Topical Corticosteroid Phobia Research Articles

Effectiveness of a nurse-led one-to-one education programme in addition to standard care in children with atopic dermatitis: a multicentre randomized control trial.

Therapeutic patient education (TPE) is recommended for children with atopic dermatitis (AD), but no consensus has been reached on the optimal tailoring of delivery. While repeated multidisciplinary group education sessions have shown effectiveness, the benefits of one-on-one educational interventions led by nurses for children with AD have not yet been assessed. To assess the benefits of additional, well-structured, 1-h nurse-led individual TPE interventions in children with AD and their families compared with standard care alone. Children with moderate-to-severe AD and their parents were randomized to receive a 1-h nurse-led education session in addition to standard care vs. standard care alone. The primary outcome was the area under the curve (AUC) of the SCORing of Atopic Dermatitis index (SCORAD) from baseline to week 24 (lower AUC values represent better long-term control of the disease). In our study, 176 patients were randomized across 11 centres, and 153 were included in the full analysis set. The mean (SD) age was 4.47 (4.57) years. By week 24, there were no significant differences in the AUCs of the SCORAD between the two groups (P = 0.3). Secondary outcomes including patient-reported severity and quality of life [AUCs of the patient-oriented SCORAD (PO-SCORAD) and Infants' Dermatitis Quality of Life Index (IDLQI), Children's Dermatitis Quality of Life Index (CDLQI) and Family Dermatitis Quality of Life Index (FDLQI)] were not significantly different between the two groups. The only significant change observed in the intervention group, when compared with the one receiving standard care, was a decrease in topical steroid phobia, as assessed by the topical corticosteroid phobia (TOPICOP) score. Prespecified subgroup analyses showed that disease severity in the intervention group was significantly lower throughout the study, compared with the standard-care group when participants had moderate AD at baseline (n = 47); while participants with severe AD at baseline (n = 106) did not show benefit from the intervention. Participants showed no additional benefit from the intervention regardless of age group. This study did not show any additional effectiveness, in long-term severity control, of a 1-h nurse-led TPE intervention in children with AD treated with standard care, compared with those treated with standard care alone. However, it should be noted that the intervention reduced the fear of using topical steroids and may be beneficial for patients in the subgroup with moderate AD.

Topical Corticosteroid Phobia among Danish Pharmacy Staff

Introduction: Topical corticosteroid (TCS) phobia may negatively impact treatment adherence. Currently, there are few studies exploring trust and knowledge of TCS use among pharmacy staff. The objective of this work was to examine TCS knowledge and possible phobia among Danish pharmacy staff. Methods: A questionnaire, based on Topical Corticosteroid Phobia (TOPICOP©) questionnaire, was developed and rephrased to fit pharmacy staff. The questions were Likert scales and numerical rating scales (NRS) (0–10). In October/November 2021, 64 pharmacies were invited. If the pharmacies agreed to participate, a researcher visited the pharmacies and distributed the questionnaires. Results: A total of 244 pharmacy workers from 59 pharmacies participated. The majority (95.4%) responded that they were aware of side effects of TCS; however, misconceptions regarding side effects were found in up to 34% of participants. Regarding TCS use, 40% sometimes advised the patients to wait as long as possible before initiating treatment with TCS. Confidence in dispensing TCS to patients was high, with a mean of 8.45 (NRS). Conclusion: Danish pharmacy staff generally reported high confidence in TCS use. Misconceptions regarding side effects were common, and there was a tendency to giving advices on TCS treatment that may indicate low confidence in TCS. Thorough education of pharmacy staff is needed to improve the knowledge of TCS.

Knowledge and Attitudes Towards Topical Corticosteroids Among Previous Users in the General Population of Saudi Arabia.

