Carers' views of topical corticosteroid use in childhood eczema: a qualitative study of online discussion forums

Br J Dermatol. 2017 Jun;176(6):1500-1507. doi: 10.1111/bjd.15130. Epub 2017 Feb 3.

Abstract

Background: Childhood eczema is very common and can have substantial impact on quality of life. One of the main treatments is topical corticosteroids, but these are often underused by parents and carers for reasons that include concerns about safety.

Objectives: To explore understandings and concerns about topical corticosteroids among parents and carers of children with eczema who had posted messages in online forums.

Methods: A qualitative study of messages and their resultant discussions about topical corticosteroids for childhood eczema posted by parents and carers on two U.K.-based discussion forums.

Results: Ninety-five forum users involved in 27 discussions relating to topical corticosteroid use in childhood eczema were identified dating from 2003 to 2015. Analysis of discussions highlighted three themes: (i) diverse beliefs about the use of topical corticosteroids; (ii) uncertainty and confusion about using and applying topical corticosteroids; and (iii) seeking to resolve conflicting advice received offline and advice on navigating health services. People expressed a general sense of cautiousness about topical corticosteroids, wide-ranging concerns and considerable confusion, for instance about potency or safe duration of use. They sought advice from other forum users who they perceived as having experiential expertise. Some posts attempted to reassure that topical corticosteroids were safe if used correctly, but overall the discussions seemed likely to amplify existing concerns.

Conclusions: Given the prevalence of concerns and uncertainties about topical corticosteroids, signposting parents and carers of children with eczema towards detailed, credible information about how to use topical corticosteroids safely would be beneficial. In the absence of such information, parents and carers are likely to turn to online discussion forums where, although much useful support and advice can be found, the credibility of advice cannot be assured.

MeSH terms

  • Administration, Cutaneous
  • Adrenal Cortex Hormones / administration & dosage*
  • Adrenal Cortex Hormones / adverse effects
  • Attitude to Health
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Dermatologic Agents / administration & dosage*
  • Dermatologic Agents / adverse effects
  • Eczema / drug therapy*
  • Female
  • Focus Groups
  • Humans
  • Infant
  • Male
  • Patient Acceptance of Health Care / psychology

Substances

  • Adrenal Cortex Hormones
  • Dermatologic Agents