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'Back to square one' - experiences influencing topical corticosteroid use in paediatric atopic dermatitis
Christabel Hoe1, Yasin Shahab1, Phyllis Lau1
1School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia.
Insights
Caregivers of children with atopic dermatitis (AD) sometimes avoid topical corticosteroids (TCS) due to concerns. Understanding these experiences can improve treatment adherence and holistic wellbeing for pediatric AD management.
Area of Science:
- Dermatology
- Pediatrics
- Psychology
Background:
- Atopic dermatitis (AD) is a chronic inflammatory skin condition significantly impacting quality of life.
- Topical corticosteroids (TCS) are the standard first-line treatment for AD, with effective use linked to improved wellbeing.
- Caregiver beliefs and concerns can influence adherence to TCS treatment for pediatric AD.
Purpose of the Study:
- To explore the experiences and reasons behind parents deviating from traditional TCS use in managing pediatric AD.
- To understand the factors influencing caregiver decisions regarding AD treatment adherence.
Main Methods:
- A qualitative study employing semi-structured, one-on-one interviews with caregivers of children diagnosed with AD.
- Convenience sampling was used for participant recruitment.
- Thematic analysis was conducted on the collected qualitative data.
Main Results:
- Steroid phobia was prevalent among caregivers and some general practitioners (GPs).
- Mismatched expectations between caregivers and healthcare providers led to seeking alternative therapies and information.
- Discrepancies in management interpretations among primary care practitioners were associated with poor adherence and reduced parental confidence.
Conclusions:
- A holistic approach to pediatric AD management is crucial for supporting caregivers and reducing treatment burden.
- Enhanced education for GPs on AD management, including psychosocial aspects and alternative therapies, may improve patient outcomes.
- Addressing caregiver concerns and fostering aligned expectations can enhance treatment adherence and confidence.
Abstract:
Background Atopic dermatitis (AD) is a chronic inflammatory skin condition that negatively impacts quality of life. Topical corticosteroids (TCS) remain the first-line management and effective TCS use is associated with improved holistic wellbeing. However, medication self-withdrawal and 'no-moisture' method discussions have emerged, and there is evidence that treatment success is influenced by caregivers' views on TCS use. The aim of this study was to understand the experiences causing parents to deviate from traditional TCS use in paediatric AD management. Methods A convenience sampling approach was used to recruit caregivers of children with AD, who subsequently participated in one-on-one semi-structured interviews following informed consent. Qualitative data were thematically analysed. Results Ten participants were interviewed, of which four were also general practitioners (GPs). The steroid phobia observed among non-healthcare participants was also evident in the views of some GPs. Mismatched expectations within therapeutic relationships lead to some participants seeking alternative therapies and non-medical information sources. Divergence in interpretations of management between primary care practitioners is associated with poor treatment adherence and lowered parent confidence. Conclusions A holistic approach to paediatric AD management can effectively support parents and caregivers, as well as reduce treatment burden. Further education for GPs,exploration of psychosocial AD management and alternative therapies may assist in improving patient outcomes.
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