High Topical Corticosteroid Phobia Reduces Treatment Adherence in Chronic Hand Eczema Patients: Study

The investigation aimed to assess patient-reported outcomes related to the use of TCS and was conducted among a subgroup of participants from the Danish Skin Cohort (DSC). Fear and beliefs of patients toward TCS were measured using the TOPICOP scale, and adherence rates among patients were assessed using the Medication Adherence Report Scale (MARS-5). The results of the study are quite relevant because the majority of patients with CHE are requiring proper information about TCS.

The study involved 1340 eligible patients from the DSC and focused on 927 (69.2%) who participated in the study. Of this population, 71.7% were women with a mean age of 55.4 years. The mean age at onset of TCS in chronic hand eczema was set at 35.9 years. Information on current and previous TCS use has been obtained. Secondly, information on patients' adherence to prescription-taken treatment as well as about their attitude towards TCS has been collected.

Key Findings

• A total of 345 (37.2%) participants said that they were actively using TCS, while 251 (27.1%) participants reported any use of them in the past three to twelve months. Key findings in the study were as follows:

• 48.9% of patients either completely agreed (12.1%) or almost agreed (36.8%) that TCS could harm their future health.

• 73.4% patients with mild disease and 81.8% patients with severe disease felt that TCS could harm their skin.

• 36.3% of patients were afraid of TCS not knowing the side effects, while 64.1% complained about the overuse of TCS.

• 40.0% of those who are using TCS responded that they did not know of any side effects but fear to use TCS.

• Nearly half of all patients (47.4%) said that they do not stop the treatment without a delay, and 30.5% report repeating early discontinuation.

• Treatment Adherence and TCS Phobia

• The overall median TOPICOP score was 51.9% and represented a moderate degree of fear related to corticosteroids among the patients. Other findings included:

• 38.8% of the patients reported taking less medication than prescribed, often or very often. Greater TOPICOP scores were associated with lesser medication adherence as indicated by MARS-5 results (β = –0.02; 95% CI, –0.031 to –0.006; P <.005).

• Increased fear of TCS was also related to low adherence, and patients had increased scores in the fear domain of the TOPICOP scale (β = –0.02; 95% CI, –0.029 to –0.009; P <.005).

The topical corticosteroid phobia is highly prevalent among patients with CHE and is closely associated with poor adherence to medication. The researchers call for increased education among patients and healthcare professionals aimed at dispelling fears associated with use of TCS. This also depends on improving non-steroidal treatments for CHE in an effort to improve patient outcomes and adherence to treatment.

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 August 22, 2024. doi:10.1016/j.jaad.2024.07.1503