American Journal of Clinical Dermatology

, Volume 19, Issue 2, pp 261–265 | Cite as

Topical Corticosteroid Concerns Among Parents of Children with Psoriasis versus Atopic Dermatitis: A French Multicenter Cross-Sectional Study

  • Sandra Moawad
  • Emmanuel Mahé
  • Hélène Aubert-Wastiaux
  • Alice Phan
  • Annabel Maruani
  • Christine Chiaverini
  • Christine Bodemer
  • Juliette Mazereeuw-Hautier
  • Audrey Lasek-Duriez
  • Catherine Droitcourt
  • Sébastien Barbarot
  • Alain Beauchet
  • Anne-Claire Bursztejn
  • for the Groupe de Recherche de la Société Française de Dermatologie Pédiatrique
short communication



Atopic dermatitis (AD) and psoriasis are chronic inflammatory cutaneous disorders for which the gold standard treatment is topical corticosteroids. Although fears about topical corticosteroids are known to be a primary cause of poor therapeutic adherence in AD, this has not been evaluated in psoriasis. TOPICOP is a helpful and easy-to-use tool for the evaluation of topical corticosteroid concerns (TCC). It may help clinicians improve adherence to treatment and correct misconceptions.


We aimed to compare the TCC of parents of children with psoriasis or AD using the TOPICOP scale and a visual analog scale (VAS).


We performed a cross-sectional multicenter study in nine French hospitals from 1 October 2015 to 31 May 2016. The TOPICOP scale was developed for patients with AD and comprises 12 questions to assess patients’ worries and beliefs about topical corticosteroids, with a maximum score of 36. We used a standardized questionnaire to collect epidemiologic and medical data, and the parents completed the TOPICOP scale and VAS (score 0–10).


A total of 122 children were enrolled (61 patients in each group). The mean Physician Global Assessment was 2.1 in the psoriasis group, and the mean SCORing AD index was 33.3 in the AD group. The TOPICOP score was 16.0 in the psoriasis group and 18.8 in the AD group (p = 0.10). The VAS score was 5.6 and 5.1 in the psoriasis and AD groups, respectively (p = 0.18). The mean TOPICOP score was higher if the mother answered (p < 0.0001; odds ratio 12.3; 95% confidence interval 9.2–15.5). In the AD group, the mean TOPICOP score was higher if follow-up for the child was as an outpatient (p = 0.018). In the psoriasis group, the mean TOPICOP score was higher if patients were seen for the first time (p = 0.047).


Using the TOPICOP questionnaire and a VAS, we found the level of TCC for the parents of pediatric patients with psoriasis to be similar to that for parents of pediatric patients with AD. As TCC is an issue in patients with psoriasis, future research is warranted to assess whether therapeutic education lessens TCC and improves treatment outcomes.


Compliance with Ethical Standards


No sources of funding were used to conduct this study or prepare this manuscript.

Conflicts of Interest

Sandra Moawad, Emmanuel Mahé, Hélène Aubert-Wastiaux, Alice Phan, Annabel Maruani, Christine Chiaverini, Christine Bodemer, Juliette Mazereeuw-Hautier, Audrey Lasek-Duriez, Catherine Droitcourt, Sébastien Barbarot, Alain Beauchet, and Anne-Claire Bursztejn have no conflicts of interest that are directly relevant to the content of this manuscript.

Supplementary material

40257_2017_318_MOESM1_ESM.pdf (16 kb)
Supplementary material 1 (PDF 16 kb)


