Corticosteroid phobia: a questionnaire study using TOPICOP score

Linguistic Validation and Reliability of the Croatian Version of the TOPICOP Questionnaire

Background and Objectives: This study demonstrates the factor structure and reliability of the Croatian version of the TOPICOP (Topical Corticosteroid Phobia) questionnaire, thereby contributing to further validation and standardization of the measurement of topical corticophobia with dermatological patients or their parents, which directly affects patient or parent compliance, as well as the final therapeutic effect. Materials and Methods: The cross-sectional, observational study was conducted at the University Hospital Centre Split, Department of Dermatovenerology. The research involved inviting 120 participants (age 12-68) who attended the University Hospital Centre Split's Atopy School, patients examined in the Dermatology Outpatient Clinic of the University Hospital Centre Split and diagnosed with atopic dermatitis (AD) or allergic contact dermatitis (ACD), and parents or legal representatives of patients younger than 12 years old. The TOPICOP questionnaire consists of 12 items assessing the three different components of topical corticophobia (worries, beliefs, and behaviour). Respondents evaluated their perception of the correctness of each statement within 10 min of filling out the questionnaire on a four-point Likert scale. Results: The response rate was 94%, resulting in a sample of 113 respondents (109 adults and 4 children). Factor analysis yielded one common factor of relatively high reliability (Cronbach α = 0.85, 95% CI 0.81 to 0.89). No differences were found in questionnaire scores between male and female participants, nor between the parents/legal representatives of dermatological patients and other patients. Conclusions: This research contributes to further development of the appropriate measuring instrument, its practical application, and thus, the better recognition, resolution, and prevention of topical corticophobia as part of the better overall healthcare and treatment of chronic dermatological patients.

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.

Unveiling the potential: Enhancing caregiver knowledge through video education to address topical corticosteroid concerns in children with eczematous dermatitis

BACKGROUND

Concerns about the use of topical corticosteroids (TCS) in pediatric eczematous dermatitis management often hinder effective treatment. Limited data exist regarding the prevalence of these concerns and the effectiveness of interventions. This study aimed to assess the prevalence of TCS concerns among caregivers and determine the effectiveness of video education in mitigating these concerns.

METHODS

A single-center prospective study was conducted from 2022 to 2023, involving caregivers of children under 18 years with eczematous dermatitis. Baseline and post-intervention questionnaires were administered after a 4-week period. Caregivers received video education on TCS use, and the TOPICOP score was evaluated before and after viewing the video.

RESULTS

The study included 150 caregivers, 85.3% female and 74% had a child with atopic dermatitis. The prevalence of TCS concerns among Thai caregivers was 62%. Following video education, the prevalence of TCS concerns significantly decreased to 10.7%. Mean belief score decreased from 43.81 ± 13.45 to 31.85 ± 16.56, mean worry score decreased from 56.22 ± 18.27 to 40.41 ± 18.55 and mean total TOPICOP score decreased from 50.02 ± 12.65 to 36.13 ± 13.52 (p-value <.001). The intervention also resulted in reduced disease exacerbations, duration of the rash, and duration of TCS use. The optimal TOPICOP cut-off score to predict TCS concerns was identified as 43.06.

CONCLUSION

Video education effectively alleviated TCS concerns among caregivers, addressing beliefs, worries, disease exacerbations, and side effects. Integration of this intervention into the management of pediatric eczematous dermatitis can yield optimal outcomes.

