Evaluation of the influence of family and friends, and the Internet on patient perceptions of long-term topical corticosteroid use

Medication safety perceptions in China: Media exposure, healthcare experiences, and trusted information sources

OBJECTIVE

Amid ongoing medication safety concerns in China and limited research on public perceptions, this study investigates the correlations between media exposure, healthcare experiences, and individuals' perceptions of medication safety. It also examines individuals' reliance on information sources during safety crises.

METHODS

A multistage stratified random sampling was employed with the gross sample containing 3090 Chinese adults aged 18-60 years. Data were analyzed using multiple linear regression.

RESULTS

Social media exposure was found to negatively correlate with perceptions of current medication safety and its perceived improvement, while exposure to television and print media showed positive correlations. Positive healthcare experiences were associated with improved medication safety perceptions. Among various information sources, healthcare professionals were deemed most trustworthy during medication safety incidents.

CONCLUSIONS

Media exposure and personal healthcare experiences significantly shape individuals' perceptions of medication safety in China, with healthcare professionals playing a crucial role in this context. Practiceimplications: Effective health crisis communication in China needs to be multifaceted, integrating traditional media and social media platforms to disseminate accurate information broadly. Additionally, healthcare professionals should be actively involved in crisis communication. Their role as trusted sources can be leveraged to clarify misconceptions, and reassure the public during medication safety incidents.

Topical Corticosteroid Phobia Among Women Affected With Vulvar Lichen Sclerosus: Results From a Cross-sectional Survey

OBJECTIVE

Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS).

MATERIALS AND METHODS

This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data.

RESULTS

The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP.

CONCLUSIONS

In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.

Corticophobia among Parents of Children with Atopic Dermatitis: Assessing Major and Minor Risk Factors for High TOPICOP Scores

Corticophobia, fear of applying topical corticosteroids (TCSs), is a rising issue in industrialized countries, despite the actual safety of TCSs for atopic dermatitis (AD). Patients attending the Pediatric Dermatology Unit for skin examination were screened for AD. AD patients were included, and data were collected. Parental corticophobia was evaluated through the Topical Corticosteroid Phobia (TOPICOP) questionnaire. The χ2 test and logistic regression were used to analyze statistical associations between parental corticophobia (mild/moderate vs. severe) and patients' and parents' characteristics. Overall, 100 patients were included (53 females; 47 males; mean age 5.9 years): 44 had mild/moderate AD (EASI ≤ 21), and 56 had severe AD (EASI > 21) (mean EASI 19.7). Of the patients, 33 never consulted healthcare providers for AD, and 67 did. Parental education was low/intermediate in 60 cases and high (gymnasium/university degree) in 40. Mean parental DLQI was 10.7. Mean parental TOPICOP was 39.1%: 51 had mild/moderate corticophobia (TOPICOP ≤ 50%), and 49 had severe corticophobia (TOPICOP > 50%). At the χ2 test, corticophobia was associated with mild/moderate AD (OR 20.9487; 95% CI 7.2489-60.5402; p < 0.001), older age of patients (OR 4.1176; 95% CI 1.7880 to 9.4828; p < 0.001), early disease onset (OR 9.8925; 95% CI 2.7064-36.1596; p < 0.001), and previous healthcare professional consultations (OR 4.9279; 95% CI 1.9335-12.5597; p < 0.001). Also, severe parental corticophobia was very significantly associated with severe parental involvement of life quality (OR 33.3333; 95% CI 10.9046-101.8937; p < 0.001) and with high education of parents (gymnasium or university degree) (29/49) (OR 5.2727; 95% CI 2.1927-12.6790; p < 0.001). At logistic regression, high parental DLQI (p < 0.0001), high parental education (p < 0.0338), older age of patients (p = 0.0015), and early disease onset (p < 0.0513) accounted for major risk factors influencing severe parental corticophobia. Assessing risk factors for corticophobia is essential for addressing groups of parents at higher risk for corticophobia using educational programs, to overcome unfounded fears and augment treatment adherence.

