P178 Misinformation, fear and knowledge gaps: patient perspectives on topical corticosteroids and steroid withdrawal

Abstract

In recent times, treatment adherence with topical corticosteroids (TC) has been compromised by fears of topical steroid withdrawal (TSW). Understanding these perceptions on safety concerns is critical for informed decision making. We surveyed 258 dermatology clinic patients (October 2025) to assess knowledge of TC and TSW. Their mean age was 55.8 years (range 0.6–95); 233 (90.3%) were adults and 54% female. Patients attended primarily for skin lesion assessment (57.8%, n = 149), eczema (14.3%, n = 37) and psoriasis (10.5%, n = 27). Only 23% of respondents (n = 59) viewed TC as beneficial, while 12% (n = 30) considered them harmful and 66% (n = 169) were unsure. Information sources were concerning: just 22% (n = 58) received guidance from healthcare professionals and 8.1% (n = 21) from reputable websites (e.g. the NHS). Many relied on informal or unregulated sources, including friends and family (16.3%, n = 42) and social media (17.4%, n = 45). Among prior users of TC (47.3%, n = 122), 68.9% (n = 84) received counselling on proper use – primarily from dermatologists (56%) or general practitioners (38%). Although 64.8% (n = 79) of the 122 patients reported understanding TC potency, only 51% of these (40 of 79) correctly identified hydrocortisone as mildly potent, with 35.2% overall (43 of 122) harbouring fears about TC use. Of the 258 participants, only 22.5% (n = 58) had heard of TSW, primarily through the internet or social media (40%, 23 of 58), doctors (38%, 22 of 58) or friends and family (19%, 11 of 58). TSW information led 12.4% (32 of 258) to avoid TC, with 63% (n = 20) of the 32 patients reporting subsequent skin deterioration. Some switched to tacrolimus or pimecrolimus (28%, 9 of 32). Notably, 12.4% (n = 32) of the 258 respondents felt dismissed when discussing TC concerns with clinicians, and 49.6% (128 of 258) desired more TSW information, preferably through written materials (64.8%, 83 of 128). This survey revealed significant patient anxiety fuelled by misinformation, inadequate understanding of steroid potency, and clinician–patient communication gaps. Enhanced patient education, particularly accessible written resources, is urgently needed to counter misconceptions and improve treatment engagement.