Patients can purchase several prescription-strength topical corticosteroids without a prescription in many cities across the US, according to the authors of a recent research letter published in the Journal of the American Academy of Dermatology.
While the FDA has only approved 1 topical corticosteroid, hydrocortisone, for over the counter use, “patients frequently present to dermatology clinics using prescription-strength topical corticosteroids without a prescription,” the authors said. In order to evaluate the prevalence of readily available high potency steroids, the authors went to 80 stores specializing in foreign imports in 13 cities across the US to identify topical medicaments. Of these stores, 36 (35%) sold 1 or more prescription-strength topical corticosteroids without requiring a prescription.
The authors found 30 distinct prescription-strength topical steroids available, which included clobetasol propionate 0.025% to 0.05% (n=8), in combination with neomycin (n=1), ketoconazole/tolnaftate (n=1), or ketoconazole (n=1); betamethasone dipropionate 0.05% to 0.12% (n=10), in combination with gentamicin/clotrimazole (n=4), neomycin (n=3), or gentamicin/clotrimazole (n=1). Other steroid preparations the authors found included betamethasone valerate 0.02% to 0.1% (n=5), in combination with gentamicin (n=1) or neomycin (n=1); dexamethasone 0.075% (n=1); fluocinonide 0.025% (n=5), in combination with neomycin (n=1) or neomycin/clotrimazole (n=3); and fluocinolone acetonide 0.05% (n=1).
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High-potency steroids were produced in various countries, including Mexico, Switzerland, India, China, El Salvador, and Italy. Additionally, the researchers found the average price of steroids available at these stores were $6.90 per 30 g for clobetasol propionate 0.05% and $10.02 per 30 g for betamethasone dipropionate 0.05%. The cost of steroids at the stores were significantly lower than the cost in the US market based on prices from GoodRx ($195.27 and $91.37 per 30 g, respectively), the researchers noted.
“These findings underscore the importance of asking about and physically examining patients’ products,” the authors concluded. They noted that practitioners should consider the cultural aspect of this issue as well. Prescription-strength topical corticosteroids are available legally in many countries and immigrants may not be aware they need a prescription to purchase these products, they added.
“Further research is needed to assess the prevalence of [prescription strength topical corticosteroids without a prescription] in other geographic areas as well as the availability of other types of medications illegally sold over the counter, such as skin lightening creams and oral antibiotics,” the researchers concluded. In addition, they stressed the importance of educating vulnerable patients on the potential harms associated with unmonitored prescription-strength topical corticosteroid use.
Kimyon RS, Schlarbaum JP, Liou YL, et al. Prescription-strength topical corticosteroids available over the counter: Cross-sectional study of 80 stores in 13 United States cities. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.10.035