Date of Award

January 2018

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Richard J. Antaya



Non-adherence to medication in atopic dermatitis is common. Topical corticosteroid phobia may be one of several contributors to non-adherence. The relationship between topical corticosteroid phobia and non-adherence, however, is not well understood.


To evaluate whether caregiver topical corticosteroid phobia is a significant predictor of medication adherence in pediatric atopic dermatitis in a 2-week treatment period.

Design, Setting, and Participants

This was a prospective cohort study. Participants were pediatric patients (0-7 years) who were referred to our dermatology clinic for management of atopic dermatitis. Atopic dermatitis severity (both caregiver-scored and clinician-scored) and caregiver topical corticosteroid phobia were assessed at baseline and after 2-week treatment of topical corticosteroid therapy. Adherence was measured by dividing weight of medication used after 2-weeks by the amount of medicine that was expected to be used, based on body surface area affected with atopic dermatitis.

Main Outcomes and Measures

Primary outcomes were treatment adherence and caregiver topical corticosteroid phobia (measured with the Topical Corticosteroid Phobia Scale [TOPICOP]). Secondary outcomes included caregiver-scored disease severity (measured with the Patient Oriented Eczema Measure [POEM]) and clinician-scored disease severity (measured with Eczema Area Severity Index [EASI]). Correlations were measured between adherence, TOPICOP, POEM, and EASI. Statistically significant correlations were retained for multiple linear regression modeling.


There was a total of 26 participants who completed both baseline and follow-up assessments. Eighteen (69.2%) were males and 8 (30.8%) were females, with median age of 8.5 months (range 3-72 months). Median EASI, POEM, TOPICOP scores decreased by 70.9%, 69.8%, 27.2%, respectively from baseline at 2-week follow-up (all p<0.001). Median adherence was 102.7% (range 13%-599%). There were significant negative correlations between adherence and EASI at baseline and follow-up (-0.45, p<0.05; -0.40, p<0.05). There were significant negative correlations between adherence and TOPICOP at both baseline and at follow-up (-0.38, p<0.05; -0.44, p<0.05). Adherence was significantly negatively correlated with POEM at follow-up (-0.51, p<0.01) but not at baseline (p=0.58). In multiple regression analysis using adherence as outcome, baseline EASI (ß=-0.376, p=0.04) and baseline TOPICOP (ß=-0.45, p=0.016) were significant predictors.

Conclusions and Relevance

Our study identifies TCS phobia as a potential contributor to non-adherence in the treatment of pediatric atopic dermatitis. Screening for TCS phobia may identify caregivers that are at higher risk of being non-adherent with TCS treatment.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/25/2100