A Hidden Epidemic: Unmasking Steroid Dependence and Cushingoid Sequelae in Resource-Limited Settings

Abstract Corticosteroid dependence is an increasingly prevalent yet under-recognized cause of iatrogenic Cushings syndrome, particularly in rural and underserved regions. The unregulated availability of steroids, insufficient patient education, and inadequate medical supervision compounds this issue. Steroids are frequently misused as symptomatic treatments for chronic pain and non-specific ailments, offering transient relief while masking underlying conditions and causing long-term harm, including metabolic dysfunction, osteoporosis, immunosuppression, and adrenal insufficiency1,3,7. The problem is exacerbated in peripheral areas due to a combination of factors: limited access to trained healthcare professionals, reliance on informal practitioners, sociocultural norms2 that favor self-medication, and weak regulatory oversight. In addition, the improper and prolonged use of drugs like phenytoin without regular monitoring has been linked to severe complications such as cerebellar atrophy. Addressing this silent public health threat requires targeted interventions, including comprehensive community education, capacity building for local healthcare providers, stricter regulation of over-the-counter steroid sales, and improved access to evidence-based medical care. Without coordinated efforts, drug dependence and steroid misuse will continue to contribute significantly to preventable morbidity and mortality in vulnerable populations