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. 2025 Jul;15(7):1851-1865.
doi: 10.1007/s13555-025-01439-6. Epub 2025 May 16.

Observational Study of Corticosteroid Phobia Using the TOPICOP Score among Adults and Caregivers of Children with Atopic Dermatitis in Japan

Takeshi Nakahara  1 , Hiroyuki Murota  2 , Shinichi Noto  3 , Miyuki Matsukawa  4 , Rikiya Toda  5 , Yasuhito Konishi  5 , Daisaku Michikami  5
Affiliations

Observational Study of Corticosteroid Phobia Using the TOPICOP Score among Adults and Caregivers of Children with Atopic Dermatitis in Japan

Takeshi Nakahara et al. Dermatol Ther (Heidelb). 2025 Jul.

Abstract

Introduction: Topical corticosteroid (TCS) phobia, which tends to interfere with the continuation of TCS treatment for atopic dermatitis (AD), has not been elucidated in Japan using the topical corticosteroid phobia (TOPICOP) scale. We aimed to clarify TCS phobia among patients with AD in Japan and evaluate its relationship with AD conditions.

Methods: This observational study, using the database of health receipt (between October 2021 and October 2022) and online questionnaire (conducted in October 2022) data, included adult respondents with and without AD and caregivers who responded to the questionnaire about their children aged ≤ 18 years, with and without AD. The TOPICOP scores measuring TCS phobia were summarized and compared according to AD severity, consultation with a doctor, and presence of AD using an analysis of covariance (ANCOVA) model (covariates: sex and age).

Results: In this study, 1507 adults with AD and 525 caregivers of children with AD were included. Among adults with AD, the mean TOPICOP score (± standard deviation) was 42.5 ± 18.9, while it was 41.7 ± 18.6 among caregivers of children with AD. Of the three TOPICOP domains (knowledge and beliefs, fears, and behaviors), the fear domain questions showed the highest percentage of agreement in both adults and caregivers of children with AD. In the ANCOVA models, the scores did not differ significantly according to AD severity, consultation with a doctor, or the presence of AD in adults and caregivers but significantly differed by sex and age (both p < 0.001) in adults.

Conclusion: We obtained the latest TOPICOP scores that were independent of AD conditions in Japan. Most adults and caregivers of children with AD had TCS phobia, regardless of the AD conditions. Periodic education may be required for a wide range of patients and caregivers to ease TCS phobia and enable them to continue appropriate AD treatment.

Keywords: Atopic dermatitis; Japan; Patient reported outcome measures; Topical corticosteroid phobia; Topical corticosteroid phobia (TOPICOP) scale.

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Conflict of interest statement

Declarations. Conflict of Interest: Takeshi Nakahara has received consulting fees and/or speaker honoraria from Mitsubishi Tanabe Pharma, Taiho Pharmaceutical, Torii Pharmaceutical, Maruho, Sanofi, AbbVie, Eli Lilly Japan, Sun Pharma and Otsuka Pharmaceutical. Hiroyuki Murota has received consulting fees and/or speaker honoraria from Maruho Co., Ltd., Sanofi K.K., Pfizer Japan Inc., Torii Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., AbbVie GK, and Otsuka Pharmaceutical Co., Ltd. Shinichi Noto has received speaker honoraria from Otsuka Pharmaceutical. Miyuki Matsukawa, Rikiya Toda, Yasuhito Konishi, and Daisaku Michikami are employees of Otsuka Pharmaceutical Co., Ltd. Ethical Approval: This study was approved on October 21, 2022 by the Research Ethics Committee of Research and Development Division, Otsuka Pharmaceutical Co., Ltd. (approval no: 221013). The dataset used in this study was purchased from the DeSC. We have permission to use this database for the purposes of the research presented in this study. As we used secondary anonymized data, no individual-level informed consent was obtained. The survey was conducted in accordance with the Ethical Guidelines for Medical and Biological Research Involving Human Subjects in Japan and Declaration of Helsinki.

Figures

Fig. 1
Fig. 1
Dispositions of adults and caregivers of children. a Adults with/without AD. b Caregivers of children with/without AD. *AD diagnosis records were L20, L281, L282, L309, L853, and L988 (International Classification of Diseases, 10 th Revision). AD, atopic dermatitis; DPC, diagnosis procedure combination
Fig. 2
Fig. 2
TOPICOP scores. a TOPICOP summary statistics in adults and caregivers of children with AD. b Distribution of TOPICOP scores in adults with AD. c Distribution of TOPICOP scores in caregivers of children with AD. Note: In the box-and-whisker plot (a), the box shows the first to the third quartiles, and the line in the middle of the box shows the median. The whiskers show the maximum and minimum values. TOPICOP topical corticosteroid phobia, AD atopic dermatitis, SD standard deviation
Fig. 3
Fig. 3
TOPICOP scores by AD severity (POEM) (including model analysis). a Adults with AD. b Caregivers of children with AD. Note: The bar graphs and tables of summary statistics were not adjusted for covariates. In the model analysis (ANCOVA), AD severity was categorized into the following four bandings of POEM: very severe + severe, moderate, mild, and clear. See Tables S2 and S3 in Supplementary Material for more information regarding the model analysis results. TOPICOP topical corticosteroid phobia, AD atopic dermatitis, POEM Patient-Oriented Eczema Measure, SD standard deviation, ANCOVA analysis of covariance
Fig. 4
Fig. 4
TOPICOP scores by consultation with a doctor (including model analysis). a Adults with AD. b Caregivers of children with AD. Note: The bar graphs and tables of summary statistics were not adjusted for covariates. See Tables S4 and S5 in Supplementary Material for more information regarding the model analysis results. TOPICOP topical corticosteroid phobia, AD atopic dermatitis, SD standard deviation
Fig. 5
Fig. 5
TOPICOP scores by prescribed topical medications. a Adults with AD. b Caregivers of children with AD. TOPICOP topical corticosteroid phobia, AD atopic dermatitis, SD standard deviation
See this image and copyright information in PMC

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