Topical Corticosteroid Misuse and Awareness of Steroid-Induced Dermatoses Among Adults in Saudi Arabia: A Cross-Sectional Survey

Background: Topical corticosteroids are among the most commonly used medications in dermatology and play a pivotal role in the management of inflammatory skin diseases. However, inappropriate use, unsupervised access, and cosmetic misuse may lead to significant adverse effects and steroid-induced dermatoses. Data regarding public awareness, knowledge, and misuse of topical corticosteroids in Saudi Arabia remain limited. Methods: A national cross-sectional survey was conducted among adults residing in Saudi Arabia between January and March 2026. Data were collected using a structured, self-administered online questionnaire assessing demographic characteristics, topical corticosteroid use, knowledge, awareness of steroid-induced dermatoses, adverse effects, and misuse practices. Topical corticosteroid misuse was defined as the presence of at least one inappropriate behavior, including non-prescription use, cosmetic use, social media-driven use, medication sharing, prolonged unsupervised use, reuse of previous prescriptions, or use for fungal infections. Multivariable logistic regression analysis was performed to identify independent predictors of misuse. Results: A total of 1,248 participants were included in the analysis, of whom 736 (59.0%) were female. Previous topical corticosteroid use was reported by 842 participants (67.5%). Among users, 289 (34.3%) obtained topical corticosteroids without a prescription, 264 (31.4%) purchased them directly from pharmacies without a prescription, and 178 (21.1%) reported cosmetic use. Overall, 362 participants (29.0%) met the definition of topical corticosteroid misuse. Knowledge regarding corticosteroid safety was generally favorable, with 971 participants (77.8%) recognizing skin thinning as a potential adverse effect and 1,112 (89.1%) acknowledging the importance of medical supervision during prolonged use. Nevertheless, awareness of hidden corticosteroids in cosmetic products was lower (693 participants, 55.5%). Among corticosteroid users, 247 (29.3%) reported at least one adverse effect, most commonly acneiform eruptions (164 users, 19.5%). Social media recommendation was the strongest independent predictor of misuse (adjusted odds ratio (aOR): 3.48; 95% confidence interval (CI): 2.51-4.82; P<0.001), followed by facial application (aOR: 1.89; 95% CI: 1.40-2.55; P<0.001), female sex (aOR: 1.72; 95% CI: 1.29-2.31; P<0.001), and non-healthcare occupation (aOR: 1.64; 95% CI: 1.08-2.48; P=0.02). Postgraduate education was associated with lower odds of misuse (aOR: 0.63; 95% CI: 0.41-0.97; P=0.036). Conclusions: Topical corticosteroid use is highly prevalent in Saudi Arabia, and nearly one-third of adults engage in at least one misuse behavior. Although overall knowledge regarding corticosteroid safety is generally satisfactory, important gaps persist regarding steroid-induced dermatoses and hidden corticosteroids in cosmetic products. Targeted educational interventions, improved patient counseling, and enhanced regulatory oversight may help reduce misuse and promote safer use of topical corticosteroids.