Nearly three-quarters of patients with atopic eczema worry about using topical steroids and almost a quarter are non-compliant, because they are afraid of side effects such as skin thinning and growth retardation, according to dermatologists.
Dr Carolyn Charman and colleagues from the Queen's Medical Centre in Nottingham gave a questionnaire to 200 patients (or parents of patients under 16) with atopic eczema, which asked whether they worried about using topical steroids, why they were worried and whether they had ever stopped using topical steroids because of their worries.
A total of 145 expressed concern and 48 had at some stage stopped using topical steroids, most commonly because of the fear of skin thinning, "non-specific long-term effects" or effects on growth and development of children using topical steroids.
Two patients out of a group of 20 controls who were given the same questionnaire but for emollient use expressed worry and were non-compliant. "Irrational fear of topical corticosteroids is a common problem among dermatology outpatients with atopic eczema," the authors say.
Of the patients using topical steroids, 34.5 per cent were concerned about skin thinning, 24 per cent worried about long-term effects and 9.5 per cent worried about effects on growth and development. According to Dr Charman and colleagues, a previous study showed that adult height did not differ significantly from that of a control group, which suggested that any growth impairment in childhood was probably temporary and reversible.
They add that, while skin thinning is a well-documented side effect of topical steroids, the patients' concern seems out of proportion to the evidence of risk.
They conclude that health care professionals need to give patients more information about their topical steroids, so that treatment is not withheld from those who need it (British Journal of Dermatology 2000;142:931).