Many Patients with Chronic Hand Eczema Report Having Corticosteroid Phobia, Shows New Research

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Corticosteroid phobia is common among patients with chronic hand eczema (CHE) and this fear negatively impacted treatment adherence, according to a study published in the Journal of the American Academy of Dermatology.

“The term ‘corticosteroid phobia’ refers to the exaggerated concerns, fears, worries, anxiety, doubts, reservations, reluctance, or skepticism regarding corticosteroid use in patients, their caregivers, or health care professionals,” first author Maria O. Christensen, MD, Department of Dermatology and Venereology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, and colleagues wrote. “Corticosteroid phobia is associated with poor treatment adherence, worsening disease outcomes and increased use of alternative medicine.”

Corticosteroid phobia is common among patients with skin disease, including atopic dermatitis, however, less is known about corticosteroid phobia and its impact on treatment adherence among patients with CHE, according to investigators. In the current study, researchers assessed the knowledge, beliefs, fears, and behaviors about topical corticosteroids (TCS) as well as treatment adherence among patients with CHE from the Danish Skin Cohort study. Participants were included in the current study if they answered 2 questionnaires, including the Topical Corticosteroid Phobia (TOPICOP) scale and Medication Adherence Report Scale (MARS-5).

Among a total of 1340 participants with CHE eligible for the study, 927 (69.2%) participants answered both questionnaires and were therefore included in the study. The majority (71.7%) of the cohort were women and the mean age was 55.4 years, according to the study.

Christensen and colleagues found that 75.5% of participants totally or almost agreed that TCS damage skin, and nearly half (48.9%) totally or almost agreed that TCS would affect their future health.

In addition, 77.9% of participants reported always or often stopping TCS treatment as soon as possible, whereas more than half (54.8%) said they always or often waited as long as possible before starting therapy.

Using less medicine than was prescribed and stopping TCS therapy during a treatment period was reported by 38.8% and 54% of patients, respectively. Investigators reported that there was a significant association between low treatment adherence and high corticosteroid phobia (P = .004), according to the study.

The results also showed that 36.3% of patients reported some degree of fear of TCS use despite being unaware of any TCS-related risks. According to Christensen and colleagues, this highlights the need for better education to address any misconceptions or misinformation regarding TCS, both of which can lead to exacerbated disease severity.

“Physicians should address any fears or concerns their patients may have proactively and instruct them properly in TCS use and application,” researchers wrote. “This will help to optimize patients’ treatment outcomes and adherence and also to reduce risk of adverse events or treatment escalation.”

The main limitation to the study was the fact that the TOPICOP scale, while used as a measuring tool for corticosteroid phobia in other dermatological diseases, has not yet been validated specifically for patients with CHE.

Reference: Christensen MO, Sieborg J, Nymand LK, et al. Prevalence and clinical impact of topical corticosteroid phobia among patients with chronic hand eczema - findings from the Danish Skin Cohort. J Am Acad Dermatol. Published online ahead of print August 22, 2024. doi:10.1016/j.jaad.2024.07.1503