Evaluation and Treatment Adherence of a Child With Atopic Dermatitis Complicated by Parental Steroid Phobia: A Case Report

TL;DR

A child with atopic dermatitis and a parent's fear of steroids was successfully treated with an alternative medication called delgocitinib.

Contribution

This case report demonstrates the effectiveness of delgocitinib as an alternative treatment when parental steroid phobia prevents corticosteroid use.

Findings

The patient's eczema severity improved significantly within one month of using delgocitinib.

Reducing the delgocitinib concentration was feasible after initial improvement in symptoms.

Delgocitinib may serve as an effective induction therapy for moderate to severe atopic dermatitis.

Abstract

The topical corticosteroid phobia (TOPICOP) score is a useful tool for evaluating the severity of steroid phobia. Following the development of novel topical therapies, such as delgocitinib, a Janus kinase inhibitor, the treatment options for atopic dermatitis (AD) have significantly expanded. Herein, we report the case of a 6-year-old girl with moderate AD whose treatment was complicated by her mother’s steroid phobia (TOPICOP score: 52.7). Despite detailed explanations addressing misconceptions regarding topical corticosteroids (TCS), the mother refused its use. As an alternative, we initiated treatment with delgocitinib 0.5% ointment, achieving significant clinical improvement. Within one month, the patient’s eczema area and severity index score improved from 13.0 to 7.2. We reduced the concentration of the delgocitinib ointment from 0.5% to 0.25% secondary to a decreased Eczema Area and Severity Index (EASI) score. After six months, her objective AD scores also improved. This case highlights the importance of assessing and addressing steroid phobia in parents of children with AD. Despite comprehensive education, some parents remain unwilling to use TCS, necessitating alternative treatment approaches. The use of a validated tool, such as the TOPICOP score, can help clinicians objectively assess parental concerns. In cases where TCS refusal persists, delgocitinib ointment may serve as an effective induction therapy. Given its favorable safety profile and rapid efficacy, initiating treatment with the 0.5% formulation may be a viable option for achieving early disease control in moderate to severe AD. In conclusion, evaluating parental concerns with the TOPICOP score is useful in clinical practice. When steroid phobia persists despite proper education, delgocitinib ointment offers an effective alternative, with higher concentrations potentially beneficial for more severe cases.

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