Topical corticosteroid phobia among caretakers of children with atopic dermatitis: A cross‐sectional study using TOPICOP in Japan

Abstract

All the authors have approved the manuscript and agree with submission to Pediatric Dermatology.This study was carried out with the approval of the hospital ethics committee of the National Center for Child Health and Development (Reception number: 761). AbstractBackground/Objectives: The TOPICOP scale is an easy-to-use scale for assessing topical corticosteroid (TCS) phobia in atopic dermatitis (AD) patients and their caretakers. TCS phobia is a common problem among AD patients and their caretakers.The aim of this study was to examine the relationship between TCS phobia in caretakers of children with AD and the characteristics of patients using the TOPICOP scale. Methods: Caretakers of AD patients who visited the allergy clinic at the National Center for Child Health and Development in Tokyo between February 2014 and May 2014 were recruited. Caretakers of patients in follow-up had already attended an education session on treatment at the institution. All participants completed an anonymous questionnaire on the characteristics of the respondents and patients using the Patient-Oriented Eczema Measure (POEM) and the Japanese version of TOPICOP.Results: In total, 243 participants (88.9% female) completed the survey. The average TOPICOP score was 40.3 and the median POEM score was 4. The TOPICOP score was significantly higher for patients younger than 12 months old with moderate to very severe AD (POEM ≥ 8) whose caretaker had not attended an educational session (P < 0.01, respectively). There was no significant difference in the family history of AD, age, or gender of the respondents. In multivariable analysis, preattendance at an education session was the only significant factor accounting for a higher TOPICOP score (P < 0.001). Conclusions:Regardless of their background, caretakers of AD patients can be affected from TCS phobia. Attending an educational session might ease their anxiety. K E Y W O R D S atopic dermatitis, questionnaire, steroid phobia, topical corticosteroid, TOPICOP 312 | Pediatric Dermatology SAITO-ABE ET Al. Patients Age, median (range) 238 4 (range: 0-17) POEM, median (range) 243 4 (2-9) Very severe (25-28), n (%) 2 (0.8) Severe (17-24), n (%) 17 (7.0) Moderate (8-16), n (%) 60 (24.7) Mild (3-7), n (%) 72 (29.6) Clear or almost clear (0-2), n (%) 92 (37.9) AD class attendance: Preattendance, n (%) 237 95(40.1) Family history of AD, n (%) 243 143 (58.8) Mother history, n (%) 243 74 (30.5) Father history, n (%) 243 77 (31.7) Sibling history, n (%) 243 50 (20.6) a Number of respondents and patients without missing value.

Healthcare utilization in Danish children with atopic dermatitis and parental topical corticosteroid phobia

“…In the big international feasibility study, including both children (80.1%) and adults (19.9%), the highest TOPICOP value was reported in Poland (58.4%), Ukraine (55.1%), and Taiwan (52.9%), and the lowest in Germany (38.5%), Denmark (35.4%), and Brazil (33.5%) 8 . Studies only assessing parental TOPICOP scores found the highest scores in Holland (44%) and Belgium (41.9%) and the lowest in Japan (32.9%) and France (18.8%) 20‐22,24 …”

“…Corticosteroid phobia is prevalent in dermatology patients and may result in delayed treatment initiation and poor disease control. 7,8,20‐25 . Corticosteroid phobia even exists among healthcare providers, where the highest scores have been found in healthcare nurses, GPs, and pharmacists and the lowest in dermatologists 20,21 .…”

“…Moreover, we found that almost one third of children with currently severe AD reported having used very potent TCS, despite this being advised against in children. 19 Corticosteroid phobia is prevalent in dermatology patients and may result in delayed treatment initiation and poor disease control.. 7,8,[20][21][22][23][24][25] Corticosteroid phobia even exists among healthcare providers, where the highest scores have been found in healthcare nurses, GPs, and pharmacists and the lowest in dermatologists. 20,21 TCS phobia is even higher in GPs and pharmacists compared to patients.…”

“…Atopic dermatitis severity at the time of the survey was assessed using the Patient-Oriented Eczema Measure (POEM) 14 ; a sevenitem, validated, self-reported outcome tool about the frequency of signs and symptoms (itch, sleep disturbance, dryness, flaking, weeping or oozing, bleeding, and cracking) in the past 7 days. The final score ranges from 0 to 28 and was divided into five rank order categories: clear or almost clear (0-2), mild (3-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16), severe (17)(18)(19)(20)(21)(22)(23)(24), and very severe eczema (25-28). 15…”

Quantitative analysis of topical treatments in atopic dermatitis: unexpectedly low use of emollients and strong correlation of topical corticosteroid use both with depression and concurrent asthma

“…Even accounting for intervening periods of remission (which our data cannot capture), the observed level of TCS use overall would appear to be on the low end of expected usage levels. In terms of underlying factors, the significantly higher use of TCS observed in juvenile patients (where parents may often be involved in treatment) suggests that ‘steroid phobia’ is unlikely to be a major factor underlying moderate TCS use.…”