Knowledge and Attitudes Towards Topical Corticosteroids Among Previous Users in the General Population of Saudi Arabia

Introduction Topical corticosteroids are a valuable tool for treating many dermatoses, offering anti-inflammatory and immunosuppressive properties. However, preexisting knowledge gaps and safety concerns may hinder treatment compliance. This study aims to evaluate knowledge and attitudes towards topical corticosteroids among former users within the general population of Saudi Arabia. Methods This cross-sectional study utilized an online survey to collect data. Knowledge was assessed through three dimensions: indications, proper use, and adverse reactions. Attitudes were assessed using the Topical Corticosteroid Phobia (TOPICOP) scale. Results Among the 397 respondents, 80.9% were females, 51.1% had suffered from a dermatological disease, and 76.3% had a bachelor's or higher educational level. When assessing knowledge, female participants (6.22±2.02) displayed significantly higher scores compared to male participants (5.26 ± 2.23) (p<0.001). Participants with dermatological diseases provided more accurate answers compared to those without. In assessing phobia towards topical corticosteroids, participants aged 18-25 years had lower topical corticosteroid phobia scores (31.06 ± 5.91), whereas those aged 56 years or more had higher scores (35.38 ± 6.04), p<0.001. Single participants had significantly lower topical corticosteroid phobia scores (32.27 ± 6.06) compared to those who were married (33.87 ±5.95) (p=0.010). Additionally, participants with dermatological diseases had higher scores in the behaviors subcategory despite having lower Global TOPICOP scores (32.58 ± 5.7) (p=0.033). Conclusion Enhancing knowledge about topical corticosteroids is crucial for mitigating corticophobia and promoting better adherence. To address gaps in knowledge, dermatologists should expand educational initiatives to include vulnerable populations, explicitly targeting males and older individuals.

An evaluation of pharmacists' general attitudes, knowledge, and phobias regarding medications that include corticosteroids: a cross-sectional study

BACKGROUND

Corticosteroid-containing medications are widely accessible in various forms, including topical, injectable, and inhaled formulations. Due to uncertain safety profiles, healthcare providers, including pharmacists, often express apprehension when dispensing these drugs. This cross-sectional study assesses the knowledge, attitudes, and phobia of Jordanian pharmacists regarding corticosteroid-containing medications.

METHODS

Conducted through a self-administered online questionnaire.

RESULTS

the study reveals that dermatological conditions and respiratory disorders are the primary indications for prescribing corticosteroid-containing drugs. The most reported side effects among pharmacists' patients include increased appetite, diabetes, and skin thinning. Pharmacists generally exhibit acceptable knowledge, with a median score of 9.0 out of 11.0 (IQR = 3.0). Over two-thirds of pharmacists (69.9%) achieve a high knowledge score (Bloom's cut-off point ≥ 8.8). However, only 55.7% are aware that corticosteroids may induce mood changes. High phobia scores, particularly concerning increased blood pressure and osteoporosis risks, indicate pharmacist reservations in corticosteroid dispensing. Interestingly, pharmacists in rural areas display lower knowledge scores, while those working outside community pharmacies exhibit lower phobia scores compared to their counterparts in urban areas and community pharmacies, respectively.

CONCLUSION

Despite generally good knowledge levels, the study underscores high phobia scores among Jordanian pharmacists regarding corticosteroid dispensing, particularly due to concerns about blood pressure elevation and osteoporosis risks. This suggests a potential need for targeted educational interventions and support systems to enhance pharmacist confidence and optimize corticosteroid usage while minimizing associated risks.

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.

Evaluation of knowledge, experiences, and fear toward prescribing and dispensing corticosteroids among Egyptian healthcare professionals: A cross-sectional study

Background

Corticosteroids (CS) are essential drugs in the treatment of several medical conditions. Assuming different roles, physicians and pharmacists play a primary role in prescribing and dispensing these medications to optimize patients' clinical management. The data on assessing knowledge and experience of healthcare professionals toward CS is scarce. Therefore, this study aimed to assess and compare knowledge, experience, and fears towards CS among Egyptian physicians and pharmacists.

Methods

A cross-sectional, self-administrated, validated online questionnaire was used to collect the data from Egyptian healthcare professionals. The questionnaire consisted of four sections with multiple choice questions: sociodemographic (7 questions), knowledge about CS (13 questions), experience with CS prescription/dispensing (5 questions), and fears and preferences toward CS prescription/dispensing (13 questions). Descriptive and inferential statistics were used to analyze the data.

