From roadside “beauty creams” in Kathmandu to reserve antifungals misused in Dhaka, dermatologists stressed that the ripple effect of India’s lax regulation is being felt sharply in neighbouring countries.
Published Nov 21, 2025 | 7:00 AM ⚊ Updated Nov 21, 2025 | 7:00 AM
Panellists agreed that fungal resistance and steroid complications will continue spreading unless India enforces proper prescription controls.
Synopsis: India’s unchecked market for topical steroids and irrational antifungal combinations is driving a growing cross-border medical emergency. Dermatologists from Nepal and Bangladesh say cheap Indian products, often sold as unlabelled “beauty creams”, are fuelling dangerous practices, including the use of reserve antifungals intended for life-threatening infections. Experts warn that without coordinated regulation and strict prescription controls, the subcontinent risks entering a future in which even routine fungal diseases may become difficult to treat.
India’s uncontrolled sale of topical steroids and irrational antifungal combinations is no longer a domestic crisis. It has become a cross-border medical emergency, disrupting fungal treatment patterns across the subcontinent.
From roadside “beauty creams” in Kathmandu to reserve antifungals being misused in Dhaka, two dermatologists from Nepal and Bangladesh, Dr Sudip Pajuli, Associate Professor at Tribhuvan University in Kathmandu, and Dr Md Saiful Islam Bhuiyan, Skin Specialist in Dhaka, stressed that the ripple effect of India’s lax regulation is being felt sharply in neighbouring countries.
Dr Sudip described the situation bluntly: “These steroid creams are not sold in pharmacies but in roadside cosmetic shops in fancy boxes. You cannot read the label – Korean, Japanese, Chinese writing.”
Dakshin Health Summit 2025. (Supplied)
The flow of cheap, unregulated Indian products, according to Dr Sudip, has fuelled rampant misuse.
“The lower the price in India, the more easily it comes to Nepal. And the misuse rises,” he said, adding that many creams are presented as imported Korean or Japanese beauty products, making their pharmaceutical contents almost impossible for users to identify.
Bangladesh faces an even more severe crisis. “Abuse is in all forms. Topical, injectables, combinations. Even parlour creams,” said Dr Bhuiyan, describing how steroid misuse has permeated every layer of the country’s dermatology landscape.
But his greatest concern is not steroids alone. It is the reckless misuse of reserve antifungals meant for life-threatening infections. “Voriconazole is being used for superficial infections. This is dangerous.”
Dr Bhuiyan presented troubling resistance data from Bangladesh’s dermatophyte studies: “Sixty-four percent of chronic, persistent dermatophytes are resistant to terbinafine, and 28 percent are resistant to itraconazole. Fifteen percent are resistant to both.”
This widespread resistance, he warned, is already forcing doctors to consider last-resort drugs far earlier than appropriate. “People are using one reserve drug after another. This is not sustainable,” he said.
Bangladesh’s pharmaceutical import numbers reflect the scale of the crisis. “Bangladesh is the third-highest importer of voriconazole after the US and India,” Dr Bhuiyan noted, despite the fact that voriconazole is primarily an intensive care antifungal and not meant for skin infections at all.
The speakers were united in calling for urgent regional action. “We request policymakers to restrict the use of pharmacological agents without prescription,” Dr Bhuiyan said.
Dr Sudip echoed the need for strong regulation. “Educated people still misuse these creams. All we can do is create awareness through media and push regulators to act,” he said.
Dermatologists on the panel from India acknowledged shared responsibility. They noted that irrational fixed-dose combinations manufactured in India routinely cross borders into Nepal and Bangladesh, worsening their dermatology burden.
“India is pushing these drugs to neighbouring countries because of low prices,” Dr Sudip said.
Panellists agreed that fungal resistance and steroid complications will continue spreading unless India enforces proper prescription controls and tackles its thriving market of unregulated steroid and antifungal combinations.
The message was clear: what starts in India does not stay in India, and unless strict regulatory action is taken, the subcontinent is heading towards an era where even common fungal infections may soon become untreatable.
