Abstract
Background: Recently, wrong belief on topical steroids for atopic dermatitis (AD) has been disseminated in Japan and been producing a number of patients with ''steroid-phobia'', which further exacerbates the disease. In order to reveal possible adverse influence of ''steroid-phobia'' on clinical course of AD, we performed questionnaire to patients with severe AD who had been hospitalized for intensive treatment for AD and analyzed relationship between clinical course and patient perception of AD treatment.
Methods: Eighty four patients with severe disseminated AD who were hospitalized and followed for 1 year after hospitalization were evaluated. Severity of disease was evaluated at admission, discharge, 1, 3, 6, and 12 months after hospitalization. Factors relating to exacerbation were also reviewed from the charts. Questionnaire asking perception and performance of treatment of AD, especially topical steroids, was filled out by patients or mothers who took care of the children.
Results: All patients improved to mild by hospitalization. Fifty to sixty percent of patients, however, temporarily experienced exacerbation by 6 months after discharge although many of them improved again by 12 months. Outcome at 12 month after hospitalization was significantly better in patients less than 2 years of age. Questionnaire revealed that about 80% of the patients or mothers had exaggerated concerns about adverse effects of topical steroids and that they were influenced by wrong information from internet or TV despite that comprehensive education had been provided during hospitalization. Patients who had concerns about steroid treatment tended not to be compliant to therapy and to have worse clinical outcome.
Conclusion: ''Steroid-phobia'' in Japan is still incorrigible even among patients who received comprehensive education by hospitalization. It is very important to advocate correct information about treatment of AD.
