Effect of Corticosteroid Phobia on Treatment Adherence and Outcome in Women With Lichen Sclerosus: A Prospective Study.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY Journal of Lower Genital Tract Disease Pub Date : 2025-01-01 Epub Date: 2024-12-02 DOI:10.1097/LGT.0000000000000854

Alessandro Borghi, Maria Elena Flacco, Lucrezia Pacetti, Natale Schettini, Giulia Toni, Monica Corazza

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Abstract

Objective: The phenomenon of topical corticosteroid (TC) phobia (TCP) poses a challenge to the adherence of patients requiring prolonged treatments, particularly those with conditions like atopic dermatitis. Nonadherence to treatment significantly contributes to the inadequate control of diseases. This study aimed to evaluate TCP among women suffering from vulvar lichen sclerosus (VLS) and its potential impact on treatment adherence and therapeutic outcomes.

Materials and methods: This observational, prospective study involved adult patients who received their first histological diagnosis of VLS and underwent a 12-week corticosteroid treatment regimen at the authors' Vulva Unit between June 2022 and September 2023. All participants completed the validated TOPICOP questionnaire, which assesses concerns, worries, and beliefs regarding TC usage. Baseline and 12-week control visit assessments were conducted to evaluate subjective and objective parameters of VLS. Patient adherence to treatment was monitored through diary entries.

Results: Among the 50 patients included (with a mean age of 64.9 ± 13.5 years), more than half (58%) had prior experience with TC treatments and 10.3% had used corticosteroids for vulvar symptoms without a precise diagnosis. The median global TOPICOP score was 19.4% (interquartile range = 5.6-36.1), with a corresponding median value of 7.0 (interquartile range = 2.0-13.0). A total of 41 patients (82.2%) adhered to the study treatment, which proved highly effective in alleviating symptoms and improving signs of VLS. Multivariate analysis revealed that neither treatment adherence nor effectiveness were significantly associated with the level of TCP.

Conclusions: Among the authors' VLS patients, TCP was relatively low and did not negatively impact treatment adherence to corticosteroids. Moreover, TCP did not influence the effectiveness of TC therapy, as it did not affect adherence.

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皮质类固醇恐惧症对女性硬化地衣患者治疗依从性和预后的影响：一项前瞻性研究。

目的：局部皮质类固醇（TC）恐惧症（TCP）的现象对需要长期治疗的患者的依从性提出了挑战，特别是那些患有特应性皮炎的患者。不坚持治疗严重导致疾病控制不足。本研究旨在评估外阴地衣硬化（VLS）女性患者的TCP及其对治疗依从性和治疗结果的潜在影响。材料和方法：这项观察性、前瞻性研究纳入了成年患者，这些患者在2022年6月至2023年9月期间接受了首次VLS组织学诊断，并在我们的外阴部门接受了12周的皮质类固醇治疗方案。所有参与者都完成了经过验证的TOPICOP问卷，该问卷评估了对TC使用的关注、担忧和信念。进行基线和12周对照访视评估，评价VLS的主客观参数。通过日记记录监测患者对治疗的依从性。结果：在纳入的50例患者（平均年龄64.9±13.5岁）中，超过一半（58%）的患者有过TC治疗的经验，10.3%的患者在没有准确诊断的情况下使用过皮质类固醇治疗外阴症状。全球TOPICOP评分中位数为19.4%（四分位数范围为5.6-36.1），对应的中位数为7.0（四分位数范围为2.0-13.0）。41例患者（82.2%）坚持研究治疗，对缓解VLS症状和改善体征非常有效。多变量分析显示，治疗依从性和疗效与TCP水平均无显著相关。结论：在我们的VLS患者中，TCP相对较低，并且对皮质类固醇治疗依从性没有负面影响。此外，TCP不影响TC治疗的有效性，因为它不影响依从性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.