#corticophobia: a review on online misinformation related to topical steroids

Misinformation in healthcare is at crisis level worldwide, with the internet as primary source of prevarication. Topical corticosteroids (TCS) are a safe and effective treatment used in multiple dermatological conditions. Nonadherence to prescribed TCS can be due to phobia secondary to misinformation. TCS phobia is a complex multifaceted phenomenon that exploits patients with skin disease, creates cognitive dissonance and can obstruct successful treatment. This study aimed to examine the content of TCS-related misinformation available online. A formal review of PubMed was performed using the terms 'topical corticosteroids' AND 'misinformation' OR 'disinformation' OR 'conspiracy theory, along with an informal Google search using combinations of these terms and further targeted searches on social media applications including Facebook™, Twitter™, Instagram™ and TikTok™. 'Topical steroid withdrawal', 'red skin syndrome' or 'TCS addiction' is a particularly prevalent myth currently being propagated on social media, with most content suggesting that eczema is due to a 'leaky gut' or food intolerance and not to skin inflammation. The risks of potential adverse effects such as skin thinning and stunted growth/development are often exaggerated. Multiple websites promoting misinformation were frequently endorsed by companies advertising consultations or testing to identify 'underlying causes', or 'natural' products as alternative treatments, including 'herbal' remedies, which can contain significant quantities of corticosteroids or other potent ingredients. The dermatology community should be vigilant of the type of TCS-related misinformation online and be active in attempts to counteract it with evidence-based advice.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.

Pharmacists’ Insights and Behaviors in Preventing the Misuse of Topical Corticosteroids in Pakistan: A Mixed-Method Study

Topical corticosteroids (TCs) misuse has become a common issue for healthcare professionals and patients, particularly in Pakistan, as no stringent laws or rules are prohibiting the selling of over-the-counter medicines. The present study was designed to examine pharmacists’ insights and behaviors regarding TCs and their potential role in preventing the misuse of TCs in Pakistan. The study was a cross-sectional mixed-methods research design (phase 1, quantitative; and phase 2, qualitative) conducted from January to June 2021. The pharmacists working in various settings in Karachi were approached through different social media platforms. Data were collected through a web link of an online questionnaire with 30 closed-ended questions. Different statistical methods were employed for tabulating the quantitative data, while inductive thematic analysis was directed to classify themes from the qualitative data and to conclude findings. The mean cumulative knowledge score was 10.59 ± 1.63. The community pharmacists knew more about the available over-the-counter TCs (p = 0.041). The experienced pharmacists were more conversant than fresh pharmacists, regarding the mode of action (p = 0.008), choice of TC potency (p = 0.001), and most common local and systemic adverse effects of TCs (p = 0.001). Overall, respondents had a favorable attitude, with more than 80% agreeing that pharmacists could ensure that important safety issues are communicated with patients, and assist considerably in avoiding TC misuse. Analysis of data has produced 7 themes, 10 sub-themes, and 30 categories. Major themes included: use and misuse of TCs, adverse drug events due to TCs, cosmeto-vigilance, patient education, referral to a physician, and future perspectives for preventing TC misuse. The respondents were well versed with the dilemma of TCs misuse, and they considered patient characteristics, free availability of TCs, and lack of physician-pharmacist coordination as the major reasons. The major barriers for patient education stated by nearly all the respondents were a lack of time and lack of material/information for counseling. They emphasized the need for stringent legal strategies and the enforcement of current drug-control regulations, so that TCs are not supplied without appropriate prescriptions. The present findings indicate that pharmacists had appropriate knowledge and a positive attitude towards their potential role in preventing the misuse of TCs. Further education and sensitization in areas of deprived knowledge will undoubtedly aid in the prevention of TCs misuse by the community.

Young adults' perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study

OBJECTIVES

Learning to take control of one's health is an important part of the transition from adolescence to adulthood. This study aimed to explore young adults' perceptions of living with atopic dermatitis (AD) in relation to the concept of self-management.

DESIGN

A qualitative study with an inductive approach was performed through semistructured interviews (n=15). The interviews were recorded, transcribed verbatim and analysed with systematic text condensation.

