Disregarded misuse of irrational corticosteroid cocktails and recalcitrant fungal infections

Indian market is flooded with several fixed-dose combinations (FDCs) of corticosteroids with one or more broad spectrum antimicrobial (antifungal and antibacterial) agents which under no circumstances can be considered as rational. In 2013, such 2 irrational steroid cocktails were the highest selling corticosteroids in the country. This haphazard use of topical corticosteroid preparations is triggering off recalcitrant infections, distorting clinical diagnoses and is indubitably a public healthconcern. Indian Dermatologists are witnessing an epidemicof fungal infections. The current alarming situation of emerging chronic, recurrent or recalcitrant dermatophytosis haunts the country. Fungal infections that were easily manageable are now resistant – with even the most potent antifungal creams failing to treat them. A big concern surrounding topical steroid cocktails i.e. fixed dose combination of a steroid and one or more antimicrobial agent(s), is the reduction of local cellular immunity that is vital to curb dermatophytes. This paves the way to recalcitrant mycosis and other atypical presentations. The daunting dearth of comparative clinic-epidemiological data necessitates dire need for well-designed large-scale studies to combat this dermatophytosis epidemic in India.