In the United States, US Food and Drug Administration (FDA) regulations require that potent topical steroids be accessible only by prescription owing to potential adverse effects. However, physicians should be aware that some prescription-strength medicines may be easily acquired as over-the-counter products.
An African American patient presented for treatment of recurrent atopic dermatitis, complicated by secondary bacterial infections. Treatment with triamcinolone, 0.1%, ointment had had little effect, and so without medical consultation the treatment was switched to a popular over-the-counter triple combination cream (anti-inflammatory/antifungal/antibacterial) called Funbact-A (Bliss GVS), purchased from a local US store specializing in African wares. The active ingredients listed in this cream were betamethasone dipropionate, clotrimazole, and neomycin sulfate. An online search revealed that this product contained prescription-strength betamethasone, a class 3 topical steroid, and was readily available for purchase online without physician authorization. Fortunately, the patient had been applying the cream for only a few days prior to the office appointment, and use of the product was promptly discontinued before any known adverse events occurred. Few reports in the literature have highlighted the sale of potent topical steroids over the counter and their unregulated use in select populations.
Burke KT, Fricke MA, DeKlotz CMC. Prescription-Strength Topical Steroids Sold Without Prescription. JAMA Dermatol. 2017;153(12):1337–1338. doi:10.1001/jamadermatol.2017.4121
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