Why do patients with atopic dermatitis refuse to apply topical corticosteroids?

BACKGROUND: The number of patients with atopic dermatitis who refuse to use topical corticosteroids because of personal fears seems to be increasing. However, studies on this subject are scarce. Consequently, we have investigated this issue further.
METHODS: A cross-sectional study based on a questionnaire. Between September 1998 and January 1999, a questionnaire was distributed to patients who responded to an announcement and to those attending 18 hospitals or clinics and 11 self-help groups throughout Japan to identify what makes patients resistant to applying topical corticosteroids.
RESULTS: Patients who are reluctant to use topical corticosteroids often experienced: ineffective or short-lasting results, adverse side effects and feelings of distrust towards their physician. These feelings of distrust were found to be significantly stronger among patients who were reluctant to apply topical corticosteroids than among patients who accepted the treatment with little or no feelings of resistance. External influences such as those from family members, acquaintances, mass media (television, newspapers and magazines), alternative 'nondoctor' therapists and self-help groups were not found to be a significant factor between both groups. However, the influence of the physician was found to be significant and directly related to the patients' lack of trust.
CONCLUSIONS: Patients with atopic dermatitis who refuse to use topical corticosteroids attribute their feelings of resistance to personal experiences rather than to information from external sources. Information or warnings about associated side effects from physicians may help to reduce these fears and ultimately benefit the physician-patient relationship.