Department of Dermatology, Federation of National Public Service Personnel Mutual Aid Associations, Hamanomachi Hospital, Fukuoka, Japan.
Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Dermatol. 2018 Feb;45(2):158-164. doi: 10.1111/1346-8138.14124. Epub 2017 Nov 23.
Topical corticosteroid phobia is an important problem in the treatment of atopic dermatitis as it can affect the ability to control disease severity and itch by reducing treatment adherence. Topical corticosteroid phobia often ends up even non-corticosteroid adherence. As such, non-corticosteroid adherence, disease severity and itch are likely to be associated with each other, but their relationship has yet to be thoroughly investigated. Thus, the purpose of this study is to investigate it in atopic dermatitis. Using data from 1190 participants in an Internet survey, we identified 255 non-corticosteroid users and 225 with moderate to severe itch who were defined as non-corticosteroid adherents. Corticosteroid users with the same itch categories (n = 878) served as controls. We also examined how itch severity affects the perception of itch in atopic dermatitis. Unexpectedly, non-corticosteroid adherents were less sensitive to the conditions to elicit itch such as perspiring, commuting homeward, drinking alcohol and wearing woolen clothes compared with the control. We also found that patients with severer itch were more sensitive to itch during/after bathing, when lying in bed, commuting homeward, studying/working, drinking alcohol, undressing, getting up in the morning, after a meal, ingesting piquant foods and when they were unoccupied, angry, busy, nervous, sad or enjoying themselves. In conclusion, we found that non-corticosteroid adherence and itch severity influence perception of itch in atopic dermatitis and discuss possible mechanisms underlying these results. The information obtained in this study may be useful for communication with and education of atopic dermatitis patients and their treatment in outpatient clinics.
外用皮质类固醇恐惧症是特应性皮炎治疗中的一个重要问题，因为它会通过降低治疗依从性来影响控制疾病严重程度和瘙痒的能力。外用皮质类固醇恐惧症通常最终会导致非皮质类固醇药物的依从性降低。因此，非皮质类固醇药物的依从性、疾病严重程度和瘙痒很可能相互关联，但它们之间的关系尚未得到彻底研究。因此，本研究旨在调查特应性皮炎中的这种关系。我们使用来自互联网调查的 1190 名参与者的数据，确定了 255 名非皮质类固醇使用者和 225 名中度至重度瘙痒者，他们被定义为非皮质类固醇依从者。具有相同瘙痒类别的皮质类固醇使用者（n=878）作为对照组。我们还研究了瘙痒严重程度如何影响特应性皮炎患者对瘙痒的感知。出乎意料的是，与对照组相比，非皮质类固醇依从者对引起瘙痒的条件（如出汗、回家、饮酒和穿羊毛衣服）的敏感性较低。我们还发现，瘙痒更严重的患者在洗澡时/洗澡后、躺在床上、回家、学习/工作、饮酒、脱衣服、早上起床、饭后、摄入辛辣食物以及空闲、生气、忙碌、紧张、悲伤或享受时，对瘙痒更敏感。总之，我们发现非皮质类固醇药物的依从性和瘙痒的严重程度会影响特应性皮炎患者对瘙痒的感知，并讨论了这些结果背后可能的机制。本研究获得的信息可能对与特应性皮炎患者的沟通和教育以及门诊治疗有用。
