Corticosteroid phobia: a questionnaire study using TOPICOP score

Choi, Ellie; Chandran, Nisha Suyien; Tan, C. Y.

doi:10.11622/smedj.2019110

Cited by 26 publications

(30 citation statements)

References 17 publications

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“…Associations with TCS phobia differed between studies. Some studies correlated age with steroid phobia, specifically in younger patients [18] and patients less than 60 years of age [5]; while other studies have found no connection [11,24,27]. Although caretakers of children younger than 12 months old were more likely to have steroid phobia, the age of the caretaker did not influence the presence of steroid phobia [28].…”

Section: Populations More Likely To Express Steroid Phobiamentioning

confidence: 99%

“…Populations more likely to express steroid phobia included female patients, female caregivers/mothers, female clinicians/pharmacists, caregivers of female patients, patients whose father had a history of AD, patients who frequently changed dermatology providers, patients who received conflicting information from healthcare providers, patients residing in metropolitan areas, patients who had a high number of general practitioner visits before referral to a dermatologist, and patients with an increased time period from onset of AD flare until initiation of TCS application (Table 1) [4,5,7,11,18,20,[22][23][24][25]. Healthcare professionals, including pharmacists, general practitioners, and non-physician professionals expressed steroid phobia more often than dermatologists [5,23,26].…”

Section: Populations More Likely To Express Steroid Phobiamentioning

confidence: 99%

“…Steroid phobia can lead to treatment failure with TCS, resulting in persistent disease and escalation of treatment to systemic agents (such as methotrexate and cyclosporine) or costly medication (dupilumab) [9,10]. A survey of dermatology patients revealed almost half of patients preferred using non-steroidal agents even if they were more expensive [11]. Caretakers and patients are willing to pay more for non-steroidal options, thus contributing to the economic burden that patients and families already face from treatment management [6,12].…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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.

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Section: Populations More Likely To Express Steroid Phobiamentioning

confidence: 99%

Section: Populations More Likely To Express Steroid Phobiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2021

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“…The TOPICOP© scale was developed to assess steroid phobia in patients with atopic dermatitis. 23 However, we included patients with all types of eczema in our study to assess steroid phobia in a larger segment of the population, as presented by our samples.…”

Section: Discussionmentioning

confidence: 99%

The effects of topical steroid fears and concerns on patients with eczema: first TOPICOP© scale-based study in Saudi Arabia

Alharbi¹,

Alhetheli

Alqahtani

et al. 2021

Int J Res Dermatol

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Background: Topical corticosteroids (TCS) are the main treatment for eczema, which are often required for months (or years) to control the disease. Despite the well-known side effects of TCS, their efficacy and safety are well established when used appropriately. This study was conducted to assess the fears, concerns, and various practices of patients with eczema toward TCS in the Qassim region of Saudi Arabia.Methods: A cross-sectional survey-based study was conducted that targeted patients with eczema among all age groups and genders attending the dermatology outpatient clinics. There were no exclusions based on the type, severity, or duration of the disease.Results: A total of 105 patients with eczema were recruited for this study. It was revealed that 46.8% of participants stopped their treatment as soon as possible, which indicates immediate discontinuation of steroids after their eczema flares had subsided and improved. An interesting finding was that 38.3% of participants did not start their TCS treatment until the disease deteriorated rather than when flare-ups occurred.Conclusions: Exaggerated fears about TCS exist among patients with eczema and their care givers. This can result in non-adherence or wasting of many prescribed TCS preparations TCS. It is very important to understand and emphasize on the nature and extent of the prevalence of TCS fears to ensure that prompt, correct advice can be offered. Since dermatologists remain the most trusted source of information, there should be an emphasis on individual patient counseling and increased engagement in social media with pre-planned content.

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“…Concerns about TSA/TSW contribute to TCS phobia, which has a prevalence ranging from 21 to 83.7% [3]. Studies using the TOPICOP score © [4], a validated score to assess steroid phobia, have found an average score of between 40.3 and 44% (0 least fear, 100 most fear) [5][6][7]. Importantly, excessive TCS concerns can lead to excessive food restriction [8], use of harmful alternatives [9], and suboptimal treatment [3], resulting in flares and escalation to systemic agents.…”

Section: Introductionmentioning

confidence: 99%

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

2021

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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.

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Corticosteroid phobia: a questionnaire study using TOPICOP score

Cited by 26 publications

References 17 publications

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

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

The effects of topical steroid fears and concerns on patients with eczema: first TOPICOP© scale-based study in Saudi Arabia

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

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