PA07 Sources of patient perceptions of topical steroid withdrawal and developing a framework to mitigate bias

Abstract Emerging concerns regarding topical steroid withdrawal (TSW) have deepened patient mistrust of dermatologists and led to the rise of ‘topical corticophobia’. Erythema and swelling are the most common reported signs of TSW. TSW is widely debated among dermatologists and remains a controversial diagnosis. Many clinicians consider TSW a rare occurrence in comparison with a more common clinical scenario of active atopic dermatitis. The lack of precise criteria for TSW as a distinct diagnosis aligns with the need to understand and mitigate the impact of topical corticophobia. A literature review of TSW and topical corticophobia was conducted using PubMed, Cochrane, Google Scholar and reviews of patient misinformation sources online – a recognized threat to global health (health misinformation fuels distrust of healthcare professionals, a common obstacle to adequate disease control in patients). Following analysis, a concept map was created from which an evidence-based mitigating framework was developed to reduce topical corticophobia misinformation among patients and carers. This aims to fulfil unmet needs in rebuilding trust and patient engagement with dermatologists. Although the literature suggests differing opinions on the existence of TSW, the Medicines and Healthcare products Regulatory Agency states ‘there is a growing body of evidence’ of TSW, and patients with perceived symptoms are often left feeling invalidated. Increasing global levels of topical corticophobia appear significant, from ‘31% to 95.7%’. Studies suggest a strong doctor–patient relationship as the most effective tool in combatting health misinformation coupled with regular follow-up appointments to reassure patients and family members. Choi et al. found providing patients with information targeting common misconceptions reduced the mean TOPICOP score in patients from 41.9 to 37.1 and 33.8 at 1-month and 3-month intervals, respectively (Choi E, Tan KW, Tang F et al. Efficacy of targeted education in reducing topical steroid phobia: a randomized clinical trial. J Am Acad Dermatol 2020; 83: 1681–7). Koster et al. concluded that education of patients and healthcare professionals combined with targeted counselling are effective methods of reducing corticophobia (Koster ES, Philbert D, Zheng X et al. Topical corticosteroid phobia among healthcare professionals using the TOPICOP score. Acta Derm Venereol 2019; 99: 1004–8). An unmet need for research of TSW, with high levels of evidence (level 1), should urgently be addressed, in order to provide clarity for patients and clinicians. Existing literary evidence is insufficient and occasionally contradictory, adding to an already complex landscape surrounding TSW. This is potentially driving patients towards alternative pseudoscientific sources, which could be disseminating misinformation. Despite a lack of TSW research, health professionals need to ensure empathy with patients with symptoms that could be linked to TSW. Emerging national and global awareness of TSW has led to more cautious patient leaflet information.