Drug Utilization and Cost Analysis for Common Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital - A Prescription Survey.

Introduction: Epidemiology of skin diseases has been studied and evaluated occasionally. In view of high incidence of skin diseases and economic burden that it poses, there is a need to evaluate the present epidemiology and prescribing pattern of skin disorders. Objective: To assess common skin conditions, drug utilization patterns and cost analysis in Dermatology Out patients Department (OPD) of Tertiary Care hospital. Methodology: After taking Ethics committee’s permission, prescriptions of 600 patients attending Dermatology OPD were audited. The prescriptions were analyzed for common skin conditions drug utilization and cost analysis. Results: The common skin conditions found were Pyoderma and Scabies while common classes of drugs prescribed were antiallergics, antifungals and steroids. Drugs prescribed by Generic name were 16.6% and Brand names were 83.4%. It was revealed that 30% of total drugs dispensed from hospital pharmacy and 70% from outside pharmacy. Average hospital and outside pharmacy costs were INR19.40 and INR116.20, respectively. The outside pharmacy cost of prescription (Spearman’s Rho = -0.130, p < 0.01) as well as cost paid by the patients (Spearman’s Rho = 0.408, p < 0.001) had a negative correlation with the socioeconomic score as the drugs were prescribed irrespective of the socioeconomic class. Conclusion: The dermatological prescription analysis gives a message to the prescribing physician to achieve rational and cost effective medical care. The drugs which are made available in the hospital pharmacy should be based on clinical evidence generated from meta-analysis of drug studies, pharmacoepidemiology and pharmacoeconomic studies. There is dire need for physicians training with regards to rational use of drugs and pharmacoeconomics. Hospital should make essential drugs available with continuous monitoring to improve the prescribing pattern. The limitation of this study is that the actual direct costs and indirect costs were not studied. It opens the scope for further study in this area.

Kaposi's sarcoma: A presenting manifestation of HIV infection in an Indian.

Kaposi's sarcoma (KS) is a multifocal neoplastic proliferation of endothelial cells predominantly involving skin and other organs. HIV-associated Kaposi's sarcoma has been rarely reported from India. A 38-year-old male presented with persistent swelling on the left lower limb for one year along with multiple erythematous to dusky papules and plaques of one and half months duration and swelling and black discoloration of right lower limb for one month. Cutaneous examination revealed numerous skin colored and erythematous papules and plaques distributed on the left lower limb on the anteromedial aspect and verrucous plaque on the left sole. Multiple erythematous, grouped papules were present over the soft palate. Skin biopsy showed numerous slit like spaces dissecting into the collagen of the upper and mid-dermis along with 'promontory sign' suggestive of Kaposi's sarcoma. Patient was found to be HIV-positive by ELISA test.