Introduction Topical corticosteroids are a valuable tool for treating many dermatoses, offering anti-inflammatory and immunosuppressive properties. However, preexisting knowledge gaps and safety concerns may hinder treatment compliance. This study aims to evaluate knowledge and attitudes towards topical corticosteroids among former users within the general population of Saudi Arabia. Methods This cross-sectional study utilized an online survey to collect data. Knowledge was assessed through three dimensions: indications, proper use, and adverse reactions. Attitudes were assessed using the Topical Corticosteroid Phobia (TOPICOP) scale. Results Among the 397 respondents, 80.9% were females, 51.1% had suffered from a dermatological disease, and 76.3% had a bachelor's or higher educational level. When assessing knowledge, female participants (6.22±2.02) displayed significantly higher scores compared to male participants (5.26 ± 2.23) (p<0.001). Participants with dermatological diseases provided more accurate answers compared to those without. In assessing phobia towards topical corticosteroids, participants aged 18-25 years had lower topical corticosteroid phobia scores (31.06 ± 5.91), whereas those aged 56 years or more had higher scores (35.38 ± 6.04), p<0.001. Single participants had significantly lower topical corticosteroid phobia scores (32.27 ± 6.06) compared to those who were married (33.87 ±5.95) (p=0.010). Additionally, participants with dermatological diseases had higher scores in the behaviors subcategory despite having lower Global TOPICOP scores (32.58 ± 5.7) (p=0.033). Conclusion Enhancing knowledge about topical corticosteroids is crucial for mitigating corticophobia and promoting better adherence. To address gaps in knowledge, dermatologists should expand educational initiatives to include vulnerable populations, explicitly targeting males and older individuals.

Topical Corticosteroid Phobia Among Women Affected With Vulvar Lichen Sclerosus: Results From a Cross-sectional Survey.

Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS). This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data. The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP. In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.

Corticosteroid fear in parents of children with atopic dermatitis.

Background: Topical corticosteroids (TCS) are the mainstay of therapy for paediatric atopic dermatitis (AD). The use of TCS is often met with fear by parents. Assessing this parental TCS fear in clinical practice is still lacking. Aim: The aim was to assess parental fear and beliefs about TCS. Furthermore, we evaluated the quality of life (QoL) of the family and the disease severity of affected children. Methods: We conducted an observational study with a cross-sectional design. Inclusion criteria were children aged 0 to 5 years with a diagnosis of AD and outpatient treatment. The outcome measures were parental fears and beliefs about TCS, assessed with the "Topical Corticosteroid Phobia Score" (TOPICOP), parental QoL evaluated with the "Family Dermatology Life Quality Index", and disease severity, assessed with the "Scoring atopic dermatitis" (SCORAD). Descriptive statistic was used to analyse the data. Results: The current study found that in 40 affected children, 25 (62.5%), suffered from mild AD, 12 (30%) children had moderate AD, and 3 (7.5%) children had severe AD. TCS fear among parents was notable (mean TOPICOP score 18.1, standard deviation (SD) 7.1). The QoL was moderately affected (mean FDLQI score 6.5, SD 2.8). Conclusions: Our study indicates that fear of TCS is prevalent. Furthermore, our data indicate that severity of TCS fear varies markedly between parents, ranging from parents with almost no fear to parents with high levels of fear. For effective education in clinical practice, the individual level of fear must be recognized and taken into account.

Topical Corticosteroid Phobia Among Parents of Children with Atopic Dermatitis (Eczema)- A Cross-Sectional Study.

Anxiety about using topical corticosteroids (TCS) for childrens among parents and caretakers is a common cause of treatment failure and an overall decline in the child's quality of life. The purpose of this study was to examine the perspectives and worries of parents of Atopic dermatitis (AD) children regarding TCS. Additionally, we investigate the degree of phobia in relation to the use of the TCS. A convenience sample of 301 parents of children who had been identified with atopic dermatitis from two hospitals in Taif city were enrolled in this study. Parents who chose to participate were sent a questionnaire measuring their level of fear of TCS using the TOPICOP© scale, which also included inquiries about their demographics and clinical characteristics. Multivariate analysis was used to determine what factors influence people's overall levels of fear. The median global TOPICOP score was 66.6% (IQR 60.4-75%), SD 12.83%, which showed that nearly two-thirds of the participants showed corticosteroid phobia. A multifactorial ANOVA model showed that parents who had a female child with AD and mothers who had experienced drug allergies had a significant influence on TOPICOP scores (P<0.05). Topical corticosteroid phobia is widespread among parents of children patients with AD in Taif. Regarding the utilization of TCS, we place a strong emphasis on the significant role that physicians play as sources of reliable information and proper education.

