‘Back to square one’ – experiences influencing topical corticosteroid use in paediatric atopic dermatitis
Christabel Hoe
A , Yasin Shahab A * Phyllis Lau A
A
Abstract
Atopic dermatitis (AD) is a chronic inflammatory skin condition that negatively impacts quality of life. Topical corticosteroids (TCS) remain the first-line management and effective TCS use is associated with improved holistic wellbeing. However, medication self-withdrawal and ‘no-moisture’ method discussions have emerged, and there is evidence that treatment success is influenced by caregivers’ views on TCS use. The aim of this study was to understand the experiences causing parents to deviate from traditional TCS use in paediatric AD management.
A convenience sampling approach was used to recruit caregivers of children with AD, who subsequently participated in one-on-one semi-structured interviews following informed consent. Qualitative data were thematically analysed.
Ten participants were interviewed, of which four were also general practitioners (GPs). The steroid phobia observed among non-healthcare participants was also evident in the views of some GPs. Mismatched expectations within therapeutic relationships lead to some participants seeking alternative therapies and non-medical information sources. Divergence in interpretations of management between primary care practitioners is associated with poor treatment adherence and lowered parent confidence.
A holistic approach to paediatric AD management can effectively support parents and caregivers, as well as reduce treatment burden. Further education for GPs, exploration of psychosocial AD management and alternative therapies may assist in improving patient outcomes.
Keywords: atopic dermatitis, caregivers, interview, medication adherence, paediatrics, parents, phobia, qualitative research, self-management, topical corticosteroid.
References
Ajzen I (1991) The theory of planned behavior. Organizational Behavior and Human Decision Processes 50(2), 179-211.
| Crossref | Google Scholar |
Alahlafi A, Burge S (2005) What should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi technique. BMJ 330(7492), 633-636.
| Crossref | Google Scholar |
Albogami MF, Aljomaie MS, Almarri SS, Al-Malki S, Tamur S, Aljaid M, Khayat A, Alzahrani A (2023) Topical corticosteroid phobia among parents of children with atopic dermatitis (Eczema)- a cross-sectional study. Patient Preference and Adherence 17, 2761-2772.
| Crossref | Google Scholar |
Bos B, Antonescu I, Osinga H, Veenje S, De Jong K, De Vries TW (2019) Corticosteroid phobia (corticophobia) in parents of young children with atopic dermatitis and their health care providers. Pediatric Dermatology 36(1), 100-104.
| Crossref | Google Scholar | PubMed |
Braun V, Clarke V (2021) To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Research in Sport, Exercise and Health 13(2), 201-216.
| Crossref | Google Scholar |
Charman CR, Morris AD, Williams HC (2000) Topical corticosteroid phobia in patients with atopic eczema. British Journal of Dermatology 142(5), 931-936.
| Crossref | Google Scholar | PubMed |
Curry ZA, Johnson MC, Unrue EL, Feldman SR (2019) Caregiver willingness to treat atopic dermatitis is not much improved by anchoring. Journal of Dermatological Treatment 30(5), 471-474.
| Crossref | Google Scholar |
Gomes TF, Kieselova K, Guiote V, Henrique M, Santiago F (2022) A low level of health literacy is a predictor of corticophobia in atopic dermatitis. Anais Brasileiros de Dermatologia 97(6), 704-709.
| Crossref | Google Scholar | PubMed |
Gore C, Johnson RJ, Caress AL, et al. (2005) The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study. Allergy 60(7), 938-943.
| Crossref | Google Scholar | PubMed |
Hon KL, Tsang YCK, Pong NH, et al. (2015) Correlations among steroid fear, acceptability, usage frequency, quality of life and disease severity in childhood eczema. Journal of Dermatological Treatment 26(5), 418-425.
| Crossref | Google Scholar | PubMed |
Hon KL, Leong KF, Leung T, et al. (2018) Dismissing the fallacies of childhood eczema management: case scenarios and an overview of best practices. Drugs in Context 7(2), 212547.
| Crossref | Google Scholar |
Kojima R, Fujiwara T, Matsuda A, et al. (2013) Factors associated with steroid phobia in caregivers of children with atopic dermatitis. Pediatric Dermatology 30(1), 29-35.
| Crossref | Google Scholar | PubMed |
LaDonna KA, Artino AR, Jr, Balmer DF (2021) Beyond the guise of saturation: rigor and qualitative interview data. Journal of Graduate Medical Education 13(5), 607-611.
| Crossref | Google Scholar | PubMed |
Lax SJ, Harvey J, Axon E, et al. (2022) Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systematic Reviews 3(3), CD013356.
| Crossref | Google Scholar |
Li Y, Han T, Li W, Li Y, Guo X, Zheng L (2018) Awareness of and phobias about topical corticosteroids in parents of infants with eczema in Hangzhou, China. Pediatric Dermatology 35(4), 463-467.
| Crossref | Google Scholar | PubMed |
Magin PJ, Adams J, Heading GS, et al. (2009) Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema. Medical Journal of Australia 190(2), 62-64.
| Crossref | Google Scholar | PubMed |
Moret L, Anthoine E, Aubert-Wastiaux H, Le Rhun A, Leux C, Mazereeuw-Hautier J, Stalder JF, Barbarot S (2013) TOPICOP©: a new scale evaluating topical corticosteroid phobia among atopic dermatitis outpatients and their parents. PLoS ONE 8(10), e76493.
| Crossref | Google Scholar | PubMed |
O’Connor C, Murphy M (2021) Scratching the surface: a review of online misinformation and conspiracy theories in atopic dermatitis. Clinical and Experimental Dermatology 46(8), 1545-1547.
| Crossref | Google Scholar | PubMed |
Powell K, Le Roux E, Banks J, et al. (2018) GP and parent dissonance about the assessment and treatment of childhood eczema in primary care: a qualitative study. BMJ Open 8, e019633.
| Crossref | Google Scholar |
Smith SD, Harris V, Lee A, Blaszczynski A, Fischer G (2017) General practitioners knowledge about use of topical corticosteroids in paediatric atopic dermatitis in Australia. Australian Family Physician 46(5), 335-340.
| Google Scholar | PubMed |
Tan S, Phan P, Law JY, Choi E, Chandran NS (2022) Qualitative analysis of topical corticosteroid concerns, topical steroid addiction and withdrawal in dermatological patients. BMJ Open 12(3), e060867.
| Crossref | Google Scholar |
Tangthanapalakul A, Chantawarangul K, Wananukul S, et al. (2023) Topical corticosteroid phobia in adolescents with eczema and caregivers of children and adolescents with eczema: a cross-sectional survey. Pediatric Dermatology 40(1), 135-138.
| Crossref | Google Scholar | PubMed |
Teasdale E, Muller I, Sivyer K, et al. (2021) Views and experiences of managing eczema: systematic review and thematic synthesis of qualitative studies. British Journal of Dermatology 184(4), 627-637.
| Crossref | Google Scholar | PubMed |
