Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis
Parental knowledge of topical therapies in the treatment of childhood atopic dermatitis
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DOI：
10.1046/j.1365-2230.2003.01357.x
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发表时间：
2003-09-01
影响因子：
4.1
通讯作者：
Lewis-Jones, MS
中科院分区：
文献类型：
--
作者：
Beattie, PE;Lewis-Jones, MS
治疗依从性差是特应性皮炎治疗失败的主要原因。给出的原因是多方面的，包括担心真实的或想象的副作用，处方不足，未能及时更新处方，缺乏时间，以及儿童拒绝治疗。然而，最重要的是缺乏有关治疗的知识，特别是局部皮质类固醇（TCS）治疗的使用。我们进行了一项基于药物的研究，以确定100名儿童的父母或照顾者在儿科门诊就诊时对常用处方TCS制剂的使用和知识水平。最常用的是弱效TCS（86%），但对其了解甚少。只有35名（41%）使用过氢化可的松的人知道它是弱效的，44%的人认为它是中度有效的。在65名使用过中等效力的TCS丁酸氯倍他松（Eumovate（R）; Glaxo Wellcome，乌克斯布里奇，英国）的患者中，19人（29%）将其评定为有效，8人（12%）将其评定为弱。在50名使用过0.1%戊酸倍他莫酯（Betnovate（R）; Glaxo Wellcome，乌克斯布里奇，英国）的人中，42%的人不认为它有效。对TCS /抗菌剂组合的理解通常较差。1%氢化可的松/2%夫西地酸组合（Fucidin H（R）; Leo，Risborough，巴克斯，英国）被74名使用过它的人中的88%评定为中度或强烈。/ g四环素3%（Trimovate（R）; Glaxo Wellcome，乌克斯布里奇，英国）假定其为有效的TCS。49名患者使用了Fucibet（R）（戊酸倍他米松0.1%，夫西地酸2%; Leo，Risborough，巴克斯，英国），但34.5%的患者不认为其有效。人们对一些最常用的TCS的强度知之甚少，所有类固醇/抗菌剂组合被认为比单独的组成类固醇具有更大的效力。几乎一半（46.9%）的受访者认为夫西地酸是类固醇。一些制药公司的不同产品的包装非常相似，标签包含有关化合物和百分比的信息，而不是TCS的效力。这可能是一个混乱的来源。我们建议制造商按效力将TCS产品清楚地标记为轻度、中度、强效或非常强效，并且每种TCS或润肤剂的包装应充分不同，以避免混淆。为了达到特应性皮炎的最佳局部治疗，患者及其护理人员必须接受充分的信息和培训，了解如何以及何时使用局部治疗，并制定书面护理计划。
Poor adherence with therapy is a major cause of treatment failure in atopic dermatitis. Reasons given are multifactorial, and include fear of real or imaginary side-effects, under-prescribing, failure to renew prescriptions on time, lack of time, and child refusal of therapy. Most important, however, is lack of knowledge about treatment, in particular the use of topical corticosteroid (TCS) therapy. We conducted a questionnaire-based study to determine the level of use and knowledge of commonly prescribed TCS preparations amongst parents or carers of 100 children attending paediatric outpatient clinics. Weakly potent TCSs were the most commonly used (86%), but poorly understood. Only 35 (41%) who had used hydrocortisone were aware that it was weakly potent, and 44% graded it as moderately potent. Of 65 who had used the moderately potent TCS clobetasone butyrate 0.05% ( Eumovate(R); Glaxo Wellcome, Uxbridge, UK), 19 (29%) graded it as potent and eight (12%) as weak. Of 50 who had used betamethasone valerate 0.1% (Betnovate(R); Glaxo Wellcome, Uxbridge, UK), 42% did not grade it as potent. Understanding of TCS / antimicrobial combinations was generally worse. The hydrocortisone 1% / fusidic acid 2% combination (Fucidin H(R); Leo, Risborough, Bucks, UK) was graded as moderate or strong by 88% of the 74 who had used it. Over half (53%) of the 34 using the combination of clobetasone butyrate 0.05% / nystatin 100 000 i.u. / g tetracycline 3% (Trimovate(R); Glaxo Wellcome, Uxbridge, UK) assumed that it was a potent TCS. Forty-nine had used Fucibet(R) ( betamethasone valerate 0.1%, fusidic acid 2%; Leo, Risborough, Bucks, UK) but 34.5% did not grade it as potent. There was poor knowledge of the strengths of some of the most commonly used TCSs, and all steroid / antimicrobial combinations were perceived as being of greater potency than the constituent steroid alone. Fusidic acid was thought to be a steroid by almost half (46.9%) of the respondents. The packaging of the different products by some pharmaceutical companies is remarkably similar and labelling contains information on the compound and percentage rather than potency of the TCS. This may be a source of confusion. We recommend that manufacturers clearly label TCS products by potency as mild, moderate, potent or very potent and that packaging is sufficiently different for each strength of TCS or emollient to avoid confusion. In order to achieve optimal topical treatment for atopic dermatitis, patients and their carers must receive adequate information and training in how and when to use topical therapies in conjunction with written care plans.