Corticophobia among Parents of Children with Atopic Dermatitis: Assessing Major and Minor Risk Factors for High TOPICOP Scores.

Corticophobia, fear of applying topical corticosteroids (TCSs), is a rising issue in industrialized countries, despite the actual safety of TCSs for atopic dermatitis (AD). Patients attending the Pediatric Dermatology Unit for skin examination were screened for AD. AD patients were included, and data were collected. Parental corticophobia was evaluated through the Topical Corticosteroid Phobia (TOPICOP) questionnaire. The χ2 test and logistic regression were used to analyze statistical associations between parental corticophobia (mild/moderate vs. severe) and patients' and parents' characteristics. Overall, 100 patients were included (53 females; 47 males; mean age 5.9 years): 44 had mild/moderate AD (EASI ≤ 21), and 56 had severe AD (EASI > 21) (mean EASI 19.7). Of the patients, 33 never consulted healthcare providers for AD, and 67 did. Parental education was low/intermediate in 60 cases and high (gymnasium/university degree) in 40. Mean parental DLQI was 10.7. Mean parental TOPICOP was 39.1%: 51 had mild/moderate corticophobia (TOPICOP ≤ 50%), and 49 had severe corticophobia (TOPICOP > 50%). At the χ2 test, corticophobia was associated with mild/moderate AD (OR 20.9487; 95% CI 7.2489-60.5402; p < 0.001), older age of patients (OR 4.1176; 95% CI 1.7880 to 9.4828; p < 0.001), early disease onset (OR 9.8925; 95% CI 2.7064-36.1596; p < 0.001), and previous healthcare professional consultations (OR 4.9279; 95% CI 1.9335-12.5597; p < 0.001). Also, severe parental corticophobia was very significantly associated with severe parental involvement of life quality (OR 33.3333; 95% CI 10.9046-101.8937; p < 0.001) and with high education of parents (gymnasium or university degree) (29/49) (OR 5.2727; 95% CI 2.1927-12.6790; p < 0.001). At logistic regression, high parental DLQI (p < 0.0001), high parental education (p < 0.0338), older age of patients (p = 0.0015), and early disease onset (p < 0.0513) accounted for major risk factors influencing severe parental corticophobia. Assessing risk factors for corticophobia is essential for addressing groups of parents at higher risk for corticophobia using educational programs, to overcome unfounded fears and augment treatment adherence.

P12 #corticophobia: a review of misinformation related to topical steroids

Abstract Misinformation in healthcare is now at crisis level worldwide, with the internet as the primary source of prevarication. Topical corticosteroids (TCS) are a safe and effective treatment used in multiple conditions in paediatric dermatology. Nonadherence to prescribed TCS can be due to phobia secondary to misinformation, and poor compliance is a common obstacle to disease control. TCS phobia is a complex, multifaceted phenomenon that exploits children with skin disease and obstructs their path to successful treatment. This study aims to examine the content of TCS-related misinformation available online. A formal review of PubMed was performed in June 2022, using the terms ‘topical corticosteroids’ AND ‘misinformation’ OR ‘disinformation’ OR ‘conspiracy theory’, along with an informal Google search using combinations of these terms, and further targeted searches on social media applications including Facebook, Twitter, Instagram and TikTok. The main fears expressed by children and parents regarding TCS included potential adverse effects (skin thinning, stunted growth/development). ‘Topical steroid withdrawal’, ‘red skin syndrome’ or ‘TCS addiction’ is a particularly prevalent myth currently being propagated on social media, with most content suggesting that eczema is due to a ‘leaky gut’ and not skin inflammation. Numerous websites promoting misinformation were frequently endorsed by companies advertising ‘natural’ products as treatment alternatives, including ‘herbal’ remedies which can contain significant quantities of corticosteroids or other potent ingredients. The paediatric dermatology community should be vigilant of the type of TCS-related misinformation online, and actively attempt to counteract it with evidence-based advice.

