Most patients with chronic hand eczema suffer from corticosteroid phobia

Key takeaways:

• 75.5% of patients totally or almost agreed that topical corticosteroids cause damage to skin.
• 36.3% of patients reported being scared to use topical corticosteroids despite being unable to name risks.

A new study finds that the majority of patients with chronic hand eczema suffer from corticosteroid phobia, which negatively impacts treatment adherence.

“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,” Maria O. Christensen, MD, of the department of dermatology and venereology, Bispebjerg and Frederiksberg Hospital at the University of Copenhagen, and colleagues wrote. “Corticosteroid phobia is associated with poor treatment adherence, worsening disease outcomes and increased use of alternative medicine.”

Previous studies have shown that 51% of patients with different skin diseases suffer from corticosteroid phobia. In this study, Christensen and colleagues assessed the knowledge, beliefs, fears and behaviors about topical corticosteroids as well as treatment adherence among patients specifically with chronic hand eczema. The study took place in Denmark and included 927 patients.

Results showed that 75.5% of patients totally or almost agreed that topical corticosteroids cause damage to skin. Nearly half of all patients (48.9%) also totally or almost agreed that topical corticosteroids would impact their future health.

A majority of patients (77.9%) also reported stopping their topical corticosteroid treatment as soon as possible, whereas more than half (54.8%) put off beginning treatment until they felt it was absolutely necessary.

Using less medicine than was prescribed and stopping treatment during a treatment period was reported by 38.8% and 54% of patients, respectively. The authors found that there was a significant association between low treatment adherence and high corticosteroid phobia (P = .004).

The study also found that 36.3% of patients reported being scared to use topical corticosteroids but were unable to name any topical corticosteroids-associated risks. According to the authors, this highlights the need for better education to address any misconceptions or misinformation, both of which can lead to exacerbated disease severity.

While the Topical Corticosteroid Phobia scale and Medication Adherence Report Scale has been used as a measuring tool for corticosteroid phobia in other dermatological diseases, it has not yet been validated specifically for CHE patients, making this a limitation of this study.

“Physicians should address any fears or concerns their patients may have proactively and instruct them properly in TCS use and application,” they wrote. “This will help to optimize patients’ treatment outcomes and adherence and also to reduce risk of adverse events or treatment escalation.”