Hon Kam Lun, Tsang Yin Ching K, Pong Nga Hin, Luk David C K, Lee Vivian W, Woo Wing Man, Lam Chak Yiu Justin, Yeung Yun Ting Eunice, Chau Yiu Shing Sunny, Chui Ka Kam Kenneth, Li Ka Hin Gabriel, Leung Ting Fan
a Department of Paediatrics , The Chinese University of Hong Kong , Hong Kong , Hong Kong SAR , China .
b Department of Paediatrics & Adolescent Medicine , United Christian Hospital , Kwun Tong , Hong Kong SAR , China .
J Dermatolog Treat. 2015 Oct;26(5):418-25. doi: 10.3109/09546634.2015.1025030. Epub 2015 Apr 20.
Topical corticosteroids (CSs) are the mainstay of treatment for eczema but CS phobia and fears are prevalent and influence therapeutic efficacy.
To quantify if CS acceptability and fear affect patients' quality-of-life (QoL).
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.
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).
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.
外用糖皮质激素（CSs）是湿疹治疗的主要药物，但对CSs的恐惧很普遍，并影响治疗效果。
量化CSs的可接受性和恐惧是否会影响患者的生活质量（QoL）。
对在大学医院儿科皮肤科门诊就诊的湿疹患者进行调查。通过量化问题测量湿疹严重程度的诺丁汉湿疹严重程度评分（NESS）、生活质量的儿童皮肤病生活质量指数（CDLQI）、对CSs的恐惧、可接受性以及报告的CSs使用频率。
湿疹患者的父母和照顾者中普遍存在对CSs的恐惧。58%的父母报告CSs的总体可接受性非常好或良好，许多人每周定期给孩子使用CSs。然而，超过40%的父母报告“总是”或“经常”害怕CSs，41%报告他们“总是”或“经常”仅在湿疹加重时才使用CSs，57%会与医生讨论对CSs的恐惧，30%会要求使用避免使用CSs的药物，14%“总是”或“经常”使用传统中药。恐惧主要是人际方面的，医源性的较少。皮肤问题是CSs最令人担忧的副作用。CSs的可接受性、使用频率、对CSs的恐惧以及替代药物的使用是湿疹管理中的独立领域：对CSs的恐惧与CDLQI相关；CSs使用频率与NESS相关，与父母教育程度呈负相关；CSs的可接受性与父母教育程度相关。有序逻辑回归显示，生活质量较差与对CSs的恐惧更多相关（优势比：1.092 [95%置信区间：1.023 - 1.165]，p = 0.008）。
对CSs的恐惧程度与CSs的可接受性无关，但与患者的生活质量相关。为了提高治疗效果和患者的生活质量，消除父母对CSs的恐惧应成为湿疹教育和治疗的一部分。