Topical corticosteroid phobia among high educational students in Al-Madinah region: A cross-sectional study

Topical corticosteroid phobia among high educational students in Al-Madinah region: A cross-sectional study

Validity and Reliability of the Topical Corticosteroid Phobia (TOPICOP©) Questionnaire: Thai Version

Objective: To determine the validity and reliability of the Thai version of the Topical Corticosteroid Phobia (TOPICOP©) questionnaire, which is used to evaluate topical corticosteroid (TCS) phobia in atopic dermatitis (AD). Materials &amp; Methods: The translation process and assessment of content validity were undertaken step-by-step. Adult patients with AD and the guardians of pediatric patients with AD completed the questionnaire twice, 2 weeks apart to test the reliability. Results: We enrolled 30 adult patients with AD and 30 caretakers of pediatric patients with AD in this study. The Index of Item-Objective Congruence (IOC) was 0.9, indicating high validity. Test-retest reliability using Pearson correlation coefficient was tested, with r 0.938 (p &lt;0.001). The Cronbach’s alpha coefficient showed reliable internal consistency, with 0.691 and 0.734, respectively. Conclusion: The Thai version of the TOPICOP© is valid, reliable, and feasible for assessing TCS phobia in patients with AD and their caretakers of pediatric patients with AD.

Topical corticosteroid phobia among general population in Riyadh, Saudi Arabia

Background: Topical corticosteroids (TCS) are medications applied directly to the skin and are commonly used in dermatological clinical settings for various skin conditions. Despite their popularity, there is a growing fear of using these medications, with adverse effects such as weight gain, thinning of the skin, stunting of growth, and aging being among the reasons for steroid phobia. Methods: This cross-sectional study included 160 randomly selected participants from the city of Riyadh, in June, July, and August 2023. Data were collected through a self-administered questionnaire published on social media. Ethical approval was obtained, and participants&amp;apos; anonymity and confidentiality were ensured. Data was analyzed using Statistical Package for the Social Sciences V.23, with a p value of 0.05 or less deemed statistically significant. Topical steroid phobia was evaluated using the TCS phobia (TOPICOP) scale. Results: 70.6% of respondents were female; the most common age group was 21-29 years (79%), and 54% of participants had used TCSs previously. According to the TOPICOP scale, there was a statistically significant correlation between level of education and TCS phobia in addition to a significant number of participants (45%) felt afraid of using TCSs even though they admitted to not knowing any potential side effects. Conclusion: TCSs phobia is a common problem among the general population of Riyadh, which is probably based on insufficient knowledge of TCSs. In order to improve patient compliance, healthcare professionals should focus on correcting misconceptions and educating patients on this group of medications.

Topical corticosteroid phobia in adolescents with eczema and caregivers of children and adolescents with eczema: A cross-sectional survey.

Steroid phobia is an increasing phenomenon that affects treatment adherence. The purpose of this study was to assess the prevalence and associated factors of steroid phobia among adolescents with eczema and the caregivers of children and adolescents with eczema by using questionnaires and TOPICOP© scale. The prevalence of steroid phobia is approximately 12% and 37% in the adolescent and caregiver groups, respectively. Caregivers who obtained information about topical corticosteroid (TCS) from dermatologists and whose children had fewer number of flares, demonstrated less concern about using TCS.

Medihoney Derma Cream Treatment for Mild to Moderate Atopic Dermatitis in Children: An Open-Label Randomized Pilot Study.

