Corticosteroid phobia and other confounders in the treatment of childhood atopic dermatitis explored using parent focus groups

• Published in: Australasian journal of dermatology Vol. 51; no. 3; pp. 168 - 174
• Main Authors: Smith, Saxon D, Hong, Esther, Fearns, Samantha, Blaszczynski, Alex, Fischer, Gayle
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.08.2010; Wiley-Blackwell
• Subjects: Adrenal Cortex Hormones - adverse effects; Adrenal Cortex Hormones - therapeutic use; Adult; Adult and adolescent clinical studies; Anxiety disorders. Neuroses; atopic dermatitis; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Child; Dermatitis, Atopic - drug therapy; Dermatologic Agents - adverse effects; Dermatologic Agents - therapeutic use; Dermatology; fear; Female; focus group; Focus Groups; Health Knowledge, Attitudes, Practice; Humans; Infant; Male; management; Medical sciences; Middle Aged; paediatric; Parents - psychology; Pharmacology. Drug treatments; Phobia; Phobic Disorders - etiology; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; topical corticosteroid; Human; Allergy; Immunopathology; Corticosteroid; Skin disease; Dermatology; Parent; Anxiety disorder; Atopy; paediatric; Local administration; Phobia; Clinical management; Treatment; Atopic dermatitis; management; focus group; topical corticosteroid; Child; fear
• ISSN: 0004-8380; 1440-0960
• DOI: 10.1111/j.1440-0960.2010.00636.x

ABSTRACT Background/Objectives:  Anxieties associated with corticosteroid treatment and preference for ‘safer natural therapy’ are common in parents of children with atopic dermatitis. We used focus groups to explore the source of these attitudes. Methods:  The study involved 16 parents. Parents expressed difficulties with living with and treating atopic dermatitis which were categorized into themes using qualitative data analysis software. Results:  Themes identified include: emotional impact of atopic dermatitis; difficulty in accepting ‘control’ verses ‘cure’; topical corticosteroid negative perceptions; anxiety and confusion with treatment; preference for ‘natural’ therapy; and attitude‐changing positive experiences. Conclusions:  Our findings illustrate the emotional impact of atopic dermatitis and the frustration with the lack of potential cure. ‘Corticosteroid phobia’ was universal among parents in our cohort and is a fear generated by doctors, pharmacists, close acquaintances and information from the internet. Participants expressed high levels of parental guilt linked to a desire for an eradicable ‘cause’ for atopic dermatitis, despite intellectually understanding this is a genetically determined condition. Parents were willing to change attitudes with accurate information from perceived reliable sources, positive hospitalization experiences and a relationship with a trusted dermatologist. Parents' suggestions to improve confidence included the provision of readily available information and better access to doctor‐ and nurse‐led paediatric dermatology services.