PARTICIPANTS

Young adults (mean age 23,4 years) with persistent AD in a longitudinal population-based birth cohort. To capture experience of living with persistent AD (preschool/school-age onset) of different severity (mild to severe/very severe), a purposive selection was performed. In total, 15 young adults were included. Persistent AD (preschool/school-age onset) was defined as dry skin in combination with itchy rash of typical localisation in the 12 months preceding the 16-year and the 24-year follow-ups. Severity was self-assessed using the Patient Oriented Eczema Measure.

RESULTS

Despite having experience of AD since childhood, the respondents expressed uncertainty about treatment and how it affected their bodies. Their uncertainties and feelings affected how they used topical corticosteroids. The respondents emphasised that they perceived availability of healthcare and knowledge about treatment of AD among healthcare providers to be limited. The participants did not state any experiences of support to self-management from healthcare, which affect young adults' possibilities to take full control of their AD care.

CONCLUSIONS

Young adults with preschool/school-age onset of AD are unsure how to treat and manage the disease. One explanation may be insufficient transition process.

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

BACKGROUND

Atopic dermatitis (AD) is a prevalent relapsing inflammatory skin disease. There is currently little knowledge about healthcare utilization and medication use along with parental corticosteroid phobia in relation to severity of pediatric AD.

OBJECTIVES

To study the association between parental-reported healthcare utilization, medication use, and topical corticosteroid phobia and pediatric AD severity.

METHODS

The study population included all children in Denmark with a diagnostic code of AD (ICD-10 code, group L20) given at a hospital department of dermatology between 2014 and 2018. A questionnaire containing 158 response items was sent to the legal parents. We surveyed disease severity, AD treatment, corticosteroid phobia, and healthcare use along with other variables. Disease severity was assessed using the Patient-Oriented Eczema Measure tool, and corticosteroid phobia was assessed using the Topical Corticosteroid Phobia (TOPICOP) score.

RESULTS

In total, 1343 (39%) parents completed the questionnaire and 95.3% were completed by the biological mother. Children's mean age was 8.9 ± 4.5 years, and 52.8% were boys. Severe AD was associated with a higher number of healthcare visits to GPs, private dermatologists, and hospital departments. Mean global TOPICOP score was 38.27 ± 19.9%. There was a significant inverse linear trend between global TOPICOP score and parental educational level (P_trend  < .0005).

CONCLUSIONS

The significant association between high global TOPICOP score and low parental educational level, resulting in delayed treatment of AD flares, indicates that improved family education ultimately may reduce healthcare expenses and burden of disease.

Quality of life of women with untreated vulval lichen sclerosus assessed with vulval quality of life index (VQLI)

BACKGROUND/OBJECTIVE

The diagnosis of vulval lichen sclerosus (VLS) is often delayed, and little is known about quality of life (QoL) of women with it prior to receiving diagnosis and treatment. This study aimed to investigate the impact on QoL on patients with previously untreated VLS using the Vulval Quality of Life Index (VQLI).

METHODS

A prospective cross-sectional survey of patients attending a dermato-gynaecology practice in Sydney, Australia from March 2018 to November 2019. Patients with a new biopsy-proven diagnosis of VLS not previously commenced on topical corticosteroid treatment were invited to complete the VQLI.

RESULTS

A total of 68 participants with median age of 58 (interquartile range, IQR 48-67) years. Median symptom duration was 24 (IQR 11-60) months. Scarring was present in 53% of participants. The median total score was 13.5 (IQR 7.5-22.0), global score 1.0 (IQR 1.0-2.0). Twelve per cent had nil to minimal effect on QoL, 38% had a mild effect on QoL, 28% had a moderate effect on QoL, 22% had a severe effect on QoL, and none had a very severe effect on QoL. The highest-scoring domains were symptoms, followed by sexuality, anxiety and activities of daily living.

CONCLUSION

There was significant impairment in all QoL areas of women with untreated VLS. Most experienced moderate-to-severe impairment as a result of the disease and approximately half had already developed scarring at the time of diagnosis. The findings emphasise the importance of improved awareness, early diagnosis and early commencement of treatment in VLS.