To the Editor: Topical corticosteroids are considered the main treatment for atopic dermatitis (AD), especially during a flare.1 Although topical corticosteroids have enormous benefits in reducing inflammation, they may be accompanied by significant adverse effects. In addition, the worldwide prevalence of topical corticosteroids phobia is extremely high, ranging from 31% to 95.7%,2 and may lead to poor adherence, resulting in persistent disease and rapid escalation to systemic agents.2 To avoid these adverse effects and the excess use of topical corticosteroids, other topical treatment modalities for AD are needed.3 Medihoney Derma Cream (Med-D-Cream) is a topical emollient cream containing 30% Medihoney antibacterial honey, coconut oil, German chamomile flower extract, evening primrose oil, aloe vera, vitamin E, glucose oxidase, and Leptospermum compounds. It has broad antibacterial and antipruritic activity,4 and by preserving skin barrier integrity and moisture, it aids in maintaining skin pH. Med-D-Cream is licensed for skin and wound care in Australia, Europe, and the United States. To offer an alternative corticosteroid-sparing option for treating mild to moderate AD in children, we conducted a trial comparing the safety and efficacy of Med-D-Cream to a common mild potency corticosteroid cream used worldwide for the treatment of AD (hydrocortisone 1% cream). The trial comprised children aged 2 to 18 years diagnosed with mild to moderate AD, with an Investigator Global Assessment (IGA) score of 2 to 3 and body surface area (BSA) of 1% to 10%, including 30 patients, 20 using Med-D-Cream, and 10 as controls using hydrocortisone 1% cream. Patients applied creams for 2 weeks and were then followed up for 2 more weeks to measure responses using IGA, BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus (Fig. 1). The duration of treatment was limited to 2 weeks to avoid prolonged use of a topical steroid. The response rate (IGA score of 0 or 1 with at least 1-grade reduction after 2 weeks of treatment) was 47.4% (9/19) in the intervention group (Med-D-Cream) and 60% (6/10) in the control group (hydrocortisone 1% cream). There was no statistically significant difference between the 2 arms in response rates. No significant changes were found between the 2 groups regarding the secondary outcomes (BSA, Eczema Area and Severity Index score, SCORing Atopic Dermatitis, and Visual Analogue Scale pruritus). In the Med-D-Cream group, 2 of the 20 patients (10%) had adverse events, which resulted in 1 patient's withdrawal. No adverse events were seen in the hydrocortisone group. Our study had some limitations. First, we had a small sample size because it was a pilot study; however, the cohort size did allow us to draw statistical conclusions. Second, the study had relatively short treatment and follow-up periods (4 weeks overall), limiting the ability to observe potential allergic contact dermatitis and properly assess Med-D-Cream's effect on barrier function. Despite these limitations, this is the first randomized study designed to explore Med-D-Cream clinical activity and compare it with a topical corticosteroid in the pediatric population.Figure 1: Flowchart of the study design and population.In conclusion, the study demonstrated that Med-D-Cream, an emollient, is safe and effective in treating pediatric mild to moderate AD. Although it failed to show that Med-D-Cream had superiority over hydrocortisone 1% cream, it showed comparable clinical efficacy. Amir Horev Pediatric Dermatology Service Soroka University Medical Center Beer Sheva, Israel Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel [email protected]Maayan SherSarah Weissmann Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, IsraelLior Golan Faculty of Health Sciences Ben-Gurion University of the Negev Beer Sheva, Israel Clinical Research Unit Soroka University Medical Center Beer Sheva, IsraelAnat Horev Neurology Department Soroka University Medical Center Beer Sheva, Israel

Parent Concern and Awareness of Corticosteroid use in Pediatric Patients with Atopic Dermatitis in Al-Majmaah, Saudi Arabia