  1. 1.
    Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155:145–51.CrossRefPubMedGoogle Scholar
  2. 2.
    Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess. 2000;4:1–191.PubMedPubMedCentralGoogle Scholar
  3. 3.
    De Jager ME, De Jong EM, Van de Kerkhof PC, et al. Efficacy and safety of treatments for childhood psoriasis: a systematic literature review. J Am Acad Dermatol. 2010;62:1013–30.CrossRefPubMedGoogle Scholar
  4. 4.
    Müller SM, Tomaschett D, Euler S, et al. Topical corticosteroid concerns in dermatological outpatients: a cross-sectional and interventional study. Dermatology. 2016;232:444–52.CrossRefPubMedGoogle Scholar
  5. 5.
    Mueller SM, Tomaschett D, Vogt DR, et al. Topical corticosteroid concerns from the clinicians’ perspective. J Dermatol Treat. 2016;7:1–5.Google Scholar
  6. 6.
    Aubert-Wastiaux H, Moret L, Le Rhun A, et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011;165:808–14.CrossRefPubMedGoogle Scholar
  7. 7.
    Hon KL, Kam WY, Leung TF, et al. Steroid fears in children with eczema. Acta Paediatr. 2006;95:1451–5.CrossRefPubMedGoogle Scholar
  8. 8.
    Charman C, Williams H. The Use of corticosteroids and corticosteroid phobia in atopic dermatitis. Clin Dermatol. 2003;21:193–200.CrossRefPubMedGoogle Scholar
  9. 9.
    Smith SD, Hong E, Fearns S, et al. Corticosteroid phobia and other confounders in the treatment of chilhood atopic dermatitis explored using parent focus groups. Australas J Dermatol. 2010;51:168–74.CrossRefPubMedGoogle Scholar
  10. 10.
    Kojima R, Fujiwara T, Matsuda A, et al. Factors associated with steroid phobia in caregivers of children with atopic dermatitis. Pediatr Dermatol. 2013;30:29–35.CrossRefPubMedGoogle Scholar
  11. 11.
    Fukaya M. Why do patients with atopic dermatitis refuse to apply topical corticosteroids? Dermatology. 2000;201:242–5.CrossRefPubMedGoogle Scholar
  12. 12.
    Brown KK, Wingfield ER, Kimball AB. Determining the relative importance of patient motivations for nonadherence to topical corticosteroid therapy in psoriasis. JAMA Dermatol. 2006;55:607–13.CrossRefGoogle Scholar
  13. 13.
    Fouéré S, Adjadj L, Pawin H. How patients experience psoriasis: results from a European survey. J Eur Acad Dermatol Venereol. 2005;19:2–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Moret L, Anthoine E, Aubert-Wastiaux H, et al. TOPICOP: A new scale evaluating topical corticosteroid phobia among atopic dermatitis outpatients and their parents. PLoS One. 2013;8:e76493.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Stalder JF, Aubert H, Anthoine E, et al. Topical corticosteroid phobia in atopic dermatitis: International feasibility study of the TOPICOP score. Allergy. 2017;. doi: 10.1111/all.13189 (Epub 25 April 2017).PubMedGoogle Scholar
  16. 16.
    Robinson A, Kardos M, Kimball AB. Physician Global Assessment (PGA) and Psoriasis Area and Severity Index (PASI): why do both? A systematic analysis of randomized controlled trials of biologic agents for moderate to severe plaque psoriasis. J Am Acad Dermatol. 2012;66:369–75.CrossRefPubMedGoogle Scholar
  17. 17.
    Oranje AP, Glazenburg EG, Wolkerstorfer A, et al. Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol. 2007;157:645–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Gonzales F, Ramdane N, Delebarre-Sauvage C, et al. Monitoring of topical corticosteroid phobia in a population of parents with children with atopic dermatitis using the TOPICOP® scale: prevalence, risk facts and the impact of therapeutic patient education. J Eur Acad Dermatol Venereol. 2017;31:172–4.CrossRefGoogle Scholar
  19. 19.
    Raffin D, Giraudeau B, Samimi M, et al. Corticosteroid phobia among pharmacists regarding atopic dermatitis in children: a national French survey. Acta Derm Venereol. 2016;96:177–80.CrossRefPubMedGoogle Scholar
  20. 20.
    Mueller SM, Itin P, Vogt DR, et al. Assessment of “corticophobia” as an indicator of non-adherence to topical corticosteroids: a pilot study. J Dermatol Treat. 2017;28:104–11.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • Sandra Moawad
    • 1
  • Emmanuel Mahé
    • 2
  • Hélène Aubert-Wastiaux
    • 3
  • Alice Phan
    • 4
  • Annabel Maruani
    • 5
  • Christine Chiaverini
    • 6
  • Christine Bodemer
    • 7
  • Juliette Mazereeuw-Hautier
    • 8
  • Audrey Lasek-Duriez
    • 9
  • Catherine Droitcourt
    • 10
  • Sébastien Barbarot
    • 3
  • Alain Beauchet
    • 11
  • Anne-Claire Bursztejn
    • 1
  • for the Groupe de Recherche de la Société Française de Dermatologie Pédiatrique
  1. 1.Dermatology DepartmentUniversity Hospital of NancyVandoeuvre les NancyFrance
  2. 2.Dermatology DepartmentHospital Victor DupouyArgenteuilFrance
  3. 3.Dermatology DepartmentUniversity Hospital of NantesNantesFrance
  4. 4.Dermatology DepartmentUniversity Hospital of LyonLyonFrance
  5. 5.Dermatology DepartmentUniversity Hospital of ToursToursFrance
  6. 6.Dermatology DepartmentUniversity Hospital of NiceNiceFrance
  7. 7.Dermatology DepartmentNecker HospitalParisFrance
  8. 8.Dermatology DepartmentUniversity Larrey HospitalToulouseFrance
  9. 9.Dermatology DepartmentInstitut Catholique de LilleLilleFrance
  10. 10.Dermatology DepartmentUniversity Hospital of RennesRennesFrance
  11. 11.Public Health Department, Ambroise Paré University Hospital CentreVersailles-Saint-Quentin-en-Yvelines UniversityBoulogne-BillancourtFrance

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