title: Correlations among steroid fear, acceptability, usage frequency, quality of life and disease severity in childhood eczema.
abstract: Topical corticosteroids (CSs) are the mainstay of treatment for eczema but CS phobia and fears are prevalent and influence therapeutic efficacy.
  
  
  OBJECTIVE
  To quantify if CS acceptability and fear affect patients' quality-of-life (QoL).
  
  
  METHODS
  Patients with eczema managed in the pediatric dermatology outpatient clinic of a university hospital were surveyed. Nottingham Eczema Severity Score (NESS) for severity, Children's Dermatology Life Quality Index (CDLQI) for QoL, CS fear, acceptability and reported frequency of CS use were measured with quantified questions.
  
  
  RESULTS
  CS fears were prevalent among parents and caregivers of patients with eczema. Fifty-eight percent of parents reported general acceptability of CS as being very good or good, and many applied CS to their child regularly every week. However, >40% of parents reported CS fear "always" or "often", 41% reported that they "always" or "often" apply CS only when eczema got worse, 57% would discuss CS fear with their doctors, 30% would request CS-sparing medications and 14% "always" or "often" use traditional Chinese herbal medicine. Fears were predominantly interpersonal and less often iatrogenic in nature. Skin problems were the most concerned side effects of CS. CS acceptability, frequency of CS usage, CS fear and usage of alternative medications were independent domains in eczema management: CS fears correlated with CDLQI; CS usage frequency correlated with NESS and negatively with parental education; and CS acceptability correlated with parental education. Ordinal logistic regressions showed worse QoL was associated with more CS fear (odds ratio: 1.092 [95% CI: 1.023-1.165], p = 0.008).
  
  
  CONCLUSIONS
  The extent of CS fears is independent of CS acceptability, but correlates with patients' QoL. Desensitization of parental CS fears should be integral part of eczema education and therapeutics in order to improve therapeutic efficacy and patients' QoL.
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China .
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China .
authors.forename: Yin Ching K
authors.initials: YC
authors.lastname: Tsang
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China .
authors.forename: Nga Hin
authors.initials: NH
authors.lastname: Pong
authors.affiliation: b Department of Paediatrics & Adolescent Medicine , United Christian Hospital , Kwun Tong , Hong Kong SAR , China .
authors.forename: David C K
authors.initials: DC
authors.lastname: Luk
authors.affiliation: c School of Pharmacy, The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China , and.
authors.forename: Vivian W
authors.initials: VW
authors.lastname: Lee
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Wing Man
authors.initials: WM
authors.lastname: Woo
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Chak Yiu Justin
authors.initials: CY
authors.lastname: Lam
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Yun Ting Eunice
authors.initials: YT
authors.lastname: Yeung
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Yiu Shing Sunny
authors.initials: YS
authors.lastname: Chau
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Ka Kam Kenneth
authors.initials: KK
authors.lastname: Chui
authors.affiliation: d Faculty of Medicine , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China.
authors.forename: Ka Hin Gabriel
authors.initials: KH
authors.lastname: Li
authors.affiliation: a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China .
authors.forename: Ting Fan
authors.initials: TF
authors.lastname: Leung
mesh_terms: D000287:Administration, Topical; D000293:Adolescent; D001294:Attitude to Health; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003880:Dermatology / Q000379:methods; D004485:Eczema / Q000188:drug therapy* / Q000523:psychology*; D005239:Fear; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007249:Inflammation; D008297:Male; D015588:Observer Variation; D010290:Parents; D010353:Patient Education as Topic; D010358:Patient Participation; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D005938:Glucocorticoids
keywords: Acceptability; CDLQI; NESS; eczema; glucocorticoid fears