The role of the nurse in the care and management of patients with atopic dermatitis

BACKGROUND

The purpose of this paper is to provide an overview of key aspects of specialised dermatology nursing practice in the management of patients with moderate to severe atopic dermatitis. The role of dermatology nurse specialists in supporting patients and promoting disease understanding, education and treatment adherence continues to evolve. As features of specialised nursing care can also inform other nursing staff in a wide range of care settings, an overview of key components is examined. Observations presented are from a pan-European perspective and represent the collected view of a group of dermatology nurse specialists, dermatologists and patient advocates following two round-table discussions.

MAIN BODY

Atopic dermatitis is a common, chronic, inflammatory disease characterised by erythematous/scaling skin lesions, with often intense pruritus. Disease course is cyclic with periodic disease flares of varying intensity, presenting management challenges to patients and families. Dermatology nurse specialists play a key role in providing education and substantial patient support to improve treatment outcomes and quality of life to patients and their family, delivered within a multidisciplinary team framework. Nurse-led education and 'eczema schools' are of benefit in reducing disease severity and improving quality of life by enhancing self-management, adherence and patient engagement. eHealth tools, such as patient portals or online training platforms, can provide online learning, individualised education, and help to improve engagement. These and other initiatives, such as written action plans, are all essential to improve or maintain treatment adherence, self-management and quality of life.

CONCLUSIONS

Dermatology nurse specialists play a central role in the assessment and management of moderate to severe atopic dermatitis patients and families. This places them in an ideal position to build strong and often long-term relationships with patients and parents. Such engagement promotes trust, assists in setting realistic expectations of treatment and outcomes, and enhances self-management and engagement in their own care. Providing emotional support, as well as formal and systematic education (including individualised practical advice) all contribute to improved treatment adherence and can enhance the quality of life of patients and their families throughout the course of this long-term condition.

Optimizing Communication About Topical Corticosteroids: A Quality Improvement Study

Background

Patients are often non-adherent to topical corticosteroids (TCS). This may be in part due to poor communication between patients and dermatologists.

Objectives

This quality improvement (QI) study aims to describe dermatologist–patient communication about TCS treatments and to compare communication before and after the implementation of an educational intervention.

Methods

This QI study assesses the communication between dermatologists and new dermatology outpatients receiving a TCS prescription in a tertiary care center. The QI intervention is 2-pronged, consisting of an educational pamphlet for patients and a communication workshop for the dermatology team. Encounters were audiotaped, and communication was analyzed using a coding system (MEDICODE). Phase 1 recordings happened preintervention and reflect the usual dermatologist–patient communication in this practice setting and phase 2 recordings were postintervention.

Results

Phase 1 reveals that dermatologists frequently address informational medication themes, such as naming the medications and informing patients about their proper use. They less frequently discuss patient experience themes, such as goals of treatment, adverse effects of treatments, and exploring patients’ emotions about medications (such as anxiety, fears, etc.). After the intervention, there was more frequent discussion of patient experience themes without increasing consultation length. But, in both phases, physicians address most themes as a monolog with little verbal input from patients.

Conclusions

Our study raises awareness regarding dermatologists’ communication patterns about TCS, identifying specific areas for improvement, such as discussions of adverse effects, and explicitly addressing patients’ attitudes and emotions. This is an essential step to foster a sense-making of TCS for patients.

Corticosteroid phobia: a questionnaire study using TOPICOP score

INTRODUCTION

Topical corticosteroids (TCS) are commonly used in dermatology for their anti-inflammatory action. The recent development of the TOPICOP© (Topical Corticosteroid Phobia) scale to assess steroid phobia has made the quantification and comparison of steroid phobia easier. The objective of this study was to assess the degree of steroid phobia at our institute and identify sources from which patients obtain information regarding TCS.

METHODS

A cross-sectional survey was performed of dermatology patients regardless of steroid use. TOPICOP scale was used for the survey. Sources from which patients obtained information were identified and their level of trust in these sources assessed.

