Topical corticosteroids (TCS) are used to treat different dermatological conditions. They are the mainstay treatment options in some conditions such as atopic dermatitis. The side effects of TCS are mainly topical [1] and they are rare if used properly. The fear of the side effects of TCS can lead to inadequate treatment of skin diseases such as atopic dermatitis [2, 3]. TCS are prescribed by dermatologists and other specialties. General physicians and family medicine practitioners are among them. The attitude and knowledge of the physician prescribing these will affect the way the patients use TCS. A recent study from Riyadh showed that the knowledge about TCS is inadequate among practicing primary care physicians [4]. Australian general practitioners’ advice given to parents about TCS, has been shown to possibly carry unintentional risk messages contributing to non-adherence to treatment of paediatric atopic dermatitis [5]. TCS phobia is the main cause of non-adherence to treatment [6] and treatment failure in atopic dermatitis patients and carers of patients. TCS phobia has been shown to improve with patients’ education [7]. Physicians (non-dermatologists) have concerns about using TCS more than dermatologists [8]. Additionally, pharmacists (from France and Australia) have low levels of confidence regarding the use of TCS [9, 10]. It is important for general physicians to have detailed knowledge about TCS in order to be able to give good advice to patients.

The aim of this study was to assess the knowledge and the attitude of family medicine residents under training toward TCS. In addition, TCS phobia was assessed as well.

Topical corticosteroids (TCS) are an important modality of treatment in different skin problems. Their proper use is essential to avoid the suboptimal therapeutic effect. Although there are side effects known to the use of TCS, they are mostly topical side effects and usually will not appear unless their prolonged use or high potency in a vulnerable area is exposed. The fear of the use of TCS by patients is described and has been studied in different areas of the world. In this study, the knowledge and the attitude of family medicine residents under training toward TCS through an electronic survey were assessed during an educational activity. The responders were in their first phase of the training program (first and second year of training).

The main source of information about TCS was the undergraduate teaching (47.19%). Owing to the minimal teaching of dermatology, teaching in the undergraduate levels, this is reflected usually on the level of knowledge about topics related to diagnosis and treatments of skin diseases. This is an international problem which led to proposals for improving this lack by searching undergraduate societies and performing other activities [13].

Most of the respondents knew that there are different formulations of TCS as part of clinical experience which is the true answer to this question. Few respondents did not know or were not sure about this information. More than 40% advised using TCS based on finger-tip unit, followed by using them sparingly or in the smallest amount possible. Only 2 responders advised the generous use of TCS. This reflect the cautious approach by family medicine trainees, similar to what is followed by Australian general practitioners and pharmacists [5, 10]. On the other hand, Australian dermatologists agreed that the label “use sparingly” should be removed from pharmacists’ labels on TCS prescriptions [14]. “The more appropriate advice on product labelling would be ‘apply enough to cover the affected areas’” as suggested by the dermatology working group guidelines [15]. This question reflects physician cautiousness or phobia regarding the amount of TCS to be used.

For the question of the most common side effects of TCS, the answer “none if used appropriately” would be the best response. More than 40% thought that thinning of the skin (atrophy) is the most common side effect of TCS, followed by pigmentation problems and only 14.6% thought that TCS will not cause side effects if used appropriately. Skin atrophy was thought to be the commonest side effect by one-third of general practitioners [5] and nearly half of the pharmacists as well [10] in Australia. In another study, among UK pharmacists, less than half of the respondents correctly answered as “no” to the question of side effects, such as skin thinning, that are common even when topical corticosteroids are used appropriately [16]. This is in contrast to the perspective of dermatologists in Australia who agreed that TCS do not cause skin atrophy when appropriately used [14]. Our family medicine trainees have some misconceptions towards TCS. This might affect their advice to patients in need for TCS leading to patients concerns or phobia. Topical corticosteroids are sometimes misused to treat hyperpigmentation by nonmedicals. Additionally, pigmentation problems as hyper- and hypopigmentation were reported to be the side effects of TCS when used inappropriately [17, 18]. This problem is seen sometimes in our society, although not reported, it might be the cause of being thought as one of the common side effects of TCS.

For the questions related to TCS phobia, “no” would be the most appropriate answer. The majority of the responders did not think that TCS use can lead to infections, weight gain or obesity, damage the skin if used for a few weeks, negatively affect health or lead to asthma. These facts are recognized by the trainees.

On the other hand, more than half of the respondents thought that TCS can be completely absorbed or absorbed to some extent and a large proportion of respondents thought that TCS cannot be used on certain skin areas such as eyelids. These reflect concerns and phobia towards TCS. Additionally, more than two-thirds of the responders responded as no when asked if it is better to wait as long as you can before treating atopic dermatitis patients with TCS. More than 40% thought that it is better to stop TCS treatment as soon as possible in atopic dermatitis patients and only 20 percent thought that this is not necessary. This reflects a very cautious approach towards TCS in treating atopic dermatitis patients by our trainees. In a Korean survey, one third of the respondents had TCS phobia [19]. Consistently delivering messages about TCS risks from pharmacists and general practitioners to patients/parents might lead to treatment non-adherence [20].

In conclusion, family medicine trainees have some fears and misconceptions regarding TCS use. There is a need to increase the knowledge about TCS in the undergraduate teaching. Additionally, postgraduate educational activities aimed at family medicine and general practitioners to dermatology topics including topical corticosteroids are needed.