Topical Corticosteroid Concerns in Dermatological Outpatients: A Cross-Sectional and Interventional Study

Abstract

Background/Aims: Topical corticosteroid concerns (TCC) are an important issue in patients with atopic dermatitis, leading to non-adherence with poor disease control and increased health care costs. However, neither the prevalence of TCC in a more comprehensible dermatological population nor the impact of patient information on topical corticosteroids given by clinicians is known. Therefore, we assessed the prevalence, characteristics, and sources of TCC in a dermatological population and the impact of written and oral patient information on TCC. Methods: A total of 643 outpatients with various skin diseases answered a 12-item questionnaire while waiting for the doctor's visit. Patients with TCC quantified their concerns on a discrete visual analogue scale before and after patient information, which consisted of written and oral information about topical corticosteroids (TCS) given by dermatologists. Results: The prevalence of TCC was 41.5%, and that of TCC-related non-adherence was 28.3%. TCC was positively associated with age <60 years, female gender, use of complementary and alternative medicine (CAM) and non-physician health care profession. The leading concerns were skin atrophy, systemic effects, and impairment of the immune system. The most frequent sources of TCC were negative reports by media, family, or friends. Both written and oral patient information significantly reduced TCC. The number needed to benefit from patient information was approximately 2. Non-responders were more often female, TCS-inexperienced, and users of CAM with an intermediate level of education. Conclusions: TCC are highly prevalent in dermatological patients. Patient information may lower TCC in almost every second patient.

Corticosteroid phobia: a questionnaire study using TOPICOP score

“…A study of adults and children with various skin conditions also found that female participants had greater steroid phobia. (14) The results of our present study also showed that female participants had higher TOPICOP scores. Rather than an actual knowledge gap, this gender difference in TCS phobia may be attributable to women being more cautious towards products that are applied to their skin and having greater concerns regarding their possible cutaneous side effects.…”

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

“…Patient fear of side‐effects of corticosteroids (corticophobia) is quite common and should be recognized and adequately addressed to improve adherence and avoid undertreatment …”

“…122 Patient fear of side-effects of corticosteroids (corticophobia) is quite common and should be recognized and adequately addressed to improve adherence and avoid undertreatment. [123][124][125] The simultaneous combination of topical corticosteroids with topical calcineurin inhibitors at the same site does not seem to be useful. At least in paediatric patients with severe AE, the efficacy and safety profile of pimecrolimus cream 1% combined with fluticasone were similar to those of fluticasone alone.…”

Tacrolimus ointment for the treatment of adult and pediatric atopic dermatitis: Review on safety and benefits

“…Several investigators pointed out that “topical corticosteroid phobia” encompasses concerns, fears, worries, anxiety, sorrow and doubts about TCS use. The term “topical corticosteroid phobia” was suggested to be a misnomer because the concerns have a rational background of available evidence . Instead, it has been proposed to use the term “corticosteroid concerns” rather than “corticosteroid phobia” in future discussions .…”

“…The term “topical corticosteroid phobia” was suggested to be a misnomer because the concerns have a rational background of available evidence . Instead, it has been proposed to use the term “corticosteroid concerns” rather than “corticosteroid phobia” in future discussions . On the other hand, in the case of topical calcineurin inhibitors, we believe that we should use the term “topical calcineurin inhibitor phobia” rather than “topical calcineurin inhibitor concerns” for the warning on malignancies due to the lack of established scientific evidence.…”