Fears regarding the use of topical corticosteroids in atopic dermatitis: looking at the coping strategies and the role of health care providers. A qualitative study

Introduction: The efficacy of Topical Corticosteroids (TCs) for Atopic dermatitis (AD) has been well established. Nevertheless, fears associated with the use of TCs are likely to impact negatively on adherence to medical recommendations. Objectives: To explore patients’ fear of using TCs in the treatment of AD and to examine if healthcare providers (HCPs) might have been in some way responsible for them. Methods: We conducted a qualitative study based on 3 focus groups and 7 individual interviews to explore the patients’ perspectives and 2 focus groups for the HCPs’ perspective. A method of thematic analysis was applied. Results: A total of 36 participants, 21 patients (10 adults, 11 parents) and 15 professionals (8 general practitioners, 7 pharmacists) took part in the study in 2008. The patients described their different fears of TCs, associated with partial adherence to the treatment. As a consequence, participants reported various behavioural strategies for reducing the doses of TCs applied, as well as cognitive strategies for “taming” these fears. The role of HCPs in the origin of these fears appeared to be major, taking different forms. Discussion: This study described the fears associated with TCs and its impact on therapeutic adherence as well as the mechanisms through which HCPs contribute to transmitting these fears. Conclusion: Training curricula need to be reassessed to reduce HCP’s uncertainty about TCs. Developing therapeutic patient education would help HCPs to accompany their patients in tackling these fears.