Steroid phobia prevalent among female patients

A dermatology outpatient setting in Singapore has seen a moderately high prevalence of steroid phobia, with gender differences for topical corticosteroids (TCS) phobia, according to a study. Misconceptions also exist regarding the side effects of steroids.

“Dermatologists were the most common source of information on TCS, and it was heartening to note that trust was also highest in dermatologists,” the researchers said. “Attempts and strategies to educate patients on TCS should take into account these factors.”

The TOPICOP scale was used to carry out a cross-sectional survey of dermatology patients regardless of steroid use. The researchers identified the sources from which patients obtained information as well as their level of trust in these sources.

The analysis included 186 surveys. The median global TOPICOP score was 44.4 percent (interquartile range [IQR], 33.3–55.6 percent). The median domain TOPICOP subscores were 38.9 percent (IQR, 27.8–50.0 percent) for knowledge and beliefs, 44.4 percent (IQR, 33.3–66.7 percent) for fears, and 55.6 percent (IQR, 33.3–66.7 percent) for behaviour. [Singapore Med J 2019;doi:10.11622/smedj.2019110]

Female gender correlated with higher behaviour, fear and global TOPICOP scores. Scores based on disease condition, steroid use, age or education showed no difference. The most common source of information on topical steroids were dermatologists, who were also the most trusted.

A 2015 study in the same clinic found a higher proportion of patients with higher educational qualification (secondary school education or above) who stopped using TCS upon subjective improvement. This finding, however, was not evident in the current study.

Several studies showed higher TOPICOP score among parents of girls and mothers. Another study of adults and children with various skin conditions reported greater steroid phobia in female participants. [J Eur Acad Dermatol Venereol 2017;31:e172-174; Pediatr Dermatol 2013;30:29-35; Dermatology 2016;232:444-452; Am J Clin Dermatol 2018;19:261-265]

“Rather than an actual knowledge gap, this gender difference in TCS phobia may be attributable to women being more cautious towards products to be applied to their skin and having greater concerns regarding their possible cutaneous side effects,” the researchers said.

Behaviour and fears between the genders could also be shaped by differences in mainstream media and information sources perused by women and men, according to the researchers. “This suggests more personalized and targeted approach and has implications for the way patients are counselled.”

The current study was limited by selection bias, since the questionnaire administered was available only in English. Populations that are English-illiterate were not represented. In addition, self-administration of the questionnaire led to some missing data and potential misinterpretation of questions.

“Further studies correlating disease activity and compliance to steroid phobia may be beneficial,” the researchers said.

Steroid phobia leads to reduced compliance, which may limit efficacy of care, according to the researchers, noting that reporting and quantification of TCS phobia have been inconsistent. The TOPICOP scale was developed to address this variability and to enable standardization and comparisons across different groups. [JAMA Dermatol 2017;153:1036-1042]