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Topical corticosteroid phobia in atopic dermatitis tied to nonadherence

Patients with atopic dermatitis reported topical corticosteroid phobia, which appeared to play a role in nonadherence to treatment, according to recently published study results in JAMA Dermatology.

Researchers at the Yale School of Medicine conducted a literature search of Ovid, PubMed and Web of Science for articles published between Jan. 1, 1946, and Oct. 31, 2016, with search words including topical steroid, corticosteroid, phobia, concern, worry, fear, anxiety, atopic dermatitis and eczema.

The articles had to examine topical corticosteroid (TCS) phobia in patients or caregivers.

The search produced 490 articles, with 16 articles on cross-sectional studies that were eligible to be included in the study.

There was a range of TCS phobia prevalence of 21% (85% CI, 15.8-26.2) to 83.7% (95% CI, 81.9-85.5).

Definition of TCS phobia ranged from concern to irrational fear in 10 studies that used the word phobia to describe the phenomenon.

Although 10 articles reported overall nonadherence rates of the patient population, two of the studies compared nonadherence rates between patients with TCS phobia and those without, finding that patients with TCS phobia had significantly higher rates of partial adherence (49.4% vs. 29.3%) and nonadherence (14.1% vs. 9.8%), compared with the non-TCS phobia cohorts.

Physicians, friends and relatives, broadcast and print media and the internet were sources of information about corticosteroids for the patients.

“Despite their safety, the use of TCSs is often met with anxiety and fear in patients, with TCS phobia being recognized as playing a key role in poor treatment adherence in [atopic dermatitis],” the researchers wrote. “

“[TCS] phobia is a pervasive and global phenomenon that has implications for patient adherence and outcomes in [atopic dermatitis],” the researchers concluded. “Improved standardization of the definition and assessment of this phenomenon is needed, as the variability found in the studies precludes purposeful and extrapolation of the data for clinical application.” – by Bruce Thiel

Disclosure: Li reports no relevant financial disclosures. Please see the full study for a listing of the other researchers’ relevant financial disclosures.