For Your Patients: Is 'Steroid Phobia’ Sabotaging Your Atopic Dermatitis Treatment Plan?

Over the past few years, the treatment of atopic dermatitis, the most common form of eczema, has improved a lot. This chronic inflammatory skin disease, which is estimated to affect 15–20% of children and 1-3% of adults worldwide, is characterized by dry, itchy, skin and patches of dark or red scaly rash that can crop up anywhere on the face or body. Although there is no cure, new, more effective medications have been developed that can safely keep symptoms under control and help prevent flare-ups.

Mild to moderate versions of the condition can often be managed by identifying and avoiding allergens and irritants, good skin care that includes adequate moisturizing, and the use of topical corticosteroids and/or calcineurin inhibitors. "Topical treatments remain one of the most popular options due to their effective track record and overall safety," said Robert Sidbury, MD, MPH, of the University of Washington School of Medicine and Seattle Children's Hospital.

For treatment to work, however, it's important to follow the treatment plan that you and your doctor develop together. Unfortunately, many people don't follow the plan. In one study, for example, up to 70% of patients with atopic dermatitis said they stopped following the recommended treatment within the first few days, and many said they didn't admit this to their doctor, even when asked.

So why does this happen? The highly visible nature of atopic dermatitis and the severe itching often leave people looking for a quick fix. Many people turn to the internet for answers, only to become alarmed when they encounter false and misleading information about topical steroids. This can lead to what's sometimes called "steroid phobia."

Just like it sounds, steroid phobia refers to the fear of using topical corticosteroids. The topical steroids used for atopic dermatitis are related to cortisone, a natural hormone made by the adrenal gland every day. Topical steroids are not the "steroids" used by body builders.

Patients and caregivers with fears of steroids often end up abandoning the treatment plan because of possible side effects, such as thinning of the skin, or concerns that steroids could impact a child's growth and development. Steroid phobia also leads many to try alternative treatments that haven't undergone the rigorous testing required for all prescription medications, including topical steroids.

Topical steroids were first introduced more than 70 years ago and remain one of the most widely used topical treatments for many skin diseases, including atopic dermatitis. These agents quickly and safely bring symptoms under control, and often prevent the need for stronger medication. Even the high-potency topical steroids used to treat severe atopic dermatitis have minimal side effects, so if you suspect that steroid phobia is interfering with the success of your treatment, talk to your doctor.

Amy S. Paller, MD, of Northwestern University Feinberg School of Medicine in Chicago, takes care of young children, tweens, and teens with atopic dermatitis and their families. "It's hard for the patients and caregivers," she said. "What parent doesn't have some worries about their child using steroids on a chronic basis?"

When left untreated, however, the intense itch associated with atopic dermatitis can ruin sleep. Incessant scratching often results in lesions that crack and bleed, ooze and crust, setting the stage for serious bacterial and viral infection. In adulthood, atopic dermatitis is also associated with other serious diseases, including osteoporosis, depression, and heart disease.

Paller said that to address any concerns that patients or caregivers may have about the use of topical steroids, she explains the different strengths of steroid medication (there are seven), and how the treatment plan is developed to minimize any risk of side effects. She also discusses incorporating non-steroidal medications into the treatment regimen.

Between visits, Paller encourages patients and caregivers to email her with questions. When topical steroid treatment improves symptoms, for instance, the treatment plan may need to be adjusted as control of atopic dermatitis symptoms shifts into "maintenance mode."

To keep adolescents with atopic dermatitis on track with treatment, the American Academy of Dermatology also recommends the use of daily text messages. This recommendation is based on the results from a 6-week study in teens with atopic dermatitis who were age 14 and older. In the study, researchers at Harvard Medical School in Boston sent the teens daily text messages with educational information about atopic dermatitis as well as reminders to take their medication.

The approach helped 85% of teens stick to their treatment plan for more days each week. It also reduced the severity of symptoms, further motivating the adolescents to follow the treatment plan. At the end of the study, 95% of the teens found the text reminders helpful and wanted to keep receiving them.

Resources

American Academy of Dermatology

American Academy of Allergy and Immunology:

Mayo Clinic

National Eczema Association

Read previous installments in this series:

For Your Patients: Atopic Dermatitis 101

For Your Patients: How Will My Doctor Diagnose Atopic Dermatitis?

For Your Patients: Skin Care to Control the Symptoms of Atopic Dermatitis in Children

For Patients: Identify Your Child's Atopic Dermatitis Triggers

For Your Patients: Which Topical Treatments Work for Atopic Dermatitis?

"Medical Journeys" is a set of clinical resources reviewed by physicians, meant for the medical team as well as the patients they serve. Each episode of this journey through a disease state contains both a physician guide and a downloadable/printable patient resource. "Medical Journeys" chart a path each step of the way for physicians and patients and provide continual resources and support, as the caregiver team navigates the course of a disease.