A cross-sectional analysis of topical steroid phobia and observable side effects in Thai psoriasis patients

Background Steroid phobia impairs adherence to topical corticosteroids (TCS) and undermines psoriasis management, yet remains understudied in adult Thai patients.Objectives To quantify TCS phobia using the TOPICOP scale in Thai adults with psoriasis and identify associated factors.Methods A cross-sectional survey at Siriraj Hospital enrolled 150 adults with psoriasis and TCS experience, who completed the validated Thai TOPICOP scale.Results Of 150 participants, 81 (54.0%) were female, median age 52 years (IQR 35.0–62.3). Mean TOPICOP score was 17.1 ± 5.3/36 (47.5% ± 14.7%). Forty percent reported explicit fear of TCS. Dermatologist-confirmed side effects, most commonly skin atrophy, were present in 50.0% and associated with higher TOPICOP scores (18.1 ± 4.3 vs. 16.0 ± 6.0; p = 0.016). Facial involvement was also associated with higher scores (18.1 ± 5.0 vs. 16.3 ± 5.4; p = 0.032). TOPICOP scores correlated positively with DLQI (r = 0.175; p = 0.030) and educational level (r = 0.240; p = 0.003).Conclusions TCS phobia is prevalent among Thai adults with psoriasis, more pronounced with facial involvement, prior side-effect experience, and quality-of-life impairment. Individualized counseling is recommended to promote safe TCS use.