Pharmacists May Require Additional Training on Corticophobia in Atopic Dermatitis

Misinformation regarding the use of corticosteroids remains persistent and may have implications on patient care.

Pharmacist in the laboratory mixing an ointment in a bowl

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Health misinformation continues to be a major topic of discussion among health care professionals and public health experts, especially due to the considerable use of social media. Misinformation about immunizations, COVID-19, glucagon-like peptide agonists, and topical corticosteroids (TCS) is incredibly common. Although conversations around topical corticosteroids are not new, misinformation still persists, causing “corticophobia,” a term coined as a phobia of TCS due to “vague negative feelings and/or erroneous beliefs about TCS held by patients and caregivers, which can be prompted by misinformation,” according to a report published in the Educational Journal of the British Association of Dermatologists.

According to the authors, when used properly, TCS can decrease the risk of needing systemic immunosuppressive agents, which have more severe adverse effects. Nonadherence and poor compliance can be common obstacles to the control of conditions including atopic dermatitis (AD), and are sometimes due to TCS-related phobias.¹

The investigators identified areas of misinformation, such as topical steroid addiction or “red skin syndrome,” known as topical steroid withdrawal. Fears of patients and caregivers included skin thinning and potential effects on growth and development for children, but investigators found no evidence of skin thinking in their review and stated that skin atrophy is uncommon for localized TCS use in AD.¹

In another study published in Journal of Clinical Medicine, investigators established risk factors that could be related to corticophobia for parents of children with AD, such as mild or moderate AD, older age of the patient, early disease onset, and previous health care professional consultations. The study authors also identified that significant parental involvement with quality of life and high education of parents were associated with severe parental corticophobia.²

Additionally, investigators of another study published in Anais Brasileiros De Dermatologia, the publication of the Brazilian Society of Dermatology, found that there was an inverse correlation with health literacy and corticophobia, demonstrating that lower health literacy is a predictor of corticophobia. They concluded that promoting health literacy is essential to ensure patients are using TCS correctly to maintain control over AD.³

Because pharmacists are among the most accessible health care professionals for patients, their role in the management of AD and combating corticophobia is paramount. However, in a study published in Healthcare (Basel), investigators found that community pharmacists sometimes lack knowledge about the use of TSC and recommendations for other treatment options were limited, despite some pharmacists receiving dermatology training after graduation.⁴

The study authors noted that this could result in inadvertently misleading patients, and inappropriate education in initial training could impact the quality of care for patients with AD. They concluded that there is a gap between the needs of patients and the dermatological education that community pharmacists undergo, so better education and training would be useful to improve the pharmacists’ skills and knowledge, especially when combating corticophobia.⁴

Specifically, the knowledge of TCS was a significant theme in all the studies evaluated and pharmacist corticophobia was a sub-theme. Investigators noted that in some studies, pharmacists lacked the knowledge of TCS potency as well as the standard measurement of applying TCS, which is a fingertip unit.⁴

Key Takeaways

Misinformation online has led to "corticophobia," a fear of topical corticosteroids (TCS) used to treat AD.
Patients may avoid using TCS, leading to uncontrolled AD and the need for stronger medications with worse side effects.
Pharmacists, a key source of information for patients, may also lack knowledge about TCS due to inadequate training.

However, the investigators also found that pharmacists often continued their dermatology education post-graduation and were eager to expand their knowledge, evident by joining training sessions, attending educational programs, or reading journal articles. There was also a correlation found that showed continuing training in dermatology helped improve the pharmacist’s overall self-confidence, with those pharmacists displaying better knowledge, attitude, and practice with TCS treatments.⁴

The study authors concluded that furthering education for pharmacists on dermatology would be beneficial to both the pharmacist’s practice and the patient’s care.⁴

References

Finnegan P, Murphy M, O'Connor C. #corticophobia: a review on online misinformation related to topical steroids. Clin Exp Dermatol. 2023;48(2):112-115. doi:10.1093/ced/llac019
Herzum A, Occella C, Gariazzo L, Pastorino C, Viglizzo G. Corticophobia among parents of children with atopic dermatitis: Assessing major and minor risk factors for high TOPICOP scores. J Clin Med. 2023;12(21):6813. October 27, 2023. doi:10.3390/jcm12216813
Gomes TF, Kieselova K, Guiote V, Henrique M, Santiago F. A low level of health literacy is a predictor of corticophobia in atopic dermatitis. An Bras Dermatol. 2022;97(6):704-709. doi:10.1016/j.abd.2021.11.007
Cayci AB, Rathbone AP, Lindsey L. Practices and perceptions of community pharmacists in the management of atopic dermatitis: A systematic review and thematic synthesis. Healthcare (Basel). 2023;11(15):2159. July 29, 2023. doi:10.3390/healthcare11152159

[This article was originally published by our sister publication, Pharmacy Times.]