Corticophobia Can Significantly Impact AD Management Strategies
Researchers investigated the current treatment strategies for atopic dermatitis and how they related to ideas of corticophobia among providers.
Corticophobia among health care professionals (HCPs) highlights significant differences in the management of atopic dermatitis (AD), according to a study published in Dermatology.1 Researchers agree more education is needed to improve AD management and reduce HCPs’ reluctance toward topical corticosteroids (TCSs).
“The basic treatment includes daily application of emollients to improve skin hydration and protection from allergens and irritants,” wrote authors of the study. “The next step consists of treatment with topical anti-inflammatory therapies. TCSs are the first-line anti-inflammatory treatment and their effectiveness and safety have been well documented.”
Above all other medication classes and formulations, TCSs have been deemed as the most important pharmacotherapy in the treatment of AD. However, regarding the strength, quantity, and duration of use recommended for these drugs, opinions vary among HCPs and patients.2
To better understand the prominence of corticophobia, researchers evaluated HCPs’ management strategies for AD. | image credit: jittawit.21 / stock.adobe.com
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While essential for the treatment of skin conditions like AD, each variation of TCSs is classified by its strength and risk of adverse effects.3 Despite arising as the first-line defense against AD, researchers have not agreed on universal dosing, formulas, duration of use, etc. Because many HCPs have a different approach to AD management, researchers wanted to better understand how these approaches varied among multiple types of HCPs.
“Various HCPs deliver care for patients with AD,” they wrote.1 “Although pivotal, management strategies and the relation with corticophobia among HCPs have not been investigated. This study aimed to investigate management strategies for AD and its relation with corticophobia among HCPs.”
Despite TCSs serving as the best pharmaceutical option for treating AD, some HCPs or patients may experience corticophobia, or the fear of applying TCSs.4 With the demonstrated safety and efficacy of this medication class, HCPs of various backgrounds still shy away from using them on patients with AD.
To parse through those backgrounds and better understand the prominence of corticophobia, researchers evaluated HCPs’ management strategies for AD.
“Dutch general practitioners (GPs), youth health care physicians (YHPs), pediatricians, dermatologists, pharmacists, and pharmacy assistants participated in a survey on management strategies and corticophobia,” continued the authors.1 “The Topical Corticosteroid Phobia questionnaire for professionals (TOPICOP-P) was used to measure attitudes toward TCSs. Higher scores reflect a more negative attitude.”
To better understand the sentiments of HCPs toward TCSs, researchers conducted a survey spanning a variety of health care experts. Their responses were recorded so researchers could better understand HCPs’ management strategies, patient education, and corticophobia. The survey was broken into parts consisted in 4 key topics: patients’ background data, medical casuistry, TCS, and TOPICOP-P.
Researchers concluded their study with a total of 407 HCP survey responses (124 GPs).
“We found that GPs and pediatricians prescribe less potent TCS than dermatologists,” wrote the authors.1 “In addition, we found large differences in TCS application instructions and the amount of TCS perceived as necessary for treatment.”
Among a variety of responses that portray HCPs’ opinions on TCS treatment, AD management strategies with the use of TCS vary significantly among HCPs. First, results highlight the possibility of mishandling TCS prescriptions in pharmacies, resulting in lost medications, nonadherence, and more. Researchers also discovered more corticophobia among pharmacists when compared with dermatologists, despite the former’s medication expertise.
“Differences in management strategies may be partially explained by differences in the setting in which HCPs operate,” they continued. “For example, GPs see fewer patients with severe AD than dermatologists and are generally used to operating based on a ‘step-up approach’ (start with less intensive treatment and raise intensity after reevaluation).”
In the context of this study, dermatologists are the most experienced at understanding skin conditions like AD. Pharmacists then exhibit medication expertise while GPs cover a variety of other areas within health care. With many of these HCPs and their expertise overlapping, survey responses significantly highlighted the differences in HCPs’ management strategies for the treatment of AD.
More research and education are needed to further HCP knowledge of AD management.
“This study reveals the differences in management strategies and patient education HCPs provide for patients with AD,” concluded the authors.1 “In general, GPs and pediatricians were more reluctant with TCS compared to dermatologists. Furthermore, this study confirmed the presence of corticophobia among HCPs and impact of corticophobia on management strategies of HCPs.”
READ MORE: Dermatology Resource Center
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