WHO core prescribing indicators in patients with allergic contact dermatitis in a coastal town of South India

Divyashanthi C. M., Bhanu P. Kolasani, Pandiamunian Jayabal, Prasanand Sasidharan, Barathane Datchanamurthy


Background: Prescribing pattern analysis utilizing WHO core drug prescribing indicators can be helpful for the assessing the beneficial and adverse impacts of the prescribed drugs.

Even though many drugs are commonly used in treatment of Allergic contact dermatitis (ACD) they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and study the WHO core prescribing indicators in patients with ACD in our institute.

Methods: A prospective observational study was carried out with prescriptions of 81 outpatients who attended the dermatology OPD with the diagnosis of ACD over a period of six months. Details such as basic demographics, specific drugs prescribed with their dose and dosage forms were recorded and WHO core prescription indicators analysed.

Results: Overall, corticosteroids both topical and systemic were the most commonly prescribed drugs (45.54%) followed by antihistamines (30.69%) and antimicrobials (13.86%). The most commonly prescribed topical corticosteroid was desonide (58.82%), systemic corticosteroid was prednisolone (47.61%), antihistamine was cetirizine (54, 83%) and antimicrobials were cephalosporins (42.86%). Average drugs per prescription for patients of ACD were 6.8. Percentage of drugs prescribed by generic name was 22.77%. Percentage of encounters with antibiotic prescribed was 13.86% whereas injection prescribed was 9.90%. Percentage of drugs prescribed from National list of essential medicines (NLEM) was 53.57%.

Conclusions: Corticosteroids remain the mainstay of treatment in ACD. The percentage of encounters with an injection and the use of systemic steroids were low and were according to the guidelines. But drugs prescribed by generic name and those prescribed from NELM were found to be satisfactory but can further be improved.


Corticosteroids, Generic name, National list of essential medicines, Prescribing pattern, WHO core drug prescribing indicators

Full Text:



Tripathi KD. Aspects of pharmacotherapy; clinical pharmacology and drug development. In: Essentials of medical pharmacology. 6thedition. New Delhi: Jaypee Brothers; 2008:68-71.

Patel V, Vaidya R, Naik D, Borker P. Irrational drug use in India: A prescription survey from Goa. J Postgrad Med. 2005;51(1):9-12.

Mohanty Bk, Aswini M, Hasamnis AA, Patil SS, Murty KSN, Jena SK. Prescription Pattern In Rajahmundry, India. Journal of Clinical and Diagnostic Research. 2010;(4):2047-51.

Giri P, Giri OP, Kanodia S. A study on drug prescription pattern in allergic contact dermatitis at tertiary care teaching hospital in south India. J of Evolution of Med and Dent Sci. 2014;3(43):10683-88.

Nguyen SH, Dang TP, MacPherson C, Maibach H, Maibach HI. Prevalence of patch test results from 1970 to 2002 in a multi-centre population in North America (NACDG) Contact Dermat. 2008;58(2):101-6.

Kohl L, Blondeel A, Song M. Allergic contact dermatitis from cosmetics. Retrospective analysis of 819 patch-tested patients. Dermatology. 2002;204(4):334-7.

Lunder T, Kansky A. Increase in contact allergy to fragrances: patch-test results 1989-1998. Contact Dermat. 2000;43(2):107-9.

Dutta S, Beg MA, Kumar S. Morbidity profile and drug utilization pattern in allergic diseases in skin outpatients in a tertiary care teaching hospital at Dehradun, Uttarakhanad India. RRJPTS. 2014;2(6):1-6.

Hogerzeil HV, Bimo, Ross-Degnan D, Laing RO, Ofori-Adjei D, Santoso B, et al. Field tests for rational drug use in twelve developing countries. Lancet. 1993;342(8884):1408-10.

WHO: How to investigate drug use in health facilities: selected drug use indicators. 1993, Geneva: WHO/DAP/93.1

WHO International Working Group for Drug Statistics Methodology, WHO Collaborating Centre for Drug Statistics Methodology, WHO Collaborating Centre for Drug Utilization Research and Clinical Pharmacological Services. Introduction to Drug Utilization Research. Geneva: World Health Organization; 2003:48.

Thyssen JP, Linneberg A, Menné T, Johansen JD. The epidemiology of contact allergy in the general population- prevalence and main findings. Contact Dermat. 2007;57(5):287-99.

Mortz CG, Lauritsen JM, Bindslev-Jensen C, Andersen KE. Contact allergy and allergic contact dermatitis in adolescents: prevalence measures and associations: the Odense adolescence cohort study on atopic diseases and dermatitis (TOACS) Acta Derm Venereol. 2002;82(5):352-8.

Kalimo K, Lammintausta K, Jalava J, Niskanen T. Is it possible to improve the prognosis in nickel contact dermatitis? Contact Dermatitis. 1997;37:121-4.

Diepgen TL, Weisshaar E. Contact dermatitis: epidemiology and frequent sensitizers to cosmetics. J Eur Acad Dermatol Venereol. 2007;21(2):9-13.

Mastromattteo E. Nickel and its compounds. In: Zenz C, Dickerson OB, Horvath EP Jr, editors. Occupational medicine. 3rd ed. St Louis: Mosby; 1994:563.

Hogan DJ, May J. Allergic Contact Dermatitis. Emedicine. Updated Mar 7, 2007. Available from http//

Bhardwaj SS, Jaimes JP, Liu A, Warshaw EM. A double-blind randomized placebo-controlled pilot study comparing topical immunomodulating agents and corticosteroids for treatment of experimentally induced nickel contact dermatitis. Dermatitis. 2007;18(1):26-31.

Saripalli YV, Gadzia JE, Belsito DV. Tacrolimus ointment 0.1% in the treatment of nickel-induced allergic contact dermatitis. J Am Acad Dermatol. 2003 Sep;49(3:):477-482.

Kalimo K, Lammintausta K, Viander M, Jansén CT. PUVA treatment of nickel contact dermatitis: effect on dermatitis, patch test sensitivity, and lymphocyte transformation reactivity. Photodermatol. 1989;6(1):16-19.

Gawkrodger DJ, Healy J, Howe AM. The prevention of nickel contact dermatitis. A review of the use of binding agents and barrier creams. Contact Dermatitis. 1995;2:257-65.

Memon AA, Molokhia MM, Friedman PS. The inhibitory effects of topical chelating agents and antioxidants on nickel-induced hypersensitivity reactions. J Am Acad Dermatol. 1994;30:560-5.

Wöhrl S, Kriechbaumer N, Hemmer W, Focke M, Brannath W, Götz M, Jarisch R. A cream containing the chelator DTPA (diethylenetriaminepenta-acetic acid) can prevent contact allergic reactions to metals. Contact Dermatitis. 2001;44(4):224-8.

Narwane SP, Patel TC, Shetty YC, Chikhalkar SB. Drug Utilization and Cost Analysis for Common Skin Diseases in Dermatology OPD of an Indian Tertiary Care Hospital -A Prescription Survey. British Journal of Pharmaceutical Research. 2011;1(1):9-18.

Pathak AK. Drug Utilization Pattern for Skin Diseases in a Indian Tertiary Care Hospital - A Prescription Survey. Journal of Clinical and Diagnostic Research. 2016 Feb;10(2):FC01-5.

Prasad PS, Rudra JT, Vasanthi P, Sushitha U, Sadiq MJ, Narayana G. Assessment of drug use pattern using World Health Organization core drug use indicators at Secondary Care Referral Hospital of South India. Chris Med J Health Res. 2015;2:223-28.