Background: Atopic dermatitis has been considered a multifactorial disease and is a chronic, relapsing, and highly pruritic skin disease; usually presents with skin itchiness which is considered the most burdensome symptom, followed by skin redness and dryness, chronic pruritus, and sleep disturbance, as well as the time and expense associated with treatment, are often most distressing for patients and families. Atopic skincare and treatment include skin hydration, pharmacologic therapy, and avoidance of relevant triggers. Corticosteroids (TCS) of appropriate strength are considered the first-line therapeutic agent. Objective: To study the parents’ concern and awareness of corticosteroid use in pediatric patients with atopic dermatitis in Al-Majmaah governorate, Saudi Arabia in 2021. Methodology: A community-based descriptive cross-sectional study was performed. The data was collected using an electronic questionnaire and analyzed using SPSS v.23. Results: 403 respondents were enrolled in the study where most of the fathers (46.2%) were within the age group of 30-45 years, and a half (50.6%) of mothers were between 30-45 years. Most children (30%) have itchy skin for 2-3 days per week due to eczema, and 174 (43.2%) have dry, rough skin every day. The mean score for the knowledge and beliefs was 49.8±19.9, 76.6±20.9 for fears, and 72.4±21.8 for behavior. More than one-third of respondents (46.2%) almost agreed that TCS could pass into a child’s bloodstream, and 157 (45.1%) of those who used steroids before almost agreed that it’s beneficial. More than one-third of our respondents (36.2%) always get their information regarding TCS from dermatologists. Marital status significantly affects Topical Corticosteroid Phobia (TOPICOP) score (P-value = 0.003), where divorced have the highest mean score compared to married or widows. Conclusion: The TOPICOP score for mean knowledge and beliefs was slightly lower than the global TOPICOP score. TCS can cause skin damage, as reported by nearly half participants. Slightly less than half of them are afraid of putting cream (TCS) on a child’s skin in certain zones like the chin and the eyelids where the skin is thinner. The most reported information source about TCS for nearly half of the participants was doctors. No statistically significant association was found between participants' age groups, occupation, and educational level and global TOPICOP score. However, a significant association was found between marital status and TOPICOP score. Keywords: Atopic dermatitis, Corticosteroids, Saudi Arabia, Pediatrics, TOPICOP score, Al-Majmaah

Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients

ObjectiveTo explore the phenomenon of topical corticosteroid (TCS) phobia and comprehensively understand the factors driving TCS concerns, in particular pertaining to steroid addiction and withdrawal.DesignProspective qualitative study using 1:1 in-depth...

Healthcare Utilization in Danish Children With Atopic Dermatitis and Parental Topical Corticosteroid Phobia

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin condition. One foundational component of AD treatment is topical corticosteroids (TCS). With this study, researchers sought to evaluate the association among parental-reported health care use, parental TCS phobia, medication use to treat AD, and AD severity in pediatric patients.In the study, researchers included 1343 children with AD in Denmark.Children were recruited from the Danish National Patient Registry from January 2014 through December 2018 for this cross-sectional study. Children with a chief complaint and diagnosis of AD on the basis of International Classification of Diseases, 10th Revision, codes registered by a dermatology department within the Danish health care system were included. A questionnaire including 158 items assessing family structure, residence, parental education, AD severity (assessed by the Patient-Oriented Eczema Measure [POEM] score), TCS phobia (assessed by validated Topical Corticosteroid Phobia [TOPICOP] score), and AD treatment were sent to parents of eligible children.A total of 3437 children met inclusion criteria, and the parents of 1343 (43%) responded to the questionnaire; the mean age of the children was 8.9 years, and 52.8% were male. Mean POEM scores were significantly higher for girls (8.2 ± 6.3) than for boys (7.3 ± 6.2; P = .009), with scores between 8 and 16, indicating moderate eczema. On the basis of POEM scores, 23.4% had clear or almost clear AD, 29.5% had mild AD, 37% had moderate AD, and 10% had severe AD. With regards to treatment, 95% of all children had received TCS in the past. Severe AD was associated with increased health care visits. With regards to TCS phobia, there was no difference in TOPICOP scores on the basis of AD severity or child age. Higher TOPICOP scores were significantly associated with lower parental educational level as well as delayed TCS application for AD flares but were not associated with increased primary care visits when adjusted for AD severity and parental educational level.Increased TOPICOP scores were associated with lower parental educational levels leading to delayed treatment of AD flares. There was no association between TOPICOP scores and AD severity or the child’s age. Increased health care use was demonstrated in children with severe AD, compared with milder forms of AD, but was not associated directly with increased TOPICOP scores.Although there are no cutoff values for TOPICOP scores to define TCS phobia, in this study, it is suggested that TCS phobia is prevalent and associated with lower parental educational levels and delayed TCS treatment of AD flares. Further study is needed to define the impact of TCS phobia and evidence-based interventions to address this.

