Attitudes and advice-giving behaviours of pharmacists in relation to topical corticosteroid use for patients with lichen sclerosus

Lichen sclerosus (LS) is a chronic inflammatory dermatosis that predominantly affects the anogenital region. The diagnosis of LS is a clinical diagnosis and a confirmatory biopsy is not always required if typical clinical features are present. A biopsy is recommended if the clinical presentation is atypical or if there is diagnostic uncertainty. Topical corticosteroids (TCS) have been a mainstay in the treatment of inflammatory skin conditions, including LS, for decades. TCS have been recommended as first-line treatment for LS in international guidelines since at least 2002. There is ample evidence to support the long-term efficacy and safety of TCS. Despite this, several studies have demonstrated suboptimal compliance with prescribed TCS therapy among patients with dermatological conditions, including LS. Concerns regarding safety of TCS, also described as corticosteroid phobia, have been among the most commonly reported reasons for non-adherence to treatment. In recent years it has been demonstrated that corticosteroid phobia is prominent among pharmacists and general practitioners, and that these health care professionals may in fact contribute towards patient concerns regarding TCS use, by emphasising their side effect profile, and by instructing patients to use TCS sparingly.