oral vitamin D3 5000 IU/day as an adjuvant in the treatment of atopic dermatitis: a randomized control trial.International Journal of Dermatology.2018;57(12): 1516-1520.
  36. Saraswat A. Ethical use of topical corticosteroids.A Treatise on Topical Corticosteroids in Dermatology: Use, Misuse and Abuse.2018; 73-79.
  37. Starch-Jensen, T, Deluiz D, Bruun N, Tinoco E. Maxillary sinus floor augmentation with autogenous bone graft alone compared with alternate grafting materials: a systematic review and meta-analysis focusing on histomorphometric outcome.Journal of Oral & Maxillofacial Research.2020;11(3).
  38. Stout A, Friedly J, Standaert C. Systemic absorption and side effects of locally injected glucocorticoids.PM&R.2019;11(4): 409-419.
  39. Taguchi R, Tsuchihashi K., Okumura Y, Nakano M, Yoshihiro T, Ohmura H, Baba, E. Thrombocytopenia caused by dexamethasone in a patient with colorectal cancer.Internal Medicine.2020;59(20): 2571-2575.
  40. Uva L, Miguel D., Pinheiro C, Antunes J, Cruz D, Ferreira J, Filipe P. Mechanisms of action of topical corticosteroids in psoriasis.International journal of endocrinolog.2012:,2012.
  41. Varshney I, Amin S, Adil M, Mohtashim M, Bansal R, Khan H. Topical Corticosteroid AbuseRisk Factors and Consequences.Indian Journal of Clinical Dermatology| Volume.2019;2(03).
  42. Vogel T, Verreault,R. Letter to Editor: Thrombocytopenia Following Steroid Therapy In An 83-year-old Woman.The Journals of Gerontology Series A: Biological Sciences and Medical Sciences.2002.57(8): M519-M520.
  43. Whalen K.Lippincott illustrated reviews: pharmacology. Wolters kluwer india Pvt Ltd.;2018.
  44. Whirledge S, Cidlowski J. Glucocorticoids, stress, and fertility.Minerva endocrinologica.2010;35(2); 109.
  45. Yahi D, Ojo N, Mshelia G. Effects of dexamethasone on progesterone and estrogen profiles and uterine progesterone receptor localization during pregnancy in Sahel goat in Semi-Arid region.Journal of animal science and technology.2017;59(1): 1-7.
  46. Zhang Q, Shan K, Raza A, Manda N, Nace T. A rare case report and literature review of anabolic-androgenic steroids (AAS)-induced acute myocardial infarction.2020;12(5).

Authors

Teeba H. Sagban

Ministry of Health, Maysan Health Department, Al-Kahla Hospital, Maysan, Iraq

Ausama Ayob Jaccob

Department of Pharmacology and Toxicology, College of Pharmacy, Basrah University, Basrah, Iraq

ORCID
Abdulla Ayob Yaqoub

Department of Dermatology, Abu Al-Khaseeb Hospital, Basrah, Iraq

Huda Khadim

Ministry of Health, Maysan Health Department, Al-Sader Hospital, Maysan, Iraq

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H. Sagban, T., اسامة, Ayob Jaccob, A., Ayob Yaqoub, A., & Khadim, H. (2023). Systemic Adverse Effects of Topical Clobetasol and Counterfeit Cosmetic Products on Iraqi Women. Iraqi Journal of Pharmacy, 20, 201–209. Retrieved from https://rjps.uomosul.edu.iq/index.php/iphr/article/view/21549