title: Topical corticosteroid phobia in parents of pediatric patients with atopic dermatitis: a multicentre survey.
abstract: BACKGROUND
  Families of children affected with atopic dermatitis (AD) often report fear and anxiety regarding treatment with topical corticosteroids (TCS), which may lead to reduced compliance. The objective of our study was to measure, through a standardized questionnaire, fear of TCS in families of pediatric patients with AD and to identify items associated with fear.
  
  
  METHODS
  Families of pediatric patients with AD were enrolled in 9 Italian centers of pediatric dermatology. Enrolled parents were invited to fill in a questionnaire including questions on sociodemographic and clinical characteristics and 3 sets of questions on corticosteroid phobia (general fear, specific fears, behaviours regarding TCS). Determinants of the level of general fear were investigated through multivariable analysis.
  
  
  RESULTS
  A total of 300 outpatients with AD were enrolled. Most parents (80%) had a high instruction level. Eighty-one percent reported to have a certain amount of fear of TCS. At the multivariable analysis, fear of TCS was associated with the following items: believing that TCS treatment advantages do not overweight disadvantages (P = 0.011); believing that TCS may be dangerous independently from the specific side effect (P < 0.001). Moreover, TCS fear was associated with fear of applying too much cream (P = 0.001).
  
  
  CONCLUSIONS
  TCS phobia is widespread among Italian families of children with AD. Fear of TCS is associated with fear of applying too much cream, thus increasing the risk of poor compliance and treatment failure. Therapeutic education of families on the use of TCS should be implemented.
authors.affiliation: Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Maya
authors.initials: M
authors.lastname: El Hachem
authors.affiliation: Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy. f.gesualdo@gmail.com.
authors.forename: Francesco
authors.identifier: http://orcid.org/0000-0002-9087-4398
authors.initials: F
authors.lastname: Gesualdo
authors.affiliation: Department of Medical and Surgical Sciences, Pediatric Unit, S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Diociaiuti
authors.affiliation: Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Giraldi
authors.affiliation: Pediatric Dermatology, AORN Santobono-Pausilipon, Naples, Italy.
authors.forename: Orsola
authors.initials: O
authors.lastname: Ametrano
authors.affiliation: Dermatology Unit, Istituto Giannina Gaslini, Genoa, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Occella
authors.affiliation: Department of Medicine, Pediatric Dermatology Unit, University of Padua, Padua, Italy.
authors.forename: Anna Belloni
authors.initials: AB
authors.lastname: Fortina
authors.affiliation: Department of Medicine, Unit of Pediatric Dermatology, ARNAS Civico, Palermo, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Milioto
authors.affiliation: Dermatology Unit, M. Bufalini Hospital, Cesena, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Arcangeli
authors.affiliation: Department of Clinical and Molecular Sciences, Clinic of Dermatology, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Oriana
authors.initials: O
authors.lastname: Simonetti
authors.affiliation: Pediatric Dermatology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Giancristoforo
authors.affiliation: Department of Medical and Surgical Sciences, Pediatric Unit, S. Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Calamelli
authors.affiliation: Dermatology Unit, San Luca Hospital, ASL 2, Lucca, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mazzatenta
authors.affiliation: Division of Dermatology, Department of Specialised, Experimental and Diagnostic Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Iria
authors.initials: I
authors.lastname: Neri
mesh_terms: D000279:Administration, Cutaneous; D002648:Child; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D003880:Dermatology; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007558:Italy; D008297:Male; D010045:Outpatients; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D010698:Phobic Disorders / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D003879:Dermatologic Agents; D005938:Glucocorticoids
keywords: Atopic dermatitis; Children; Corticophobia; Topical corticosteroids