Fear keeps many eczema patients from using steroid creams

(Reuters Health) - Many people with eczema, a common skin disease, may avoid creams and ointments that can help ease symptoms like itching and inflammation because they’re afraid to try topical corticosteroids, a recent study suggests.

Eczema, also known as atopic dermatitis, usually develops in early childhood and often runs in families. Scaly, itchy rashes are the main symptoms. The condition can be treated using moisturizers, avoiding certain soaps and other irritants and with prescription creams and ointments containing corticosteroids to relieve itching.

For the study, researchers examined results from 16 previously published studies and found as many as four in five people were afraid to use corticosteroids for eczema. Between one third and one half of people who were prescribed steroid creams but also expressed concerns about them did not adhere to the treatment - meaning they didn’t use the creams and missed out on their benefits.

“Steroids have developed a bad reputation because of the potential side effects that come with improper or chronic use of high-potency steroids,” said senior study author Dr. Richard Antaya, director of pediatric dermatology at Yale School of Medicine in New Haven, Connecticut.

Common side effects of corticosteroids can include stretch marks as well as thinning, thickening or darkening of the skin. Less often, these steroids can cause acne or infected hair follicles or more serious side effects in the eyes like glaucoma and cataracts.

“The resistance to using topical corticosteroids is definitely partly driven by the confusion over the adverse effects of long term use of high potency steroids versus those of short term use of low potency steroids,” Antaya said by email. “The risks from using short-term low potency steroids are vastly lower.”

For the study, Antaya and colleagues examined studies published from 1946 to 2016 that surveyed patients and caregivers about their opinions of topical corticosteroids. The studies included in the analysis were done in Australia, Canada, Croatia, France, Germany, Hong Kong, Japan, Korea, Mexico, the Netherlands, Poland, Singapore and the U.S.

Two studies compared how often patients used these medicines based on whether or not they had phobias.

In one of these studies, 49 percent of people with phobias didn’t adhere to a prescribed steroid cream, compared with 14 percent of patients without concerns. In the second study, 29 percent of people with phobias didn’t use their steroid cream, compared with 10 percent of patients who weren’t worried.

Five of the studies in the analysis looked at why people had phobias and found skin thinning was the most frequent concern, followed by fear that steroids might affect growth and development. Some previous research has found long-term use at high doses may impact growth and development in children.

Limitations of the study include the wide variety of phobia definitions used across the 16 smaller studies in the analysis, the authors note in JAMA Dermatology.

Even so, the findings add to evidence that phobias keep many parents in many parts of the world from using corticosteroids to treat their children with eczema, said Dr. Saxon Smith, a dermatologist at the School of Medicine at the University of Sydney in Australia.

“It is critical to recognize the high frequency of fears patients and parents have about using topical corticosteroids,” Smith, who wasn’t involved in the study, said by email.

Left untreated, eczema doesn’t just leave kids itchy, Smith said. Itchy and discomfort can be so severe that kids don’t sleep at night, impacting normal development and socialization.

“Too often we see infants who suffer and have not slept for months and parents exhausted just because they have wrong fear or beliefs about the treatment or the disease and don’t treat their child,” Dr. Helene Aubert-Wastiaux, a dermatologist at Nantes University Hospital in France who wasn’t involved in the study, said by email.

SOURCE: JAMA Dermatology, online July 19, 2017.