Results

A total of 600 responses were analyzed in this study. The study sample was almost two-half of healthcare providers: 303 (50.5%) pharmacists and 297 (49.5%) physicians. Pharmacists had marginally higher knowledge scores as compared to those recorded for physicians (11.29 versus 10.16, respectively; P = 0.047). Physicians had more experience choosing corticosteroids in treatment plans based on their experience (51.8% vs 38.5%) and guideline recommendations (72.8% vs 50.9%) than pharmacists. However, pharmacists had more experience dealing with corticosteroid use based on patients' preferences (19.5% vs 4.9%) and showed a broader scope of experiencing side effects of corticosteroids with their patients. The two professions demonstrated high levels of fear, with pharmacists acknowledging significantly lower concerns about CS than physicians (3.72 versus 4.0, respectively; P = 0.003).

Conclusion

Discrepancies exist among healthcare professionals in knowledge and experience, favoring better scientific knowledge of pharmacists related to corticosteroids. Based on these findings, the interprofessional collaborative efforts would provide comprehensive, patient-centered care that maximizes the benefits of CS while minimizing their risks.

Perception of Illness and Fear of Inhaled Corticosteroid Use among Parents of Children with Asthma

The most prevalent children's chronic disease worldwide is asthma which has notable negative impacts on patients' and parent's quality of life. Daily inhaled corticosteroids (ICS) therapy is a preferred controller choice. This study was conducted on 148 parents of asthmatic children to establish parents' perception of illness and fear of inhaled corticosteroids using B-IPQ and TOPICOP questionnaires. Children were in the majority male (66.9%), older than five years (58.8%), with comorbidities, and family history of atopy. Parents were female, with a mean age of 38, employed, and with a history of some form of corticosteroid use. Most parents were not afraid of ICS usage (71.6%). Unemployed parents and parents who had no medical education had a statistically significantly higher fear of using ICS (p = 0.002, p = 0.03). A child's illness affects the parents' lives and parents who are afraid of using ICS react more emotionally to the child's illness. Better understanding and less concerned about child's disease are parents of children with controlled asthma. The parents' perspective of children's asthma will affect the duration and dose of ICS treatment they will give to their children and directly influence the level of asthma control.

Assessment of Knowledge, Perception, Experience and Phobia toward Corticosteroids Use among the General Public in the Era of COVID-19: A Multinational Study

BACKGROUND

Corticosteroids play a significant role in managing the vast majority of inflammatory and immunologic conditions. To date, population-based studies on knowledge and attitudes concerning corticosteroids are scarce. This study aims to comprehensively assess knowledge, perception, experience and phobia toward corticosteroid use among the general population in the era of COVID-19.

METHODS

A cross-sectional self-administrated questionnaire was used to collect the data from 6 countries. Knowledge and corticophobia scores, descriptive statistics and logistic regression were computed.

RESULTS

A total of 2354 participants were enrolled in this study; the majority were females (61.6%) with an average age of 30. Around 61.9% had been infected previously with COVID-19, and about one-third of the participants had experience with corticosteroid use. The mean knowledge score was relatively satisfactory (8.7 ± 4.5 out of 14), and Corticophobia ranked a high score in all countries. Age, female gender, and history of COVID-19 were positively correlated with developing corticophobia.

CONCLUSION

Our study highlights that the general knowledge about steroids was satisfactory. However, the phobia toward its use upon indication is high. Therefore, enhancing awareness and providing essential counseling regarding the rational use of corticosteroids may reduce corticophobia.