Knowledge and Awareness of Topical Steroid Phobia in Atopic Dermatitis: Pre and Post Education of Family Medicine Providers, Pharmacist Interns and Dermatology Residents

Purpose: Treatment nonadherence is a primary barrier in the management of Atopic Dermatitis (AD) and often attributed to Topical Corticosteroid (TCS) phobia. Misinformation of TCS safety and utility among providers perpetuates TCS phobia. We aimed to assess provider knowledge of TCS in AD and determine the feasibility of educational interventions in modifying their beliefs and practices. Methods: Pharmacy interns and family medicine providers (nondermatology clinicians) in attendance of virtual education sessions were evaluated before and after an evidence-based lecture on the use of TCS in AD. Dermatology residents were evaluated pre-lecture. All responses were recorded via electronic questionnaires. Results: Response rates for the pre- and post-questionnaires were 50% and 26%, respectively. Dermatology residents were more likely to believe that TCS used appropriately are safe for patients and scored higher on the pre-lecture evaluation compared to non-dermatology clinicians (62 vs. 27%, p=0.036). Non-dermatology clinicians also scored higher in overall knowledge after attending the evidence-based lecture (68 vs. 27%, p&lt;0.001). Conclusions: There may be beliefs and knowledge gaps among nondermatologist clinicians in the treatment of AD that perpetuate TCS phobia. These beliefs and counseling practices appear modifiable, however, through post-graduate educational interventions. Collaboration of healthcare providers involved in the treatment of AD is important for the dissemination of reliable information to patients.

Assessment of topical steroid phobia in dermatology patients, a cross-sectional study from an urban area of Pakistan

Background Topical corticosteroid (TCS) phobia is a fear of steroids, most prevalent among the general steroid users, the origin of anxiety and fear about steroids is still unclear. Although multiple studies have been using the validated TOPICOP© scale to assess the scores of steroid phobia in various skin disorders. Objectives The aim of the study was to analyze the steroid phobia among users of topical corticosteroids and also to assess the association between demographical characteristics and TCS phobia. Methods A cross-sectional survey was conducted to evaluate the belief and perspectives of TCS in a large range of patients of both genders of all ages. Patients presenting in dermatology clinic with any dermatological complaint, who were being treated or currently on topical steroids were included. TOPICOP© scale was used to assess the topical steroid phobia. Results A total of 221 topical steroid users were selected for this study, among them 56 (26.7%) were male and 162 (73.3%) were female. The median of global TOPICOP score was 18% and CI 22–12%, S.D: 6.23. The median score of knowledge and beliefs was 7%, (IQR: 9–4%), S.D: 3.33, while fear showed median 5% (IQR: 7–3%), S.D: 2.24, and 6% (IQR: 8–4%), S.D:2.4 for behavior 96 (43.4%). Patients who were not well aware of steroids but still afraid of using steroids. 112 (50.7%) acknowledged the non-adherence to treatment. Conclusion Steroid phobia is more prevalent among uneducated users of topical steroids than among those who are knowledgeable and literate. Healthcare practitioners should counsel their patients about steroids use and related concerns, rather than addressing the issue that is causing fear in patients.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions.

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.

Addressing topical corticosteroid phobia in atopic dermatitis: The role of the pharmacist.

Addressing topical corticosteroid phobia in atopic dermatitis: The role of the pharmacist.