‘Back to square one’ – experiences influencing topical corticosteroid use in paediatric atopic dermatitis

Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that negatively impacts quality of life. Topical corticosteroids (TCS) remain the first-line management and effective TCS use is associated with improved holistic wellbeing. However, medication self-withdrawal and ‘no-moisture’ method discussions have emerged, and there is evidence that treatment success is influenced by caregivers’ views on TCS use. The aim of this study was to understand the experiences causing parents to deviate from traditional TCS use in paediatric AD management. Methods: A convenience sampling approach was used to recruit caregivers of children with AD, who subsequently participated in one-on-one semi-structured interviews following informed consent. Qualitative data were thematically analysed. Results: Ten participants were interviewed, of which four were also general practitioners (GPs). The steroid phobia observed among non-healthcare participants was also evident in the views of some GPs. Mismatched expectations within therapeutic relationships lead to some participants seeking alternative therapies and non-medical information sources. Divergence in interpretations of management between primary care practitioners is associated with poor treatment adherence and lowered parent confidence. Conclusions: A holistic approach to paediatric AD management can effectively support parents and caregivers, as well as reduce treatment burden. Further education for GPs, exploration of psychosocial AD management and alternative therapies may assist in improving patient outcomes.