When patients or parents hear the word cortisone, alarm bells often go off. Where does the fear come from and are the worries justified?
Patients often have concerns about the use of glucocorticosteroids (cortisone). This sometimes even leads to cortisone not being used or not being used as prescribed.
Fear of cortisone is widespread
According to recent studies, corticoid phobia, i.e. the fear of cortisone, appears to be a widespread phenomenon worldwide .
The concerns regarding the use of topical glucocorticoids are very complex: in addition to fear of skin thinning or fear of growth and developmental impairments, other concerns are frequently mentioned, such as fear of skin fading, of burning when applying the preparation, of wrinkling, of skin ageing and of unspecific long-term effects.
Yet we need to mention that some of the most feared concerns about using cortisone (e.g. bone density loss, developmental impairments, diabetes, Cushing’s syndrome) are usually confined to systemic therapy with glucocorticoids and are not to be associated with its topical use.
What is corticoid phobia?
Corticoid phobia or steroid anxiety describes emotions that range from mild concerns to irrational fears.
In addition to the information on the package leaflets, patients sometimes obtain information from print media, TV programs or the Internet. They also talk to friends or relatives as well as doctors or pharmacists. However, patients often feel that they do not receive enough detailed advice from the latter parties mentioned in particular. In one study, patients stated that they received little information from doctors and pharmacists, resulting in a lack of trust in the prescribed therapy.
Openly share any concerns with your doctor
It is therefore always advisable to openly share your fears or concerns regarding the use of cortisone with your doctor. Patients should feel free to ask questions if they feel insufficiently informed.
The guidelines for atopic dermatitis recommend step-ladder therapy
The latest S2k guideline for atopic dermatitis recommends a step-ladder therapy that is adapted to the current skin condition. From stage 2 (mild eczema) and upwards, low-potency topical glucocorticoids and/or topical calcineurin inhibitors can be used. These substances should be applied consistently once or twice daily until the lesions disappear.
What are guidelines?
Guidelines provide recommendations on how a disease should be diagnosed and optimally treated. They are primarily aimed at physicians, but also at nursing staff and other healthcare professionals. Guidelines help to ensure that patients are treated and cared for appropriately. A guideline commission, i.e. experts from all professional groups relevant to a specific disease, develops a guideline according to the highest scientific standards.
References:
- Li AW et al. Topical corticosteroid phobia in atopic dermatitis. A systematic review. JAMA Dermatol 2017, online 19. Juli 2017, DOI:10.1001/jamadermatol.2017.2437
- Raffin D et al. Corticosteroid phobia among pharmacists regarding atopic dermatitis in children: a national french survey. Acta Derm Venereol 2016;96:177-180, DOI: 10.2340/00015555-2157
- Zuberbier T et al. Use of topical steroids is ¬largely restricted by irrational emotional concerns in both patients and physicians. Allergy 2008;63:1559-1565
- S2k-Leitlinie Neurodermitis, Hrsg. Deutsche Dermatologische Gesellschaft (DDG), AWMF-Registernummer: 013-027, Stand 03/2015, gültig bis 05/2018
