Review Finds Topical Corticosteroid Phobia in Atopic Dermatitis Contributes to Medication Nonadherence

Although topical corticosteroids (TCSs) are an effective therapy for patients with atopic dermatitis (AD), nonadherence to this treatment is common. A recent study in JAMA Dermatology sought to better understand TCS phobia, which is a major reason for treatment failure in patients with AD.

TCS phobia was originally described as an irrational fear of corticosteroids, but it has evolved to include descriptions of negative feelings and beliefs that patients hold about TCSs. The authors reviewed literature to investigate the prevalence of TCS phobia, causes of concern, sources of the phobia, and effects on treatment adherence.

“A better understanding of TCS phobia will enhance clinicians’ ability to provide personalized education for their patients and colleagues about the safety and efficacy of TCSs, thereby increasing adherence and decreasing morbidity related to AD,” the authors wrote.

The researchers identified 676 articles published between January 1, 1946, and October 31, 2016, that included combinations of terms such as topical steroid, corticosteroid, phobia, atopic dermatitis, anxiety, and worry. Of those articles, only 16 remained after exclusion criteria were applied. The 16 studies spanned 16 countries: Australia, Canada, Croatia, France, Germany, Hong Kong, Japan, Mexico, the Netherlands, Norway, Poland, Singapore, South Korea, Spain, the United Kingdom, and the United States.

In the articles being reviewed, 10 used the word “phobia,” but there was variation in how it was defined, including irrational and/or unwarranted fear of TCSs, the general fear related to TCS use, and concern and anxiety about TCS use. The prevalence of TCS phobia in these studies ranged from 21% to 83.7%. The study with the lowest prevalence of TCS phobia included only caregivers of pediatric patients and the study with the highest prevalence included only adult patients.

In addition, only 2 studies compared nonadherence rates between patients with and without TCS phobia. They found a higher proportion of patients with phobia reported partial adherence or nonadherence.

“Assessing for TCS phobia at the onset of a new patient-physician relationship could provide a potential target for early intervention by physicians and an opportunity to increase patient adherence with focused counseling,” the authors wrote.

Interventions may also target the source of TCS phobia. Four of the studies found that physicians and healthcare workers were the top source of information about TCSs. One noted that insufficient information and conflicting opinions among providers about TCSs caused anxiety and confusion. The authors of the review suggest better educating physicians and pharmacists on safe TCS use.

“Future research endeavors should work toward the development of well-controlled studies assessing interventions that may reduce TCS phobia and improve treatment outcomes in AD,” the authors concluded.