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 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.
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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: http://bit.ly/2tZvKrU JAMA Dermatology, online July 19,
2017.
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