People with eczema are now understood to run the risk of developing treatment phobias, possibly affecting over 80 per cent of sufferers. The phobia of topical corticosteroids when treating eczema is a very real problem, being called ‘a phenomenon’ by researchers.
A review by Dr Richard Antaya and his colleagues at Yale University School of Medicine explains the idea: if you are treating an ear infection with antibiotics, but you don’t prescribe enough antibiotics, the ear infection will not go away. Similarly, if you prescribe topical corticosteroids for eczema, you must prescribe the correct amounts so that the problem resolves, at least temporarily. If you don’t get rid of the eczema, the person can develop a negative association with steroids and avoid the treatment.
The review looked over studies to find the prevalence of topical corticosteroid phobias, which in the studied groups ranged from 21 per cent to 84 per cent. The phobias ran the full gamut from ‘concern’ to ‘irrational fear’. Two studies compared people who had the phobia and a group that didn’t, with patients in both groups found to have a higher rates of noncompliance with steroid treatments compared to other health conditions and medications, however those with the phobia were significantly more noncompliant.
How do these phobias come about?
People with skin conditions spend a lot of time taking care of their skin, so having treatments that do not appear to work, for whatever combination of reasons, can present a psychological conundrum. People with anxiety or confusion regarding their treatments may be more weighted towards developing genuine phobias, meaning that doctors have a pivotal role to play in terms of adequate education of treatments. One study found that a brief education session reduced patient phobia index scores by 43 per cent.
There are some well-known problems that can develop with long-term corticosteroid use, which patients are well aware of and which feed their anxieties. There are issues with hormones (hypothalamic-pituitary-adrenal axis suppression), thinned skin, and stretch mark development. Continuous use without interruptions does lead to problems, so effectively managing combinations of treatments is key. In dealing with phobias, strategies need to be developed to not only prevent them, but effectively manage people who are suffering phobias.
If you find yourself having problems managing your eczema, contact our clinic – we can help.