PA08 Do parents and carers of children with eczema understand topical steroid potency? Results of a patient survey

Abstract

Abstract Dermatologists consider topical corticosteroids (TCS) to be the first-line active treatment for most inflammatory skin disorders, including eczema. Well-known adverse effects can usually be avoided by careful prescribing. However, widespread public antipathy to TCS, sometimes amounting to steroid avoidance and phobia, can impair patient care. This fear is largely independent of steroid potency, even though there can be up to a 100-fold difference between the mildest and the most potent products. National Institute for Health and Care Excellence guidelines refer to the World Health Organization’s four-level grading system (mild, moderate, potent and very potent), but information about potency is never found on TCS packaging and rarely in patient information leaflets (Haider Z, Proctor A, Moss C. Potency of topical steroids should be clearly labelled on all packaging. Br J Dermatol 2023; 188:427–8). We surveyed parents and carers to investigate their knowledge and understanding of steroid potency. A SurveyMonkey® questionnaire was promoted by the National Eczema Society on social media, and by Eczema Outreach Support in a newsletter to supporters in January 2023. Of 984 responses received, 25% were from parents or carers of children with eczema. Of these, 97% knew that TCS could have different strengths (potencies), but 44% did not know how many different grades there were, with only 20% correctly answering four. Despite this, 77% of respondents felt ‘somewhat confident’ or ‘very confident’ that they knew how strong their cream was, but of those who were ‘very confident’, 29% did not know how many potency grades there were. Follow-up questions revealed that of those who had used these specific TCS, 93% knew that hydrocortisone is mild, but only 48% correctly identified Fucidin H as mild. Only 54% correctly identified DermovateTM as very potent. When asked ‘Where would you look to find out how strong your steroid creams and ointments are?’ most (69%) answered ‘on the packaging’. Ninety-seven per cent were in favour of clear potency labelling on all steroid creams and ointments. Sixty-two respondents provided free-text comments that were analysed thematically: 51% expressed confusion about TCS or a need for more information; 18% complained that general practitioners were not sufficiently knowledgeable; 20% voiced concerns about TCS, some vehemently, and most citing ‘topical steroid withdrawal’; 11% were positive about TCS and the information provided, two of whom used the ‘Aron regimen’. Several responses indicated confusion between percentage concentration (stated on the tube) and potency. These findings confirm the clinical impressions that parents of children with eczema have limited understanding of potency and need clearer information on the tube and packaging.