Steroid Phobia Cannot Be Dismissed: Practical Management Tips

Take home message: When giving a treatment, patients concerns must be taken into account when it comes to fear of steroids. Education and tailored instructions might just make the difference between a patient who gets better by following his treatment vs the one who doesn’t ! (Presentation from Singapore)

Comments:
Management strategies include:
-using a topical alternative to a topical steroid: a calcineurin inhibitor to treat eczema for example
-giving detailed instructions on how to apply a corticosteroid: the fingertip unit (FTU): More information HERE . 1 FTU represents 0.5g of cream (2 hand palm surfaces)
–rephrasing the treatment instructions like “use sparingly” instead of “apply enough on affected areas”
–using a moisturizer and other skin care (ie for eczema) allows the reduction of effective steroid quantity by improving skin barrier function
-mentioning the body surface area (rule of 9’s: HERE). The hand palmar surface is equal to 1% of the total body surface area = patients treating small surfaces can be reassured of the then negilgeable systemic effects.
-In areas where the skin is thicker such as the hands, it is worth mentioning the difficulty of the steroid to penetrate.

Abstract
-Topical corticosteroids are the integral drug in the practice of Dermatology. Topical corticosteroid phobia is a real and palpable concern to patients and their care-givers, of which the most commonly cited concern is with possible side effect of skin atrophy or skin thinning. It is not an unsubstantiated concern as there is adequate evidence to support this fear that may compromise optimal care and treatment of the patient’s primary skin condition.
-Use of topical alternatives to topical corticosteroid is one of the strategies. Another strategy will be to engage the concern by giving specific explicit instruction on the use of topical corticosteroid, like the fingertip unit (FTU) to allay unnecessary fear. Rephrasing of terms like “use sparingly or thinly” that convey the cautionary message of danger to more objective but effective phrase like “apply enough to cover affected areas” may just be the significant step to take to change the paradigm of topical steroid phobia.

Reference: Regional Congress of Dermatology (RCD) 2016 – Singapore.  RCD16-0421 Practical Tips & Pearls The steroid phobic patient Y.H. Leow1 1, Singapore. THE STEROID PHOBIC PATIENT. Dr Leow Yung Hian, National Skin Centre Singapore