Risk factors for corticophobia in atopic dermatitis

Atopic Dermatitis and Self-Image Design: A Real-Life Study in Children Using Drawings

Background: Atopic dermatitis (AD) induces alterations of external appearance and self-esteem, with impact on the personal development of the children. However, tools for estimating such suffering are lacking. We aimed to assess how children with AD represent themselves through their drawings. Methods: In this retrospective study, we included children (<18 years) suffering from AD who followed the instruction "draw yourself with and without eczema" at the end of a routine follow-up consultation. Drawings were interpreted with the child and then classified in different analysis groups by 5 independent evaluators. Results: A total of 64 children (41 [64.1%] girls and 23 [35.9%] boys, median [range] age 8 [3-7] years) made 64 drawings. Five groups of drawing were identified: "amputee" (n = 8, 12.5%), "identical" (n = 18, 28.1%), "sad" (n = 19, 29.7%), "complex" (n = 11, 17.2%), and "other" (n = 8, 12.5%). Univariate analysis found that age was differently distributed among the different drawing groups (P = 0.0047), as was the predominance of light colors (P = 0.038). The distribution of the other variables (gender, investigator global assessment score, active AD, and duration of activity) was not different among drawing groups. Conclusions: The drawing allows a majority of the AD children to express their self-image with and without eczema, as well as their feelings and their interactions with the environment and with their entourage. The visual tool proposed herein could be used during consultations, to (a) become aware of the need to treat AD, (b) better evaluate the impact of AD burden in childhood, and (c) adjust appropriately AD treatment.

Efficacy and tolerability of a repairing moisturizing cream containing amino-inositole and urea 10% in adults with chronic eczematous dermatitis of the hands

BACKGROUND

Patients suffering from eczematous dermatitis always required moisturizing cream as a background therapy with the aim to reduce flares and minimize steroids use. The term emollients plus (EP) refers to a topical formulations with vehicle-type substances and additional active, non-medicated substances. We have conducted a study with a topical emollient containing urea 10% and amino-inositole on 20 patients affected from chronic eczematous dermatitis. Primary outcomes were to evaluate effectiveness, in term of Investigator Global Assessment (IGA), and tolerability of EP. Secondary aims included the comparison of NRS (numerical rating scale) itch and NRS-pain, DLQI (Dermatological Life Quality Index) between day one and day 28 and to evaluate the characteristics of EP.

METHODS

Subjects were instructed to apply the EP twice daily for 4 weeks on affected skin and use a soft soap while not to put any other topical or systemic product. Statistical analysis was conducted through the test t-Student by comparing IGA, itch-NRS, pain-NRS and DLQI at time 0 and day 28.

RESULTS

High statistically significant difference (P=0.0038) between IGA value at T0 and T4 has been demonstrated as for itch and pain (respectively P=0.0203 and P=0.0146). Almost all the patients (89.5%) have declared a good or better tolerability of EP. Two patients did not complete the study.

CONCLUSIONS

Patients with chronic eczema could often resolve the dermatitis with the correct choice of emollient without steroids use, especially if it is an EP.

Steroid Phobia: A Review of Prevalence, Risk Factors, and Interventions

Topical corticosteroid phobia may lead to poor adherence, resulting in persistent disease and escalation to systemic agents. The aim of this paper was to review current literature to assess topical steroid phobia prevalence, populations most at risk, reasons behind steroid phobia, and interventions to reduce it. A systematic search of PubMed, Ovid (Journals@Ovid, MEDLINE), ScienceDirect, and Web of Science was performed. Studies ranged from May 2000 to February 2021. In total, 37 articles met the inclusion criteria. There was inter-study variation in the way steroid phobia is defined, from concern to irrational fear. The worldwide prevalence of topical steroid phobia ranges from 31 to 95.7% and does not differ with patient race/ethnicity or dermatological condition. Female patients and caregivers, and those who have experienced side effects of topical corticosteroids are most likely to express steroid phobia. Reasons for steroid phobia include lack of education, fear of side effects, polypharmacy, misinformation, negative experience with topical steroids, and frequently changing of clinics. Successful interventions to address steroid phobia include patient education in the form of educational videos followed by individualized oral education based on concerns, and demonstrations of application of topical steroids. Multiple interventions address topical corticosteroid phobia and improve adherence of topical corticosteroids in the management of dermatological conditions. Providers should screen patients for steroid phobia, especially in populations particularly at risk. Interventions using patient education should be individualized based on concerns expressed during screening. Further research should investigate if reducing steroid phobia can in fact improve long-term adherence.