RESULTS

186 surveys were analysed. The median domain TOPICOP subscores were 38.9% (interquartile range [IQR] 27.8%-50.0%, standard deviation [SD] 24.4%) for knowledge and beliefs, 44.4% (IQR 33.3%-66.7%, SD 24.4%) for fears and 55.6% (IQR 33.3%-66.7%, SD 27.2%) for behaviour. The median global TOPICOP score was 44.4% (IQR 33.3%-55.6%, SD 17.6%). Female gender was associated with higher behaviour, fear and global TOPICOP scores. There was no difference in the scores based on disease condition, steroid use, age or education. Dermatologists were the most common source of information on topical steroids and trust was highest in dermatologists.

CONCLUSION

The prevalence of steroid phobia in our dermatology outpatient setting was moderately high, with gender differences. Dermatologists were the most common source of information on TCS, and it was heartening to note that trust was also highest in dermatologists. Strategies to target steroid phobia should take into account these factors.

Patient satisfaction with information, concerns, beliefs and adherence to topical corticosteroids

OBJECTIVE

Adherence to topical corticosteroids (TCS) for inflammatory skin conditions is sub-optimal. This Australian study aimed to test the hypothesis that patients who are more satisfied with the level of information they receive about TCS, are less concerned about using TCS and more adherent to healthcare professionals' instructions.

METHODS

Individuals who were prescribed or had used TCS in the past month were invited to complete an online cross-sectional survey. Reliability and validity of multi-item scales were tested using confirmatory factor analysis. Self-reported adherence to TCS was measured with MARS-5. Multivariate regression with mediation analyses was used to explore relationships between variables.

RESULTS

Mediation analyses of 195 survey (64.4%) responses was performed. Overall satisfaction with information about TCS action and usage (SIMS-AU) (mean = 60.7%) was higher than potential concerns (SIMS-PC) (mean = 48.2%). Analysis revealed that the SIMS subscales were highly correlated (α = 0.57, p < 0.05). Higher overall SIMS scores were predictive of stronger beliefs that TCS was beneficial, fewer concerns about TCS and better adherence.

CONCLUSION

Being more satisfied with TCS information was associated with having more favourable disposition towards TCS and higher adherence.

PRACTICE IMPLICATIONS

Healthcare professionals should identity areas of dissatisfaction with medication information and tailor their counselling accordingly.

Focus group parental opinions regarding treatment with topical corticosteroids on children with atopic dermatitis

INTRODUCTION AND OBJECTIVES

Atopic dermatitis is common among children of 0-5 years old. Treatment consists of emollients and topical corticosteroids. Due to corticophobia, however, adherence to topical corticosteroids is low. Our aim was to find factors that influence opinions about topical corticosteroids among parents of children with atopic dermatitis.

METHODS

A qualitative focus group study in secondary care with parents of children with atopic dermatitis. Questions concerned opinions, attitude, sources of information, and the use of topical corticosteroids.

RESULTS

The parents indicated that they lack knowledge about the working mechanism and side effects of topical corticosteroids. Dermatologists and paediatricians emphasise the beneficial effects, whereas other healthcare workers and lay people often express a negative attitude.

CONCLUSIONS

This study gives a complete overview of factors influencing adherence. Treatment with topical corticosteroids can be improved by better informing parents about the working mechanisms, the use, and how to reduce the dose. Healthcare professionals need to be aware of the consequences of their negative attitude concerning topical corticosteroids.

The impact of lifestyle factors on evolution of atopic dermatitis: An alternative approach

Atopic dermatitis (AD) is a multifactorial chronic inflammatory disease with an incompletely understood etiopathogenesis. With a significant impact on the quality of life of patients, AD has attracted the interest of many research studies aiming to investigate the complex cellular and molecular mechanisms and to identify new therapeutic pathways. Various studies have focused on psycho-immunology, emphasizing the involvement of stress, defined as a general response of the body to external or internal challenges to the AD pathology. Factors like lifestyle and leisure activities may change the behavior of immune cells in AD with a strong impact on the evolution of the disease. Moreover, the poor adherence of AD patient to standard treatment approach has led to the necessity to combine different therapies in the field of complementary and alternative medicine. Although there are still not enough data to conclude that adjuvant therapies are effective in a conventional sense, there are already promising results suggesting that alternative therapeutic strategies could be a main subject of further research.