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October 2017

Topical Corticosteroid Phobia in Atopic Dermatitis: A Systematic Review

Author Affiliations
  • 1Medical student, Yale School of Medicine, New Haven, Connecticut
  • 2Departments of Dermatology and Pediatrics, Yale School of Medicine, New Haven, Connecticut
JAMA Dermatol. 2017;153(10):1036-1042. doi:10.1001/jamadermatol.2017.2437
Key Points

Question  What are the prevalence, origin, and effect on treatment adherence of topical corticosteroid phobia in atopic dermatitis?

Findings  In this systematic review, the prevalence of topical corticosteroid phobia ranged from 21.0% to 83.7%; compared with patients without phobia, patients reporting phobia had higher nonadherence rates. Patients receive misinformation about topical corticosteroids from a variety of sources, including health care workers, friends and relatives, print media, and the internet.

Meaning  Topical corticosteroid phobia is a widespread and cross-cultural phenomenon; recognition may identify potential targets for intervention and opportunities to increase treatment adherence.


Importance  Topical corticosteroid (TCS) phobia refers to the negative feelings and beliefs related to TCSs experienced by patients and patients’ caregivers. This phenomenon may be a major contributing factor in treatment failure in patients with atopic dermatitis, yet it has been sparsely described in the literature.

Objective  To systematically assess the nomenclature, prevalence, origins, and effect on treatment adherence of TCS phobia in atopic dermatitis.

Evidence Review  A literature search was conducted using specific eligibility criteria across electronic databases, including Ovid (MEDLINE, EMBASE), PubMed, and Web of Science, for articles published from January 1, 1946, to October 31, 2016. Included articles must have assessed TCS phobia in patients with atopic dermatitis or their caregivers. Quality ratings of studies were based on a modified version of the Oxford Centre for Evidence-Based Medicine quality rating scheme for individual studies.

Findings  Of the 490 articles identified by literature search, 16 met the eligibility criteria. All studies were cross-sectional. Topical corticosteroid phobia prevalence ranged from 21.0% (95% CI, 15.8%-26.2%) to 83.7% (95% CI, 81.9%-85.5%). There was significant variation in how phobia was defined, ranging from concern to irrational fear. Questionnaires used to assess for TCS phobia included 1 to 69 questions. In the 2 studies that compared nonadherence between a phobia group and a nonphobia group, patients in both phobia groups were found to have a significantly higher rate of nonadherence (49.4% vs 14.1% and 29.3% vs 9.8%). The sources from which patients were receiving information about corticosteroids included physicians, friends and relatives, broadcast media, print media, and the internet.

Conclusions and Relevance  Features of TCS phobia are commonly reported by patients across cultures and may be associated with a higher rate of nonadherence. Patients with TCS phobia and the sources from which patients are receiving information about corticosteroids may be targetable for intervention to increase adherence to treatment regimens. The nomenclature and assessment methods for TCS phobia used in studies, however, lack standardization, precluding quantitative comparison and extrapolation of data. Additional research, using standardized definitions and methods of assessment, is needed to better characterize this phenomenon and evaluate the efficacy of potential interventions.

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