Topical corticosteroid phobia in adolescents with eczema and caregivers of children and adolescents with eczema: A cross-sectional survey

Steroid phobia is an increasing phenomenon that affects treatment adherence. The purpose of this study was to assess the prevalence and associated factors of steroid phobia among adolescents with eczema and the caregivers of children and adolescents with eczema by using questionnaires and TOPICOP© scale. The prevalence of steroid phobia is approximately 12% and 37% in the adolescent and caregiver groups, respectively. Caregivers who obtained information about topical corticosteroid (TCS) from dermatologists and whose children had fewer number of flares, demonstrated less concern about using TCS.

Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients

OBJECTIVE

To explore the phenomenon of topical corticosteroid (TCS) phobia and comprehensively understand the factors driving TCS concerns, in particular pertaining to steroid addiction and withdrawal.

DESIGN

Prospective qualitative study using 1:1 in-depth semistructured interviews and analysed using grounded theory.

PARTICIPANTS

Patients with a prior experience of TCS use for a dermatological condition recruited from a tertiary academic dermatology clinic, or through word of mouth and online social media platforms.

RESULTS

26 participants encompassing those with positive, neutral and negative opinions towards TCS were interviewed. 13 reported having topical steroid addiction or withdrawal. The drivers of TCS concerns could be categorised into seven themes: attitudes towards TCS (comprising beliefs and knowledge about TCS), availability of alternatives, treatment inconvenience, personality, patient's ongoing evaluation of clinical response to TCS, doctor-patient relationship and healthcare-seeking behaviour. Of mention, patients placed high value and trust on their own experiences with TCS, such as their perceived experienced side effects. The doctor who failed to acknowledge the patient's opinions and instead emphasised the safety of TCS was often viewed as dismissive, resulting in a deteriorating patient-doctor relationship.

CONCLUSION

Provision of knowledge and education is important but may be ineffective if the basis for TCS concern regarding safety is reasonable, or when the patient has a firmly established belief supporting his/her concern. In such instances, failure to acknowledge and respect the patient's decision to avoid TCS could worsen the doctor-patient relationship.

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.

Lipid-based nanoparticles for psoriasis treatment: a review on conventional treatments, recent works, and future prospects

Psoriasis is a lingering inflammatory skin disease that attacks the immune system. The abnormal interactions between T cells, immune cells, and inflammatory cytokines causing the epidermal thickening. International guidelines have recommended topical treatments for mild to moderate psoriasis whilst systemic and phototherapy treatments for moderate to severe psoriasis. However, current therapeutic approaches have a wider extent to treat moderate to severe type of psoriasis especially since the emergence of diverse biologic agents. In the meantime, topical delivery of conventional treatments has prompted many unsatisfactory effects to penetrate through the skin (stratum corneum). By understanding the physiology of stratum corneum barrier functions, scientists have developed different types of lipid-based nanoparticles like solid lipid nanoparticles, nanostructured lipid carriers, nanovesicles, and nanoemulsions. These novel drug delivery systems help the poorly solubilised active pharmaceutical ingredient reaches the targeted site seamlessly because of the bioavailability feature of the nanosized molecules. Lipid-based nanoparticles for psoriasis treatments create a paradigm for topical drug delivery due to their lipids' amphiphilic feature to efficiently encapsulate both lipophilic and hydrophilic drugs. This review highlights different types of lipid-based nanoparticles and their recent works of nano formulated psoriasis treatments. The encapsulation of psoriasis drugs through lipid nanocarriers unfold numerous research opportunities in pharmaceutical applications but also draw challenges for the future development of nano drugs.

