The Pharmaceutical Journal
Vol 270 No 7233 p107
25 January 2003

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Primary care teams have crucial role in providing information about atopic eczema and its treatment

Primary care teams have a crucial role to play in providing patients and parents of children with atopic eczema with reliable information about the disease and its treatment, according to the Drug and Therapeutics Bulletin (2003;41:5).

In its January issue, the DTB suggests that information should be provided on the benefits, risks and limitations of topical corticosteroids as well as practical advice on the correct use of these preparations. It comments that suboptimal use of such therapy is often a result of poor communication, and time spent in carefully explaining and educating patients is essential to encourage confidence in, and correct use of, these treatments.

The DTB adds that providing patients with inadequate information undermines their confidence in treatment and can sometimes fuel anxiety about steroids, which in turn may lead to avoidance or non-adherence to treatment ("steroid phobia"). Dr Christine Clark, a consultant pharmacist with an interest in dermatology, told The Journal that not only does steroid phobia exist, but there is sometimes confusion between potency and concentration. "Patients have been known to decide that hydrocortisone 1 per cent is stronger than betamethasone 0.1 per cent or clobetasol butyrate 0.05 per cent," she says.

The result is that they are then at risk of putting the mild steroid on the most severe disease and the more potent steroid on the thinnest skin or least affected areas. "It is important for pharmacists to be aware of this misconception so that they can guide patients appropriately," she warns.

However, the DTB says that there is an urgent need for better quality evidence from clinical trials to support any advice given. "In particular, there is a need for clearer data to rank topical corticosteroids according to their effects on relevant clinical outcomes, for long-term efficacy and safety studies, and for studies conducted in primary care". Few clinical studies have assessed topical corticosteroids in primary care. Most have been conducted in patients attending dermatology outpatient clinics, the DTB says. Dr Clark adds that it is important to encourage regular systemic use of emollients. She points out that pharmacists can help patients find the product whose smell and texture they like.