A study conducted in patients with chronic hand eczema (CHE) revealed that topical corticosteroid (TCS) phobia is a great concern, with many fearing future health risks associated with this type of treatment.
This study, recently published in the Journal of the American Academy of Dermatology, surveyed 1340 eligible patients with CHE. Researchers hoped to assess patient-reported outcomes associated with use of TCS and the overall treatment adherence. They analyzed data from patients with dermatologist verified CHE from the population-based prospective Danish Skin Cohort (DSC).
“The term “corticosteroid phobia” refers to the exaggerated concerns, fears, worries, anxiety, doubts, reservations, reluctance, or skepticism regarding corticosteroid use in patients, their caregivers, or health care professionals.” According to the study, this phobia is associated with poor treatment adherence, worsening disease outcomes, and the increased use of alternative medications.
The study set out to evaluate 1340 patients with CHE, a total of 927 (69.2%) of which participated in the study. Most of these (71.7%, n = 665) were women. Taking into consideration CHE severity, a total of 516 (55.8%) were clear or almost clear, 280 (30.3%) had moderate CHE, 93 (10.1%) had severe CHE, and 35 (3.8%) had very severe CHE. In addition, a total of 345 (37.2%) patients said that they were currently using TCS, 251 (27.1%) patients had used TCS within the last 3 to 12 months, 267 (28.8%) reported last TCS usage >12 months ago, and 38 (4.1%) stated that they had never used TCS.
Researchers used the topical corticosteroid phobia (TOPICOP) scale to assess knowledge, beliefs, fears, and behavior regarding TCS, and the 5-item Medication Adherence Report Scale (MARS-5) to evaluate medication adherence. Only patients who answered questions in both TOPICOP and MARS-5 were included in the study.
Results of the study showed that 75.5% of patients totally or almost agreed that TCS damages the skin. Another 48.9% totally or almost agreed that TCS would affect their future health, while 36.3% reported some degree of fear of TCS although they were unaware of any TCS-associated risks.
It was also reported that 77.9% always or often stop treatment as soon as possible, while 54.8% always or often wait as long as possible before starting treatment. Furthermore, 38.8% of patients stated that they had taken less medicine than prescribed, with 54.0% reporting that they had stopped treatment throughout a period. It is noted also that treatment adherence decreased with increasing corticosteroid phobia.
The researchers conclude “the results of our study show that TOPICOP is highly prevalent among patients with CHE and negatively associated with treatment adherence. This emphasizes both, the need for better TCS education among patients with CHE and health care professionals as well as the demand for nonsteroidal treatment alternatives that are both efficacious and have a favorable safety profile.”
It is recommended that physicians help to address any fears or concerns that their patients may be experiencing and guide them in the proper use and application of TCS. “This will help to optimize patients’ treatment outcomes and adherence and also to reduce risk of adverse events or treatment escalation.”
Source:
- Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema—Findings from the Danish Skin Cohort. (2024). Journal of the American Academy of Dermatology.
