Efficacy of targeted education in reducing topical steroid phobia: A randomized clinical trial

Choi, Ellie; Tan, Ken Wei; Tang, Fengjie; Tan, C. Y.; Chandran, Nisha Suyien

doi:10.1016/j.jaad.2020.02.079

Cited by 22 publications

(37 citation statements)

References 13 publications

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“…In the control group, TOPICOP scores increased 7% by 1 month and remained increased at 3 months. Although this intervention reduced TOPICOP scores, the change was due to an increase in the knowledge subcomponent of the TOPICOP survey rather than a reduction in fear [40].…”

Section: Interventions To Address Steroid Phobiamentioning

confidence: 84%

“…Patient and caregiver education materials consisted of educational videos [40], written information [5,37,40], oral information [5,41], educational classes [28,42], demonstrations of how to correctly apply TCS [35], and online forums [40]. Educational topics covered parental/patient concerns [5], clinical trial evidence, anecdotal evidence [37], risks/ benefits [28,41], risks of untreated dermatological conditions [41], explanations of the pathology and treatment of their dermatological condition [28,42], and common misconceptions of TCS [40]. Some of the educational interventions involved personalized education based on the patient's specific concerns and questions [5].…”

Section: Interventions To Address Steroid Phobiamentioning

confidence: 99%

“…Patient education interventions successfully reduced steroid phobia and improved the willingness to treat with TCS [4,28,37,40]. However, one study demonstrated a "paradoxical" effect of patient education.…”

Section: Interventions To Address Steroid Phobiamentioning

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: Interventions To Address Steroid Phobiamentioning

confidence: 84%

Section: Interventions To Address Steroid Phobiamentioning

confidence: 99%

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

2021

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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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“…This study used an excellent intervention that improved patients' knowledge but that did not reduce patients' fears. 2 Efforts to increase knowledge do not seem particularly effective at reducing patients' fears. Perhaps there could be other more effective knowledgebased approaches, but given how carefully the intervention used in this study was designed, we suspect that other knowledge-based approaches are unlikely to be effective as well.…”

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confidence: 99%