Steroid phobia isn't reduced by improving patients' knowledge of topical corticosteroids

Feldman, Steven R.; Huang, William W.

doi:10.1016/j.jaad.2020.03.011

Cited by 15 publications

(12 citation statements)

References 5 publications

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“… 17 , 29 , 30 , 31 The question of how to reduce these concerns remains unanswered: While some studies suggest that targeted patient education (‘eczema schools’) may mitigate such concerns, 32 , 33 others conclude that even when patients are armed with more knowledge, their fear levels remain unchanged. 34 , 35 This expert group reached 100% consensus that therapeutic patient education is valuable and agreed that hesitancy and phobia need to be specifically addressed.…”

Section: Discussionmentioning

confidence: 99%

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

Graaf

Janmohamed

Schuttelaar

et al. 2022

Acad Dermatol Venereol

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Background Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. Objectives This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision‐making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate‐to‐severe AD. Methods Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two‐round Delphi process, they reached full or partial consensus on 37 statements. Results Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non‐systemic therapy. Systemic therapy should achieve long‐term disease control and reduce short‐term interventions. Recommended are cyclosporine A for short‐term use (all ages) and dupilumab or methotrexate for long‐term use (ages ≥6 years). Consensus was not reached on the best long‐term systemics for children aged 2–6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real‐world data will become available. Conclusions This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate‐to‐severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.

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Section: Discussionmentioning

confidence: 99%

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

Graaf

Janmohamed

Schuttelaar

et al. 2022

Acad Dermatol Venereol

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“…The review also found that the concerns most frequently encountered by patients and caregivers are related to topical steroid side effects and the potential for overuse leading to these problems [9,25]. Additionally targeting knowledge gaps in patients and caregivers has not been shown to be effective at reducing TCS phobia and the subsequent nonadherence [26].…”

Section: Discussionmentioning

confidence: 99%

“…Steroid phobia among clinicians is evaluated with a standardized tool and definition via the Topical Corticosteroid Phobia questionnaire for professionals (TOPICOP-P) [10]. The high prevalence of TCS phobia found among providers (32-49%) demonstrates knowledge gaps that reflect their professional recommendations, and ultimately, patient adherence [10,26]. Despite clinical guidelines published from the American Academy of Dermatology [27], the American Academy of Pediatrics [28], and Annals of Asthma Allergy, and Immunology [29], other drug information is readily available from unreliable sources such as websites and other healthcare workers [20,30].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Awareness of Topical Steroid Phobia in Atopic Dermatitis: Pre and Post Education of Family Medicine Providers, Pharmacist Interns and Dermatology Residents

PC¹,

Dyer²,

Kaupla³

et al. 2021

jfammed

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Purpose: Treatment nonadherence is a primary barrier in the management of Atopic Dermatitis (AD) and often attributed to Topical Corticosteroid (TCS) phobia. Misinformation of TCS safety and utility among providers perpetuates TCS phobia. We aimed to assess provider knowledge of TCS in AD and determine the feasibility of educational interventions in modifying their beliefs and practices. Methods: Pharmacy interns and family medicine providers (nondermatology clinicians) in attendance of virtual education sessions were evaluated before and after an evidence-based lecture on the use of TCS in AD. Dermatology residents were evaluated pre-lecture. All responses were recorded via electronic questionnaires. Results: Response rates for the pre- and post-questionnaires were 50% and 26%, respectively. Dermatology residents were more likely to believe that TCS used appropriately are safe for patients and scored higher on the pre-lecture evaluation compared to non-dermatology clinicians (62 vs. 27%, p=0.036). Non-dermatology clinicians also scored higher in overall knowledge after attending the evidence-based lecture (68 vs. 27%, p<0.001). Conclusions: There may be beliefs and knowledge gaps among nondermatologist clinicians in the treatment of AD that perpetuate TCS phobia. These beliefs and counseling practices appear modifiable, however, through post-graduate educational interventions. Collaboration of healthcare providers involved in the treatment of AD is important for the dissemination of reliable information to patients.

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“…The phenomenon of steroid phobia as a result, is the biggest hurdle in successful clinical management. [22] The introduction of calcineurin inhibitors enable clinicians and patients to apply non-steroid topical treatment for mild or limited severity of eczema. But it also bears black box warning for possible safety concern and products are limited to [19,20,21] the proven clinical value of this role, clinicians should encourage and supervise patients to achievement a better compliance in moisturizer use [Figure 3 and Table 3].…”

Section: Topical Corticosteroids (Tcs)mentioning

confidence: 99%

Overcoming challenges in management of atopic dermatitis: Role of oxidative stress in the pathogenesis and treatment target of atopic dermatitis (ROAD)

Ho¹,

Hau²,

Chan

et al. 2022

CSDM

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The Dermatology Advisory Board on Atopic Dermatitis from Asian Medical Expert Academy compiles current evidence-based approach review in managing atopic dermatitis (AD) among Asians. Electronic searches were performed to retrieve relevant published paper, systematic reviews, and guidelines on AD in the period of 2010-2020. A premeeting survey was performed prior to the meeting to gather opinions from experts to identify the individual unmet demands in the current management, and the possible strategies to overcome these issues. Collective opinions are scrutinized during the next step in a meeting, with the establishment of the opinions into an updated consensus in current AD management. Meeting of all committees through webinar platform in 2020 is called in making the current position in the AD management. Current challenges in AD management include steroid phobia, compliance, myths among the community, frequent flares leading to loss of patience, and good rapport. The Expert Panel recommends a stepwise approach to treatment based on disease severity. The use of moisturizers is recommended across all levels of AD severity. Oxidative stress is recognized as an important contributor to AD that can directly damage skin cells and induce an immune response that leads to AD. Prescribed Emollient Device (PED) with antioxidants can help mitigate the effects of oxidative stress in causing AD. Furfuryl palmitate is an antioxidant that has demonstrated efficacy in managing symptoms of AD in adults and children, as well as other inflammatory dermatoses. PEDs can potentially play an important role in the treatment of AD by augmenting "upstream" treatment. This could potentially help reduce the risk of side effects and adverse events in patients undergoing treatment for AD. Furfuryl palmitate is an antioxidant that has demonstrated efficacy in managing symptoms of AD in adults and children.

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Steroid phobia isn't reduced by improving patients' knowledge of topical corticosteroids

Cited by 15 publications

References 5 publications

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

Knowledge and Awareness of Topical Steroid Phobia in Atopic Dermatitis: Pre and Post Education of Family Medicine Providers, Pharmacist Interns and Dermatology Residents

Overcoming challenges in management of atopic dermatitis: Role of oxidative stress in the pathogenesis and treatment target of atopic dermatitis (ROAD)

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