Steroid Phobia: Is There a Basis? A Review of Topical Steroid Safety, Addiction and Withdrawal

There is a growing concern amongst patients about topical corticosteroid (TCS) side effects, with increasing discussion of topical steroid addiction (TSA) and topical steroid withdrawal (TSW) particularly on social media platforms. However, the acceptance of TSA/TSW as a distinct condition remains controversial within the dermatological community. We conducted a literature search using PubMed, MEDLINE, Cochrane Library, Google Scholar, Embase and Web of Science to identify original articles addressing TSA/TSW. We described the definition and reported clinical features of TSA/TSW including its classification into erythemato-edematous and papulopustular subtype. To assess the validity of TSA/TSW, we summarised and objectively appraised the postulated mechanisms for this condition, including tachyphylaxis, dysregulation of glucocorticoid receptors, rebound vasodilation and impaired skin barrier leading to a cytokine cascade. Understanding the evidence including its limitations and uncertainties highlights areas for future research and helps medical practitioners better counsel and provide care to patients who may be experiencing or who have concerns about TSA/TSW.

Assessment of topical steroid phobia in dermatology patients, a cross-sectional study from an urban area of Pakistan

BACKGROUND

Topical corticosteroid (TCS) phobia is a fear of steroids, most prevalent among the general steroid users, the origin of anxiety and fear about steroids is still unclear. Although multiple studies have been using the validated TOPICOP© scale to assess the scores of steroid phobia in various skin disorders.

OBJECTIVES

The aim of the study was to analyze the steroid phobia among users of topical corticosteroids and also to assess the association between demographical characteristics and TCS phobia.

METHODS

A cross-sectional survey was conducted to evaluate the belief and perspectives of TCS in a large range of patients of both genders of all ages. Patients presenting in dermatology clinic with any dermatological complaint, who were being treated or currently on topical steroids were included. TOPICOP© scale was used to assess the topical steroid phobia.

RESULTS

A total of 221 topical steroid users were selected for this study, among them 56 (26.7%) were male and 162 (73.3%) were female. The median of global TOPICOP score was 18% and CI 22-12%, S.D: 6.23. The median score of knowledge and beliefs was 7%, (IQR: 9-4%), S.D: 3.33, while fear showed median 5% (IQR: 7-3%), S.D: 2.24, and 6% (IQR: 8-4%), S.D:2.4 for behavior 96 (43.4%). Patients who were not well aware of steroids but still afraid of using steroids. 112 (50.7%) acknowledged the non-adherence to treatment.

CONCLUSION

Steroid phobia is more prevalent among uneducated users of topical steroids than among those who are knowledgeable and literate. Healthcare practitioners should counsel their patients about steroids use and related concerns, rather than addressing the issue that is causing fear in patients.

A comparison between mometasone furoate nasal spray and intranasal glycyrrhetic acid in patients with allergic rhinitis: a preliminary study in clinical practice

Allergic rhinitis (AR) is caused by an IgE-mediated inflammatory reaction consequent to the exposure to the causal allergen. Glycyrrhetic acid (GlyAc) is a natural compound extracted from the liquorice that exerts anti-inflammatory activity. This real-life study compared intranasal GlyAc, present in a medical device containing also glycerol and mannitol, with mometasone furoate nasal spray (MFNS) in 50 adult outpatients with AR. Both treatments lasted 2 months. Endoscopic signs, perception of symptom severity, assessed by VAS, and nasal function measured by rhinomanometry were evaluated at baseline (T0), after one (T1) and two (T2) months. The intergroup analysis showed that at T1 there was no significant difference between groups about the use of decongestants and antihistamines, turbinate hypertrophy and pale mucosa, perception of olfaction and snoring. At T2 there was no significant difference between groups about use of relievers, all endoscopic signs, and perception of nasal discomfort, nasal obstruction, olfaction, and snoring. The intragroup analysis showed that in MFNS group there was a significant change during the entire period of treatment for all parameters except watery rhinorrhea (sign) and ocular discomfort; in GlyAc group there was a significant change during the entire period of treatment for all parameters. In conclusion, this preliminary study, conducted in clinical practice, evidenced that intranasal CysAC plus mannitol was able to significantly improve nasal endoscopic signs, perception of symptoms, and nasal function in patients with AR. Therefore, GlyAc could be a reasonable therapeutic option to control allergic inflammation. (www.actabiomedica.it)